title: Surgical management of coccidioidomycosis of the spine: clinical article.
abstract: OBJECTIVE
  Coccidioides immitis is a dimorphous fungus endemic in the southwestern US and northern Mexico. While its primary presentation is pulmonary, it can have devastating neurological sequelae.
  
  
  METHODS
  The authors provide a retrospective review with long-term follow-up between 1986 and 2008 at a single institution.
  
  
  RESULTS
  The authors identified 27 patients between 13 and 81 years old (mean 41.4 years) with spinal coccidioides who were treated surgically at the Barrow Neurological Institute between 1986 and 2008. There were 24 males (89%) and 3 females (11%). Eleven patients (41%) had cervical spine involvement, 15 (56%) had thoracic involvement, 7 (26%) had lumbar involvement, and 2 (7%) had sacral involvement. All 27 patients presented with localized or radiating pain. Nine patients (33%) had myelopathic symptoms at presentation, 5 (19%) had radiculopathy, 4 (15%) had fever, and 12 (44%) had progressive kyphosis. The disease was most frequently seen among African American patients (14 patients [52%]), followed by Caucasians (5 patients [19%]), Asians (3 patients [11%]), and Hispanics (3 patients [11%]). Ten patients (37%) required multiple operations at the same level. Follow-up was available in 19 patients (70%) (mean 9.8 months, range 1-39 months). Sixteen (84%) of these 19 patients improved from their preoperative baseline states, 1 (5%) was stable on examination, 1 patient's condition (5%) deteriorated compared with the preoperative examination, and 1 patient (5%) died in the postoperative period.
  
  
  CONCLUSIONS
  Although spinal involvement of coccidioidomycosis is relatively uncommon, a high index of suspicion and aggressive therapy are warranted to prevent devastating neurological injury, and lifelong antifungal therapy is often warranted.
authors: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors: Udaya K
authors: UK
authors: Kakarla
authors: M Yashar S
authors: MY
authors: Kalani
authors: Giriraj K
authors: GK
authors: Sharma
authors: Volker K H
authors: VK
authors: Sonntag
authors: Nicholas
authors: N
authors: Theodore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D003047:Coccidioidomycosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D013123:Spinal Fusion; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents