Abstract Background Osteoarticular involvement in coccidioidomycosis is an uncommon manifestation leading to significant morbidity, but evidence surrounding it is limited. We aimed to describe clinical characteristics of osteoarticular coccidioidomycosis and identify factors associated with treatment failure. Methods We performed a retrospective chart review of adults ≥18 years hospitalized with confirmed osteoarticular coccidioidomycosis at an academic tertiary care center between 2004-2021. We extracted demographic, clinical, microbiologic, treatment, and outcomes data. Univariable regression analysis was used to identify risk factors of disease progression or relapse. Results Thirty-two patients were reviewed, of which 29 (91%) were male with median age of 46.8 (IQR 35.1-65.6) years and median time of follow up of 84 months (IQR 47-127). 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. Median treatment duration was 45.0 months (IQR 13.3-66.7) with 26 (81%) patients remaining on antifungal through the last day of follow up. 15 (47%) patients experienced progression and/or relapse. Knee (OR 18.29, CI 91-175.35) and multi-site infections (OR 6.56, 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, CI 0.44-0.90). Conclusions Patients with osteoarticular coccidioidomycosis required prolonged therapy with a substantial risk of disease progression or relapse. Knee and multi-site infections were associated with poorer outcomes. Larger studies are needed to validate these findings and optimize treatment strategies.
Arya et al. (Sun,) studied this question.