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Gassie K, Rea B, Zamore R, Alikhani P. Rare case of syringohydromyelia expansion after kyphotic cervical deformity correction in a patient with history of spinal coccidiomeningitis. Neuroradiol J 2024; 37:361-365. [PMID: 37540579 PMCID: PMC11138335 DOI: 10.1177/19714009231193160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023] Open
Abstract
Syringomyelia resulting from arachnoiditis due to disseminated coccidioidomycosis meningitis has been previously established in the literature. Worsening syringomyelia after kyphotic cervical deformity correction in a patient with spinal coccidioidomycosis, however, has not yet been reported. Herein we present an extremely rare case of disseminated coccidioidomycosis with cystic cervical lesions and an associated syrinx which, after undergoing cervical kyphotic deformity correction in the setting of iatrogenic loss of cervical lordosis, experienced acute syrinx expansion requiring urgent syringosubarachnoid shunt. To our understanding, this is the first case reported of such an event.
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Affiliation(s)
- Kelly Gassie
- Department of Neurological Surgery, Tampa General Hospital, University of South Florida, Tampa, FL, USA
| | - Brittany Rea
- Department of Radiology, Tampa General Hospital, University of South Florida, Tampa, FL, USA
| | - Robert Zamore
- Department of Radiology, Tampa General Hospital, University of South Florida, Tampa, FL, USA
| | - Puya Alikhani
- Department of Neurological Surgery, Tampa General Hospital, University of South Florida, Tampa, FL, USA
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2
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Branigan GL, Ozgur HT, Lim J, Riaz T. Syndrome of inappropriate antidiuretic hormone release secondary to central nervous system coccidioidomycosis with vasculitis. BMJ Case Rep 2024; 17:e258915. [PMID: 38553023 PMCID: PMC10982722 DOI: 10.1136/bcr-2023-258915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 04/02/2024] Open
Abstract
A man in his 60s presented to the clinic due to night sweats and weight loss following pneumonia. He was found to have hyponatraemia due to a syndrome of inappropriate antidiuretic hormone (SIADH). CT of the thorax was concerning for pulmonary nodules. He was ultimately diagnosed with pulmonary coccidioidomycosis (CM) and started on fluconazole 400 mg daily with improvement in symptoms. Due to the report of headaches, head MRI was conducted which suggested central nervous system (CNS) involvement. Cerebrospinal fluid analysis was consistent with CNS CM and head magnetic resonance angiography confirmed the presence of CNS vasculitis. Fluconazole dose was increased to 800 mg daily which the patient continued to tolerate and showed improvement. This report depicts a case of SIADH associated with CNS CM with vasculitis and demonstrates the importance of high clinical suspicion for SIADH secondary to CNS CM in the setting of hyponatraemia and headache.
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Affiliation(s)
- Gregory Lawrence Branigan
- Medical Scientist Training Program, Department of Neurology, The University of Arizona College of Medicine Tucson, Tucson, Arizona, USA
| | - Hasan T Ozgur
- Department of Medical Imaging, University of Arizona College of Medicine Tucson, Tucson, Arizona, USA
| | - James Lim
- Department of Medicine, Divison of Infectious Disease, University of Arizona College of Medicine Tucson, Tucson, Arizona, USA
| | - Talha Riaz
- Department of Medicine, Divison of Infectious Disease, University of Arizona College of Medicine Tucson, Tucson, Arizona, USA
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Charles-Lozoya S, Ruíz-Zenteno G, Lizcano-Martínez ME, Cobos-Aguilar H, León-Ruíz J, Domínguez-Delgado J. Vertebral coccidioidomycosis with mechanical instability treated solely with antifungals: A case report. Med Mycol Case Rep 2023; 42:100615. [PMID: 38022891 PMCID: PMC10656722 DOI: 10.1016/j.mmcr.2023.100615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Surgical treatment of vertebral coccidioidomycosis presents a challenge, with an unpredictable course and uncertain results. We present a 52-year-old man with disseminated infection due to coccidioidomycosis in the thoracolumbar spine, with vertebral instability, and deferral surgical treatment due to SARS-CoV-2 contingency. Treatment with itraconazole was initiated, followed by liposomal amphotericin B and fluconazole due to a relapse. The patient was discharged long-term with voriconazole. The axial pain improved without neurological deficits. Surgical treatment was not required. 2012 Elsevier Ltd. All rights reserved.
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Affiliation(s)
- Sergio Charles-Lozoya
- Health Science Division, Unit of Spine Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Av. José Ma. Pino Suárez y Juan Ignacio Ramón s/n, Centro, 64300, Monterrey, NL., Mexico
- Health Science Division, Vice-rectory of Health Sciences, Universidad de Monterrey, Av. Ignacio Morones Prieto 4500 Pte.col. Jesus M. Garza, 66238, San Pedro Garza García, N.L., Mexico
| | - Gibran Ruíz-Zenteno
- Health Science Division, Unit of Spine Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Av. José Ma. Pino Suárez y Juan Ignacio Ramón s/n, Centro, 64300, Monterrey, NL., Mexico
| | - María E. Lizcano-Martínez
- Health Science Division, Unit of Spine Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Av. José Ma. Pino Suárez y Juan Ignacio Ramón s/n, Centro, 64300, Monterrey, NL., Mexico
| | - Héctor Cobos-Aguilar
- Health Science Division, Vice-rectory of Health Sciences, Universidad de Monterrey, Av. Ignacio Morones Prieto 4500 Pte.col. Jesus M. Garza, 66238, San Pedro Garza García, N.L., Mexico
| | - Joél León-Ruíz
- Health Science Division, Unit of Spine Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Av. José Ma. Pino Suárez y Juan Ignacio Ramón s/n, Centro, 64300, Monterrey, NL., Mexico
| | - Jesús Domínguez-Delgado
- Health Science Division, Unit of Spine Orthopedic Surgery, Hospital de Traumatología y Ortopedia No. 21, Instituto Mexicano del Seguro Social (IMSS), Av. José Ma. Pino Suárez y Juan Ignacio Ramón s/n, Centro, 64300, Monterrey, NL., Mexico
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Gamaletsou MN, Rammaert B, Brause B, Bueno MA, Dadwal SS, Henry MW, Katragkou A, Kontoyiannis DP, McCarthy MW, Miller AO, Moriyama B, Pana ZD, Petraitiene R, Petraitis V, Roilides E, Sarkis JP, Simitsopoulou M, Sipsas NV, Taj-Aldeen SJ, Zeller V, Lortholary O, Walsh TJ. Osteoarticular Mycoses. Clin Microbiol Rev 2022; 35:e0008619. [PMID: 36448782 PMCID: PMC9769674 DOI: 10.1128/cmr.00086-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. Candida osteomyelitis and Candida arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of Candida and Aspergillus arthritis. Relapsed infection, particularly in Candida arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.
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Affiliation(s)
- Maria N. Gamaletsou
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Blandine Rammaert
- Université de Poitiers, Faculté de médecine, CHU de Poitiers, INSERM U1070, Poitiers, France
| | - Barry Brause
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Marimelle A. Bueno
- Far Eastern University-Dr. Nicanor Reyes Medical Foundation, Manilla, Philippines
| | | | - Michael W. Henry
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aspasia Katragkou
- Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University School of Medicine, Columbus, Ohio, USA
| | | | - Matthew W. McCarthy
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Andy O. Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Zoi Dorothea Pana
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Ruta Petraitiene
- Weill Cornell Medicine of Cornell University, New York, New York, USA
| | | | - Emmanuel Roilides
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | | | - Maria Simitsopoulou
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Nikolaos V. Sipsas
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Valérie Zeller
- Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Olivier Lortholary
- Université de Paris, Faculté de Médecine, APHP, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, CNRS UMR 2000, Paris, France
| | - Thomas J. Walsh
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
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5
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Marena GD, Ramos MADS, Carvalho GC, Junior JAP, Resende FA, Corrêa I, Ono GYB, Sousa Araujo VH, Camargo BAF, Bauab TM, Chorilli M. Natural product‐based nanomedicine applied to fungal infection treatment: A review of the last 4 years. Phytother Res 2022; 36:2710-2745. [DOI: 10.1002/ptr.7460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/25/2022] [Accepted: 03/26/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Gabriel Davi Marena
- Department of Drugs and Medicines, School of Pharmaceutical Sciences São Paulo State University (UNESP) Araraquara Brazil
- Department of Biological Sciences, School of Pharmaceutical Sciences São Paulo State University (UNESP) Araraquara Brazil
| | - Matheus Aparecido dos Santos Ramos
- Department of Drugs and Medicines, School of Pharmaceutical Sciences São Paulo State University (UNESP) Araraquara Brazil
- Department of Biological Sciences, School of Pharmaceutical Sciences São Paulo State University (UNESP) Araraquara Brazil
| | - Gabriela Corrêa Carvalho
- Department of Drugs and Medicines, School of Pharmaceutical Sciences São Paulo State University (UNESP) Araraquara Brazil
| | | | | | - Ione Corrêa
- Department of Biological Sciences, School of Pharmaceutical Sciences São Paulo State University (UNESP) Araraquara Brazil
| | - Gabriela Yuki Bressanim Ono
- Department of Biological Sciences, School of Pharmaceutical Sciences São Paulo State University (UNESP) Araraquara Brazil
| | - Victor Hugo Sousa Araujo
- Department of Drugs and Medicines, School of Pharmaceutical Sciences São Paulo State University (UNESP) Araraquara Brazil
| | - Bruna Almeida Furquim Camargo
- Department of Drugs and Medicines, School of Pharmaceutical Sciences São Paulo State University (UNESP) Araraquara Brazil
| | - Tais Maria Bauab
- Department of Biological Sciences and Health University of Araraquara (UNIARA) Araraquara Brazil
| | - Marlus Chorilli
- Department of Drugs and Medicines, School of Pharmaceutical Sciences São Paulo State University (UNESP) Araraquara Brazil
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6
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Azeem A, Quimby D, Krajicek B, Horne J. (Ig)Easy diagnosis of disseminated coccidioidomycosis. BMJ Case Rep 2022; 15:e248894. [PMID: 35260409 PMCID: PMC8905869 DOI: 10.1136/bcr-2022-248894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/03/2022] Open
Abstract
An immunocompetent man in his 20s came to the hospital for shortness of breath, fevers and lower back pain with unintentional 20 lbs. weight loss. Relevant history included a recent trip to Arizona 3 months prior to presentation. On arrival, he was noted to have decreased breath sounds bilaterally, and paraspinal tenderness in the lumbar area. CT scan revealed diffuse pneumonitis and an abscess with osteomyelitis in the sacrum and right iliac bone. Continued respiratory decompensation led him to the intensive care unit where he had a bronchoscopy and later sacroiliac joint fluid collection was performed. Based on his travel history, and elevated serum IgE, liposomal amphotericin B was initiated. Later his antibodies against Coccidiodes resulted elevated and fungal cultures from the bronchoalveolar lavage and abscess from the sacral vertebrae grew mould, morphologically consistent with Coccidiodes posadasii He was transitioned to oral fluconazole and will have a close follow-up outpatient.
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Affiliation(s)
- Ahad Azeem
- Infectious Diseases, Creighton University, Omaha, Nebraska, USA
| | - David Quimby
- Infectious Diseases, Creighton University, Omaha, Nebraska, USA
| | - Bryan Krajicek
- Pulmonary, Critical Care and Sleep Medicine Department, Creighton University, Omaha, Nebraska, USA
| | - John Horne
- Infectious Diseases, Creighton University, Omaha, Nebraska, USA
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Vecchié A, Raybould JE, Sangal K, Bonaventura A, Gillen M, Abbate A, Sastry S, Bhardwaj H. Pericarditis and Sacroiliitis in a World Traveler. JACC Case Rep 2021; 3:1322-1326. [PMID: 34471887 PMCID: PMC8387803 DOI: 10.1016/j.jaccas.2021.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/01/2021] [Accepted: 04/16/2021] [Indexed: 11/11/2022]
Abstract
A 65-year-old immunocompromised woman presented with progressive dyspnea and sacroiliac joint pain. Cardiac magnetic resonance showed abnormal right ventricular filling with septal bounce and abnormal pericardial enhancement, suggestive of constrictive pericarditis. Cultures from pericardium following pericardiectomy grew Coccidioides immitis. She was diagnosed with coccidioidomycosis and responded to pericardiectomy and amphotericin. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Alessandra Vecchié
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jillian E Raybould
- Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Kunal Sangal
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Aldo Bonaventura
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Internal Medicine, First Clinic of Internal Medicine, University of Genoa, Genoa, Italy
| | - Melissa Gillen
- Department of Medicine, Duke University Health System, Durham, North Carolina, USA
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sangeeta Sastry
- Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Hem Bhardwaj
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
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Bhattacharyya S, Bradshaw MJ. Infections of the Spine and Spinal Cord. Continuum (Minneap Minn) 2021; 27:887-920. [PMID: 34623097 DOI: 10.1212/con.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Infections of the spine and spinal cord are associated with a high risk of morbidity and mortality and, therefore, require prompt clinical recognition, efficient diagnostic evaluation, and interdisciplinary treatment. This article reviews the pathophysiology, epidemiology, clinical manifestations, diagnosis, and treatment of infections of the spine and spinal cord to help practicing clinicians recognize, evaluate, and manage patients with such infections. RECENT FINDINGS Aging of the population, increasing use of immunosuppressive medications, and other factors have contributed to increasing rates of spinal infections. Although the most common agents responsible for spinal infections remain bacteria and viruses, fungal infections occur in individuals who are immunocompromised, and parasitic infections are common in endemic regions, but patterns are in evolution with migration and climate change. Recent outbreaks of acute flaccid myelitis in children have been associated with enteroviruses A71 and D68. SUMMARY Infections of the spine and spinal cord can be challenging to diagnose, requiring a thorough history and neurologic examination, laboratory studies of serum and CSF, neuroimaging (particularly MRI), and, in some instances, biopsy, to establish a diagnosis and treatment regimen. Interdisciplinary management including collaboration with experts in internal medicine, infectious disease, and neurosurgery is important to improve clinical outcomes.
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Grizzle AJ, Wilson L, Nix DE, Galgiani JN. Clinical and Economic Burden of Valley Fever in Arizona: An Incidence-Based Cost-of-Illness Analysis. Open Forum Infect Dis 2021; 8:ofaa623. [PMID: 33575419 PMCID: PMC7863867 DOI: 10.1093/ofid/ofaa623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 12/11/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Coccidioidomycosis, ie, Valley fever, is an important fungal infection in the Southwest, with half to two thirds of all cases occurring in Arizona. This endemic respiratory disease can range from primary uncomplicated pneumonia to disseminated infection such as meningitis with chronic pulmonary complications. Valley fever diagnoses have risen over recent years and cause substantial morbidity and economic burden in Arizona. METHODS We estimated the lifetime cost-of-illness associated with all cases of Valley fever diagnosed in 2019 in Arizona. Natural history of the disease was determined from literature and expert opinion and assigned costs from national data sources to determine lifetime direct and indirect costs (work loss). RESULTS Total lifetime costs of $736 million were estimated for the 10 359 cases of Valley fever diagnosed in Arizona in 2019. Direct costs of $671 million accounted for over 90% of expenditures, with $65 million in indirect costs. Disseminated infection produces the highest economic burden at $1.26 million direct and $137 400 indirect costs per person. The lowest Valley fever lifetime costs were for cases of primary uncomplicated pneumonia with $23 200 in direct costs and $1300 in lost wages. The average lifetime direct costs across all Valley fever manifestations are $64 800 per person diagnosed in Arizona in 2019 and $6300 for indirect costs. CONCLUSIONS Valley fever is responsible for substantial economic burden in Arizona. Our estimates underscore the value of supporting research into developing more rapid diagnostic tests, better therapies, and ultimately a preventative vaccine to address this important public health problem in Arizona.
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Affiliation(s)
- Amy J Grizzle
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona College of Pharmacy, Tucson, Arizona, USA
| | - Leslie Wilson
- Department of Clinical Pharmacy, University of California, San Francisco, California, USA
| | - David E Nix
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
- Department of Medicine, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
| | - John N Galgiani
- Department of Medicine, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
- Valley Fever Center for Excellence, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
- Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
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Toyne JM, Esplin N, Buikstra JE. Examining variation in skeletal tuberculosis in a late pre-contact population from the eastern mountains of Peru. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2020; 30:22-34. [PMID: 32416540 DOI: 10.1016/j.ijpp.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 03/31/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE AND MATERIALS This research evaluates the presence and chronology of tuberculosis (TB) in the northeastern highlands of Peru (CE 800-1535) through the analysis of osseous lesions from Pre-Contact Kuelap, Chachapoyas. METHODS We examined macroscopic lesion morphology and distribution from the skeletal series (MNI = 207). RESULTS We determined that skeletal evidence was highly consistent with advanced multifocal and spinal tuberculosis in 13 individuals. Destructive lesions of the lower thoracic and/or lumbar vertebra bodies and sacroiliac joints are evident in most cases, but we also observed lesions within the manubriosternal, hip, and knee joints. Both adult males (n = 7) and females (n = 6) present skeletal lesions from young adult to older adults, but there is only one late adolescent. Only three individuals demonstrate similar lesion distributions. CONCLUSIONS Variation in lesion distribution in this population-based study shows the importance of identifying extra-vertebral tuberculosis and suggests that the disease may have manifested differently than at other coastal sites. These cases confirm the presence of tuberculosis both before and after Inca occupation across this central Andean highlands region. SIGNIFICANCE This evidence for the likely endemic presence of TB in the New World prior to European Contact furthers our understanding of the distribution of this infectious disease across the region as well as elucidating lesion distribution. LIMITATIONS The diagnosis of tuberculosis is based on skeletal lesions and it should be confirmed by molecular analysis. FUTURE RESEARCH Additional examination of vertebral bodies (including juvenile remains) for evidence of earlier manifestations of infection.
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Affiliation(s)
- J Marla Toyne
- Department of Anthropology, University of Central Florida, Orlando, FL 32803-1361, United States.
| | - Nathan Esplin
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Jane E Buikstra
- School of Human Evolution and Social Change, Arizona State University, Phoenix metropolitan area, AZ, United States
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11
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Sakya SM, Sakya JP, Hallan DR, Warraich I. Spinal Coccidioidomycosis: A Complication From Medication Noncompliance. Cureus 2020; 12:e9304. [PMID: 32832301 PMCID: PMC7437094 DOI: 10.7759/cureus.9304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Spinal coccidioidomycosis is a rare disseminated form of coccidioidomycosis infection. According to the literature, majority of patients are African American males. We present a rare case of spinal coccidioidomycosis in a young, Caucasian female with coccidioidomycosis meningitis at age 16 years who presented with bilateral lower extremity weakness after antifungal medication lapse for one year. Imaging revealed cystic arachnoid formations along her thoracic spine. Pathology report confirmed spinal arachnoiditis with coccidioidomycosis. This case report details a rare incidence of spinal coccidioidomycosis and reviews previous literature.
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Affiliation(s)
- Surav M Sakya
- Medicine, Penn State College of Medicine, Hershey, USA
| | - Judy P Sakya
- Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - David R Hallan
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Irfan Warraich
- Pathology, Texas Tech University Health Sciences Center, Lubbock, USA
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12
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Coccidioidal meningitis in non-AIDS patients. A case series at a Mexican neurological referral center. Clin Neurol Neurosurg 2020; 196:106011. [PMID: 32593044 DOI: 10.1016/j.clineuro.2020.106011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Coccidioidal meningitis is a life-threatening condition and a diagnostic challenge in cases of chronic meningitis. It is associated to severe complications, like basal arachnoiditis, hydrocephalus, and secondary vasculitis. OBJECTIVE To present a 20-year retrospective clinical series of coccidioidal meningitis cases at a Mexican neurological referral center. RESULTS The clinical records of 11 patients, predominantly males, were retrieved. Weight loss and night sweats were observed in 64 % of cases. Neurological signs included intracranial hypertension in 91 % of cases, altered alertness and meningeal syndrome in 72 %, and neuropsychiatric symptoms in 64 %. Mean CSF glucose levels were 30 ± 25 mg/dL, and pleocytosis ranged from 0 to 2218 cells/mm3. The diagnosis was confirmed by coccidioidal antigen latex agglutination in 91 % of cases. Radiological findings were hepatomegaly in 55 % of cases and pneumonia in 45 %. Neuroimaging findings included leptomeningitis in 73 % of cases, pachymeningitis in 45 %, and vascular involvement in 91 %. Less common findings included spinal cord lesion and mycotic aneurism, found in 18 % of cases. A molecular coccidioidal DNA test confirmed the predominance of Coccidioides immitis, detected in 64 % of cases. With respect to the clinical outcome, 46 % of patients died. The survivors suffered from sequels like chronic headache, cognitive alterations, and depression. CONCLUSIONS Coccidioidal meningitis is an entity with high mortality rates. More than one half of patients suffered disseminated disease. Although meningeal signs are not frequent in chronic meningitis, more than two-thirds of our patients showed mild nuchal rigidity. In addition, cerebral and cerebellar volume loss, associated with cognitive impairment and depression, was often observed in surviving patients during the clinical-radiological follow-up.
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13
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Bonifaz A, Estrada-Caraveo Y, Tirado-Sánchez A. Epidemiology of Endemic Mycosis in Children. CURRENT FUNGAL INFECTION REPORTS 2019. [DOI: 10.1007/s12281-019-00358-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Araújo PSRD, Souza Junior VRD, Padilha CE, Oliveira MID, Arraes LC, Vieira R, Antunes A, Lima Neto RGD, Marsden A. Coccidioidomycosis: first cases reported in Pernambuco, Brazil. Rev Inst Med Trop Sao Paulo 2018; 60:e75. [PMID: 30462798 PMCID: PMC6235429 DOI: 10.1590/s1678-9946201860075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/25/2018] [Indexed: 12/16/2022] Open
Abstract
Coccidioidomycosis is a fungal infection caused by Coccidioides immitis or Coccidioides posadasii. These fungi are known to thrive in desert climate. Fungi produce infectious arthroconidia in soil, they are aerosolized in the air and when inhaled by humans, usually cause infections such as pneumonia. The first cases of coccidioidomycosis in Brazil were reported in 1978. Since then, there have been other reports mainly from desert regions of Northeastern Brazil. The present report describes three cases of coccidioidomycosis on male farmers from Serra Talhada county, Pernambuco State, who developed pneumonia and were subsequently diagnosed with pulmonary coccidioidomycosis. These three farmers were successfully treated with oral fluconazole. They reported having hunted armadillos in a rural and arid area of Pernambuco State. Armadillos are known to be carriers of Coccidioides. This is the first report of infection caused by Coccidioides in Pernambuco State, Brazil.
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Affiliation(s)
- Paulo Sergio Ramos de Araújo
- Universidade Federal de Pernambuco, Hospital das Clínicas, Serviço de Infectologia, Recife, Pernambuco, Brazil.,Universidade Federal de Pernambuco, Departamento de Medicina Tropical, Recife, Pernambuco, Brazil.,Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Recife, Pernambuco, Brazil
| | | | - Carlos Eduardo Padilha
- Universidade Federal de Pernambuco, Hospital das Clínicas, Serviço de Infectologia, Recife, Pernambuco, Brazil
| | - Marta Iglis de Oliveira
- Universidade Federal de Pernambuco, Hospital das Clínicas, Serviço de Infectologia, Recife, Pernambuco, Brazil
| | - Luciana Cardoso Arraes
- Universidade Federal de Pernambuco, Hospital das Clínicas, Serviço de Infectologia, Recife, Pernambuco, Brazil
| | | | - Ana Antunes
- Secretaria Estadual de Saúde, Vigilância Epidemiológica, Recife, Pernambuco, Brazil
| | | | - Armando Marsden
- Universidade Federal de Pernambuco, Departamento de Micologia, Recife, Pernambuco, Brazil
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Crete RN, Gallmann W, Karis JP, Ross J. Spinal Coccidioidomycosis: MR Imaging Findings in 41 Patients. AJNR Am J Neuroradiol 2018; 39:2148-2153. [PMID: 30287458 PMCID: PMC7655371 DOI: 10.3174/ajnr.a5818] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 08/09/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Coccidioides immitis is a dimorphic fungus endemic to the Southwest United States and Mexico, and at our institution, it is a relatively common pathogen presenting with a broad spectrum of associated spine diseases. We describe the various spinal manifestations resulting from coccidioidal infection and provide MR imaging examples from 41 pathologically proved cases. MATERIALS AND METHODS Retrospective electronic medical record and PACS searches were performed. Patients found to have both MR imaging findings positive for infection and confirmative biopsy and/or CSF studies were included. Abnormal MR imaging findings were identified, categorized, and quantified. Patient demographics and associated intracranial involvement if present were also recorded. RESULTS Forty-one patients were included. Positive findings were categorized as leptomeningeal enhancement (26 patients, 63%), arachnoiditis (22 patients, 54%), osteomyelitis-discitis (14 patients, 34%), cord edema (11 patients, 27%), and true syrinx (3 patients, 7%). Thirty patients had documented brain involvement (73%), most commonly in the form of basilar meningitis. Four patients were positive for HIV (10%). Fifteen patients had pulmonary manifestations at presentation (37%). CONCLUSIONS C immitis results in various spinal manifestations, most commonly leptomeningeal enhancement and arachnoiditis/adhesive disease followed by osteomyelitis, which may resemble tuberculous or pyogenic infection on MR imaging.
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Affiliation(s)
- R N Crete
- From the Department of Neuroradiology (R.N.C., W.G., J.P.K.), Barrow Neurological Institute, Phoenix, Arizona
| | - W Gallmann
- From the Department of Neuroradiology (R.N.C., W.G., J.P.K.), Barrow Neurological Institute, Phoenix, Arizona
| | - J P Karis
- From the Department of Neuroradiology (R.N.C., W.G., J.P.K.), Barrow Neurological Institute, Phoenix, Arizona
| | - J Ross
- Department of Radiology (J.R.), Mayo Clinic College of Medicine, Phoenix, Arizona
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Hofler RC, Jones GA. Medical and Surgical Treatment of Endemic Mycotic Spinal Osteomyelitis. World Neurosurg 2018; 113:254-256. [DOI: 10.1016/j.wneu.2018.02.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 10/17/2022]
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17
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Sharif S, Hussain N. What's New in Spinal Coccidioidomycosis? World Neurosurg 2018; 110:99-100. [DOI: 10.1016/j.wneu.2017.10.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 10/31/2017] [Indexed: 11/24/2022]
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18
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Tender GC. Coccidioidomycosis for Neurosurgeons. World Neurosurg 2018; 110:1-3. [DOI: 10.1016/j.wneu.2017.10.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
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