{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:05:06Z","timestamp":1785247506610,"version":"3.55.0"},"reference-count":61,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T00:00:00Z","timestamp":1647302400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Coccidioidomycosis represents an endemic and challenging disease, with rare extrapulmonary manifestations. The present review of all published cases of core and extremities osseous coccidioidomycosis aims to describe epidemiology, patients\u2019 characteristics, symptoms as well as medical and surgical treatment options and their effectiveness. Methods: A thorough review of all published skeletal core and extremity infections due to Coccidioides species was conducted. Information regarding demographics, causative fungus, antifungal treatment (AFT), surgical management as well as the infection outcome was recorded. Results: A total of 92 cases of Coccidioides spp. skeletal infections were recorded in 87 patients. The patients\u2019 mean age was 35.3 years. The most common site of infection was the spine (82.6%), followed by the foot (6.5%), while the predominant symptom upon presentation was pain (29.9%). Immunosuppressive conditions and\/or medications were observed in 21 patients (24.1%). Regarding imaging methods, indicating diagnosis, plain X-rays or CT scans were performed in most patients (50.6%), followed by magnetic resonance imaging (MRI) (47.1%). Most cases were diagnosed through histopathology (62; 71.3%), followed by serology testing (36; 42.4%) and by cultures (35; 40.2%). In 32 cases (36.8%), Coccidioides immitis was cultured, while in the remaining 55 cases (63.2%) the fungus was not further characterized. Regarding AFT, amphotericin B was the preferred agent (52.9%), followed by fluconazole (43.3%). In most cases (78.2%) surgical treatment was also performed. Treatment was successful in 80.5% of cases. Conclusions: Skeletal core and extremity infections due to Coccidioides spp. represent a severe disease. With the available data, the combination of prolonged proper AFT with surgical intervention seems to be the optimal current therapeutic approach.<\/jats:p>","DOI":"10.3390\/diagnostics12030714","type":"journal-article","created":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T03:34:13Z","timestamp":1647401653000},"page":"714","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Skeletal Infections Caused by Coccidioides Species"],"prefix":"10.3390","volume":"12","author":[{"given":"Christos","family":"Koutserimpas","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, \u201c251\u201d Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Symeon","family":"Naoum","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, \u201c251\u201d Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Raptis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, \u201c251\u201d Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4766-8238","authenticated-orcid":false,"given":"Georgia","family":"Vrioni","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Samonis","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Crete, 71500 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0185-8474","authenticated-orcid":false,"given":"Kalliopi","family":"Alpantaki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, \u201cVenizeleion\u201d General Hospital of Crete, 71409 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.idc.2021.03.010","article-title":"Coccidioidomycosis","volume":"35","author":"Bays","year":"2021","journal-title":"Infect. 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