Coccidioidomycosis is endemic to the southwestern United States. Forty percent of infections are symptomatic; of this 5-10% will develop serious pulmonary infections. Of those that have serious infections less than 1% will develop chronic pulmonary disease and/or extra-pulmonary dissemination. Patients with coccidioidal spinal infection (CSI) present unique medical and surgical management considerations.
Data from CSI treated in our institution between September 1986 and May 2011 was retrospectively collected. Charts were reviewed to obtain presenting complaints, specific area of involvement, treatments, and respective outcomes.
Thirty seven cases of CSI were reviewed. The mean age at presentation was 40; 5 females and 32 males. Races included Black (21), Caucasian (6), Hispanic (4), Asian (3), Native American (1), and other (2). Presenting symptoms included: neck, back, and flank pain, radicular pain, weakness, meningismus, gait impairment, bowel and bladder dysfunction, saddle anesthesia, and erectile dysfunction. Ten of the 37 (27%) patients presented with neurological deficits beyond sensory impairment. Magnetic resonance imaging (MRI) were abnormal in all cases, showing degrees of enhancement and destructive lesions, most commonly epidural abscesses (73%), in addition to focal vertebral lesions with compression fractures, osteomyelitis/discitis. Levels of involvement were spread throughout the entire neuro-axis; 3 only had involvement limited to one level. Most patients received fluconazole (24), amphotericin (19), and voriconazole (15). Twenty-seven patients underwent at least one spinal surgery. After treatment, the majority of patients (26/37) had at least some improvement of neurological symptoms; only 2 patients were completely asymptomatic at follow-up. One patient had worsening of symptoms, while the remaining patients had no improvement.
These series suggest that the majority of patients required medical- surgical intervention and the increased neurological impairment pre- and post-operatively appears to be associated with worse outcomes. Also shows male gender and Black ethnicity were the predominant among CSI patients.
A. Moran, None
N. Theodore, None
O. Gonzalez, None