Coccidioides immitis osteomyelitis: a case series review.
A retrospective chart review and telephone follow-up was conducted on patients who were treated for disseminated coccidioidomycosis involving bones or joints at the Naval Medical Center, San Diego, California from 1993-1999. Thirteen patients were identified, with average follow-up of 36 months. Six patients underwent surgical debridement and systemic medical therapy, and seven patients were treated medically only. All patients improved symptomatically with decreasing complement fixation titers at last follow-up. Five of the six patients treated with combined therapy are currently quiescent. Of those treated medically, four patients are quiescent; three were lost to follow-up. Coccidioidomycosis osteomyelitis remains a rare but difficult disease to treat, with a lifelong risk of recurrence. A combined medical and surgical approach has been shown to be effective, but medical therapy alone with intravenous amphotericin B followed by suppressive azole therapy may be effective in selected patients.
Holley
Keith
K
Department of Orthopedic Surgery, Naval Medical Center, 34800 Bob Wilson Dr, Ste 5, San Diego, CA 92134-1005, USA.
Muldoon
Michael
M
Tasker
Sybil
S
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D003045:Coccidioides / Q000302:isolation & purification; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000628:therapy*; D003646:Debridement / Q000379:methods; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D007717:Knee; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D010388:Pelvis; D012189:Retrospective Studies; D016896:Treatment Outcome
D017964:Itraconazole; D000666:Amphotericin B