title: Coccidioidal Tenosynovitis of the Hand and Wrist: Report of 9 Cases and Review of the Literature.
abstract: BACKGROUND
  Tenosynovitis is an uncommon manifestation of disseminated infection with Coccidioides fungal species. Most experts treat this infection with combined surgical debridement and antifungal medication. The aim of our study was to examine the outcomes of patients with coccidioidal tenosynovitis of the hand and wrist.
  
  
  METHODS
  We retrospectively searched for the records of patients with coccidioidal tenosynovitis of the hand and wrist at our institution. between 1987 and 2013. We also conducted a review of the literature from 1950 to 2014 to identify additional cases.
  
  
  RESULTS
  We identified 9 cases of coccidioidal tenosynovitis of the hand and wrist at our institution, along with 5 other cases found in a review of the literature. The relapse rate was high overall (50%) and was higher after discontinuation of antifungal therapy (71%) in both immunocompromised and immunocompetent patients. Results of serologic testing were not predictive of relapse.
  
  
  CONCLUSIONS
  A treatment strategy for coccidioidal tenosynovitis should focus on long-term administration of antifungal agents.
authors.affiliation: Department of Internal Medicine.
authors.forename: Mark
authors.initials: M
authors.lastname: Campbell
authors.affiliation: Division of Infectious Diseases.
authors.forename: Shimon
authors.initials: S
authors.lastname: Kusne
authors.affiliation: Department of Orthopedics and Division of Plastic and Reconstructive Surgery, Mayo Clinic Hospital, Phoenix, Arizona.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Renfree
authors.affiliation: Division of Infectious Diseases.
authors.forename: Holenarasipur R
authors.initials: HR
authors.lastname: Vikram
authors.affiliation: Division of Infectious Diseases.
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Smilack
authors.affiliation: Division of Infectious Diseases.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Seville
authors.affiliation: Division of Infectious Diseases.
authors.forename: Robert
authors.initials: R
authors.lastname: Orenstein
authors.affiliation: Division of Infectious Diseases.
authors.forename: Janis E
authors.initials: JE
authors.lastname: Blair
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D003045:Coccidioides / Q000302:isolation & purification*; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D003646:Debridement; D005260:Female; D006225:Hand / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013717:Tenosynovitis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D014953:Wrist / Q000473:pathology*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Coccidioides species; coccidioidal tenosynovitis; coccidioidomycosis; fungal infection; hand and wrist