ABSTRACT
Coccidioidomycosis (valley fever) is a systemic fungal infection caused by soil fungi,
Coccidioides species, and is associated with significant morbidity and mortality. This infection
is endemic in northern Mexico, the southwestern United States, and parts of Central
and South America. The risk factors include ethnicity (especially African and Pacific
Island ancestry), male gender, and immunosuppression. The primary infection occurs
in lungs, but fewer than 40% of patients are symptomatic. Fewer than 1% of infections
result in disseminated disease, which may involve any organ. Skeletal infection occurs
in 10 to 50% of these patients and is frequently multicentric with axial skeleton
involvement. The diagnosis can be confirmed by culture of the organism or visual detection
from cytological or histological specimens obtained from sites of disease. A presumptive
diagnosis can be made in patients with a compatible illness and a positive serologic
test. Imaging plays a significant role in diagnosis and follow-up treatment of musculoskeletal
coccidioidomycosis and includes radiography, magnetic resonance imaging, computed
tomography, and bone scintigraphy. Skeletal coccidioidomycosis is difficult to treat
and frequently requires a combination of medical therapy and surgical debridement.
Medical therapy must be continued for a prolonged period of time, potentially for
a lifetime in some patients.
KEYWORDS
Coccidioidomycosis - musculoskeletal fungal infection - skeletal coccidioidomycosis
- valley fever
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Mihra S TaljanovicM.D.
Department of Radiology, The University of Arizona Health Network
1501 N. Campbell Ave., Tucson, AZ 85724-5067
Email: mihrat@radiology.arizona.edu
