Osteoarticular Coccidioidomycosis in California: A Single-Center Experience

TL;DR

This study examines the outcomes of patients with a rare fungal infection affecting bones and joints, finding that some infections are more likely to relapse or worsen.

Contribution

The study identifies risk factors for treatment failure in osteoarticular coccidioidomycosis based on a single-center experience.

Findings

Knee and multisite infections were associated with higher rates of disease progression or relapse.

Spinal infections were linked to lower rates of progression or relapse.

Most patients required long-term antifungal therapy, with many still on treatment at the end of follow-up.

Abstract

Osteoarticular involvement in coccidioidomycosis is an uncommon manifestation leading to significant morbidity, but evidence surrounding it is limited. We aimed to describe the clinical characteristics of osteoarticular coccidioidomycosis and identify factors associated with treatment failure.

We performed a retrospective chart review of adults age ≥18 years hospitalized with confirmed osteoarticular coccidioidomycosis at an academic tertiary care center between 2004 and 2021. We extracted demographic, clinical, microbiologic, treatment, and outcomes data. Univariable regression analysis was used to identify risk factors of disease progression or relapse.

Thirty-two patients were reviewed, of whom 29 (91%) were male, with a median age (interquartile range [IQR]) of 46.8 (35.1–65.6) years and a median time of follow-up (IQR) of 84 (47–127) months. The most common sites of infection were spine (n = 15, 47%) and knee (n = 9, 28%). Itraconazole was the most common antifungal used (n = 16, 50%), followed by posaconazole (n = 8, 25%), and surgery was performed in 24 (75%) patients. The median treatment duration (IQR) was 45.0 (13.3–66.7) months, with 26 (81%) patients remaining on antifungals through the last day of follow-up. Fifteen (47%) patients experienced progression and/or relapse. Knee (odds ratio [OR], 18.29; 95% CI, 91–175.35) and multisite infections (OR, 6.56; 95% CI, 1.10–39.32) were associated with disease progression and/or relapse, while spine infection was associated with lower rates of progression and/or relapse (OR, 0.20; 95% CI, 0.44–0.90).

Patients with osteoarticular coccidioidomycosis required prolonged therapy with a substantial risk of disease progression or relapse. Knee and multisite infections were associated with poorer outcomes. Larger studies are needed to validate these findings and optimize treatment strategies.

Patients with osteoarticular coccidioidomycosis had high rates of disease progression and relapse despite prolonged antifungal treatment and surgical interventions. Knee and multisite infections were associated with higher risk of treatment failure while spinal infections had lower risk of failure.