Vertebral Coccidioidomycosis: Presentation and Multidisciplinary Management
| Autor: | Robert B. Dzioba, Rodney D. Adam, Mihra S. Taljanovic, Larissa A. Szeyko, Jennifer L. Rapiejko |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Antifungal Agents Adolescent medicine.medical_treatment White People Risk Factors Amphotericin B medicine Humans Combined Modality Therapy Aged Retrospective Studies Coccidioidomycosis Debridement business.industry Osteomyelitis Arizona Retrospective cohort study General Medicine Odds ratio Middle Aged medicine.disease Discontinuation Surgery Black or African American Treatment Outcome Spinal fusion Female Spinal Diseases Steroids business medicine.drug |
| Zdroj: | The American Journal of Medicine. 125:304-314 |
| ISSN: | 0002-9343 |
| DOI: | 10.1016/j.amjmed.2011.10.018 |
| Popis: | Background Vertebral involvement is a severe complication of infection caused by Coccidioides species. Methods We conducted a retrospective review of patients diagnosed with vertebral coccidioidomycosis at an academic medical center between 1996 and 2009. Results We identified 39 cases of vertebral coccidioidomycosis. Thirty-four patients (79%) were male, and 23 patients (61%) were black. Black patients were overrepresented in comparison with all other patients by a 50-fold odds ratio (95% confidence interval, 26-95). Only 8 patients (20%) were immunocompromised, including 7 who had received systemic steroids. The number of infected vertebrae ranged from 1 to 24; 8 patients (21%) had epidural involvement. All patients received a triazole as part of medical therapy, and 20 patients also received amphotericin B, typically early in the course. Twenty-six patients (67%) required surgery, 18 of whom also required hardware placement. The most common indication for surgery was pain, but 7 patients had neurologic compromise. No patients developed recurrent or refractory infection at the site of surgical debridement, but 6 patients experienced disease relapse after stopping antifungal therapy. Conclusion Vertebral infection caused by Coccidioides species requires a multispecialty approach that always includes medical therapy and frequently requires surgical intervention for debridement or stabilization. A favorable outcome can usually be achieved, but discontinuation of medical therapy is associated with a high risk of relapse, which can occur years later. |
| Databáze: | OpenAIRE |
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