Coccidioides immitis osteomyelitis: a case series review |
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Authors: | Holley Keith Muldoon Michael Tasker Sybil |
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Affiliation: | Department of Orthopedic Surgery, Naval Medical Center, 34800 Bob Wilson Dr, Ste 5, San Diego, CA 92134-1005, USA. |
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Abstract: | 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. |
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