title: Vertebral coccidioidomycosis: presentation and multidisciplinary management.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Infectious Disease Section, University of Arizona College of Medicine, Tucson, 85724-5039, USA.
authors.forename: Larissa A
authors.initials: LA
authors.lastname: Szeyko
authors.forename: Mihra S
authors.initials: MS
authors.lastname: Taljanovic
authors.forename: Robert B
authors.initials: RB
authors.lastname: Dzioba
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Rapiejko
authors.forename: Rodney D
authors.initials: RD
authors.lastname: Adam
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001130:Arizona; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000208:ethnology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000175:diagnosis* / Q000208:ethnology / Q000382:microbiology* / Q000628:therapy*; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data
chemical_list: D000935:Antifungal Agents; D013256:Steroids