Diagnosis and Initial Management of Musculoskeletal Coccidioidomycosis in Children

Persistent Link:
http://hdl.handle.net/10150/281177
Title:
Diagnosis and Initial Management of Musculoskeletal Coccidioidomycosis in Children
Author:
Ho, Aaron K.
Affiliation:
The University of Arizona College of Medicine - Phoenix
Issue Date:
Mar-2013
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Collection Information:
This item is part of the College of Medicine - Phoenix Scholarly Projects 2013 collection. For more information, contact the Phoenix Biomedical Campus Library at pbc-library@email.arizona.edu.
Publisher:
The University of Arizona.
Abstract:
Coccidioidomycosis is an invasive fungal infection caused by the inhalation of aerosolized spores of Coccidioides spp., which reside in the arid soil of the southwestern United States and northern Mexico. Dissemination of coccidioidomycosis is rare, and can lead to extrapulmonic diseases including meningitis, osteomyelitis, and skin and soft-tissue involvement. The purpose of this study is to report our experience with musculoskeletal coccidioidomycosis in children. We retrospectively reviewed the charts of patients with musculoskeletal infection with Coccidioides spp. at our institution from 1997 to 2010. Demographic and clinical data were collected from medical records, including the age of the patient, gender, white blood cell count, immunocompetence, length of stay, location of involvement, and initial treatment. In total, we identified 20 children with musculoskeletal coccidioidomycosis. The mean age was 12.3 years (range: 2 to 17) at time of diagnosis. Diagnostic criteria included positive imaging tests (usually MRI), serological positive titers, and/or biopsy with positive cultures. The most common presenting symptom was bone pain (100%) and just 3 (15%) patients had accompanying signs/symptoms of pulmonary infection. Only 2 (5%) patients had a white blood cell count > 15×109/L (5%). Locations of infection included the foot (24%), knee (14%), spine (19%), forearm (10%), lower leg (7%) and other sites (26%). Fluconazole was the most common antifungal agent used (75%). Surgical intervention was required in 12 (60%) of patients. This is the first series that has described musculoskeletal coccidioidomycosis exclusively in children. This study suggests that the initial presentation of this disease can be nonspecific and difficult to recognize in children. Clinicians should consider this diagnosis when faced with a musculoskeletal infection in children from the southwestern United States and northern Mexico.
MeSH Subjects:
Coccidioidomycosis; Musculoskeletal Diseases
Description:
A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
Mentor:
Shrader, M. Wade, MD

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_US
dc.titleDiagnosis and Initial Management of Musculoskeletal Coccidioidomycosis in Childrenen_US
dc.contributor.authorHo, Aaron K.en_US
dc.contributor.departmentThe University of Arizona College of Medicine - Phoenixen_US
dc.date.issued2013-03-
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.collectioninformationThis item is part of the College of Medicine - Phoenix Scholarly Projects 2013 collection. For more information, contact the Phoenix Biomedical Campus Library at pbc-library@email.arizona.edu.en_US
dc.publisherThe University of Arizona.en_US
dc.description.abstractCoccidioidomycosis is an invasive fungal infection caused by the inhalation of aerosolized spores of Coccidioides spp., which reside in the arid soil of the southwestern United States and northern Mexico. Dissemination of coccidioidomycosis is rare, and can lead to extrapulmonic diseases including meningitis, osteomyelitis, and skin and soft-tissue involvement. The purpose of this study is to report our experience with musculoskeletal coccidioidomycosis in children. We retrospectively reviewed the charts of patients with musculoskeletal infection with Coccidioides spp. at our institution from 1997 to 2010. Demographic and clinical data were collected from medical records, including the age of the patient, gender, white blood cell count, immunocompetence, length of stay, location of involvement, and initial treatment. In total, we identified 20 children with musculoskeletal coccidioidomycosis. The mean age was 12.3 years (range: 2 to 17) at time of diagnosis. Diagnostic criteria included positive imaging tests (usually MRI), serological positive titers, and/or biopsy with positive cultures. The most common presenting symptom was bone pain (100%) and just 3 (15%) patients had accompanying signs/symptoms of pulmonary infection. Only 2 (5%) patients had a white blood cell count > 15×109/L (5%). Locations of infection included the foot (24%), knee (14%), spine (19%), forearm (10%), lower leg (7%) and other sites (26%). Fluconazole was the most common antifungal agent used (75%). Surgical intervention was required in 12 (60%) of patients. This is the first series that has described musculoskeletal coccidioidomycosis exclusively in children. This study suggests that the initial presentation of this disease can be nonspecific and difficult to recognize in children. Clinicians should consider this diagnosis when faced with a musculoskeletal infection in children from the southwestern United States and northern Mexico.en_US
dc.typeThesisen_US
dc.subject.meshCoccidioidomycosisen_US
dc.subject.meshMusculoskeletal Diseasesen_US
dc.descriptionA Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.en_US
dc.contributor.mentorShrader, M. Wade, MDen_US
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