Skeletal Infections Caused by Coccidioides Species

Abstract

Background: Coccidioidomycosis represents an endemic and challenging disease, with rare extrapulmonary manifestations. The present review of all published cases of core and extremities osseous coccidioidomycosis aims to describe epidemiology, patients’ characteristics, symptoms as well as medical and surgical treatment options and their effectiveness. Methods: A thorough review of all published skeletal core and extremity infections due to Coccidioides species was conducted. Information regarding demographics, causative fungus, antifungal treatment (AFT), surgical management as well as the infection outcome was recorded. Results: A total of 92 cases of Coccidioides spp. skeletal infections were recorded in 87 patients. The patients’ mean age was 35.3 years. The most common site of infection was the spine (82.6%), followed by the foot (6.5%), while the predominant symptom upon presentation was pain (29.9%). Immunosuppressive conditions and/or medications were observed in 21 patients (24.1%). Regarding imaging methods, indicating diagnosis, plain X-rays or CT scans were performed in most patients (50.6%), followed by magnetic resonance imaging (MRI) (47.1%). Most cases were diagnosed through histopathology (62; 71.3%), followed by serology testing (36; 42.4%) and by cultures (35; 40.2%). In 32 cases (36.8%), Coccidioides immitis was cultured, while in the remaining 55 cases (63.2%) the fungus was not further characterized. Regarding AFT, amphotericin B was the preferred agent (52.9%), followed by fluconazole (43.3%). In most cases (78.2%) surgical treatment was also performed. Treatment was successful in 80.5% of cases. Conclusions: Skeletal core and extremity infections due to Coccidioides spp. represent a severe disease. With the available data, the combination of prolonged proper AFT with surgical intervention seems to be the optimal current therapeutic approach.

Coccidioidomycosis Osteoarticular Dissemination

“…While few reports have established diabetes as a risk factor for disseminated coccidioidomycosis, most clinical and scientific reports have argued that diabetes is mostly associated with complicated pulmonary coccidioidomycosis rather than with disseminated disease [6]. In one retrospective review of 39 patients with vertebral coccidioidomycosis, Szeyko and colleagues [27] supported the idea that diabetes is not to be considered as a risk factor for disseminated coccidioidomycosis, yet several clinical reports have mentioned diabetes mellitus as part of the medical history of the patients with disseminated coccidioidomycosis [3,8,28,29].…”

“…Recently estimated at 350,000 infections annually in the United States, Coccidioidomycosis, also known as Valley Fever, continues to expand its clinical footprint from established endemic areas such as Arizona and California to several new hotspots in the northern areas of Mexico, and select regions in Central and South America potentiating new endemic areas [1], likely as a result of both climatic and populational changes [2,3]. This neglected disease is caused by inhalation of aerosolized spores of two dimorphic fungi Coccidioides immitis and C. posadasii.…”

Diagnosis, Treatment, and Outcome of Coccidioidal Osseous Infections: A Systematic Review

“…Coccidioides, a dimorphic fungus, may lead to coccidioidomycosis, an uncommon infection primarily impacting the respiratory system [1]. Coccidioidomycosis exhibits remarkable diversity in both its clinical appearance and severity levels.…”

“…Moreover, infections may result in acute respiratory distress syndrome and potentially fatal pneumonia. The risk of symptomatic infection rises with advancing age [1,2].…”

“…Alveolar macrophages subsequently engulf these endospores, initiating a localized host response that culminates in acute inflammation. Endospores have the potential to proliferate within tissues and, upon release into the environment, can promote mycelial growth [1,2].…”