{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:05:11Z","timestamp":1785247511563,"version":"3.55.0"},"reference-count":85,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T00:00:00Z","timestamp":1712275200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Extrapulmonary infections by Coccidioides spp., though rare, can occur via dissemination, affecting singular or multiple sites, including the skin and musculoskeletal system. Skeletal involvement often manifests as osteomyelitis, particularly in the axial skeleton. The present systematic review evaluates all documented cases of skeletal coccidioidomycosis to assess the diagnostic and treatment strategies alongside the outcomes, drawing insights from an analysis of 163 verified cases. A systematic review following PRISMA guidelines identified all studies reporting skeletal infections by Coccidioides spp. up to 2023 from the PubMed and Scopus databases. Eligible studies evaluated osteoarticular infections from Coccidioides spp. Data extraction included demographics, microbiological data, diagnostic methods, and treatment outcomes. Of the 501 initially identified records, a total of 163 patients from 69 studies met the inclusion criteria. Most cases were from the USA, predominantly males, while the median age of the population was 36 years. Diabetes mellitus was the common comorbidity (14.7%). C. immitis was the most prevalent pathogen. The spine and hand were common sites of infection (17.5% and 15.1%, respectively). Osteomyelitis by Coccidioides spp. was diagnosed, in most cases, by positive cultures (n = 68; 41.7%), while, in 49 (30.9%), both the histological examination and cultures yielded the fungus. Surgical debridement was performed in 80.9% of cases. A total of 118 (72.3%) patients were treated with monotherapy, while combination therapy with two or more antifungal agents was reported in 45 (17.7%). Amphotericin B (either liposomal or deoxycholate) was the most commonly given agent as monotherapy in 51 (31.2%) patients, while 30 (18.4%) patients received itraconazole as monotherapy. The rate of infection\u2019s resolution was higher in patients undergoing surgical debridement (79.5%), compared to those treated only with antifungal agents (51.6%, p = 0.003). Treatment outcomes showed complete resolution in 74.2% of patients, with a mortality rate of 9.2%. Coccidioidal osseous infections present diagnostic and therapeutic challenges. Surgical intervention is often necessary, complementing antifungal therapy. Vigilance for Coccidioides spp. infections, especially in regions with endemicity, is crucial, particularly when bacterial cultures yield negative results.<\/jats:p>","DOI":"10.3390\/jof10040270","type":"journal-article","created":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T08:27:52Z","timestamp":1712305672000},"page":"270","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Diagnosis, Treatment, and Outcome of Coccidioidal Osseous Infections: A Systematic Review"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3695-0759","authenticated-orcid":false,"given":"Andreas G.","family":"Tsantes","sequence":"first","affiliation":[{"name":"Laboratory of Hematology and Blood Bank Unit, \u201cAttikon\u201d University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece"},{"name":"Microbiology Department, \u201cSaint Savvas\u201d Oncology Hospital, 11522 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Koutserimpas","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery and Sports Medicine Department, Croix-Rousse Hospital, University Hospital, 69317 Lyon, France"},{"name":"Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Symeon","family":"Naoum","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopedics, Royal Berkshire Hospital, Reading RG1 5AN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lida-Paraskevi","family":"Drosopoulou","sequence":"additional","affiliation":[{"name":"Microbiology Department, \u201cSaint Savvas\u201d Oncology Hospital, 11522 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellada","family":"Papadogeorgou","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Interbalkan Medical Center, 55535 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Petrakis","sequence":"additional","affiliation":[{"name":"2nd University Department of Internal Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68131 Alexandroupolis, Greece"},{"name":"Department of Infectious Diseases, HIV Unit, University General Hospital of Alexandroupolis, Democritus University of Thrace, 68131 Alexandroupolis, 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 Heraklion, 71409 Iraklio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Samonis","sequence":"additional","affiliation":[{"name":"First Department of Medical Oncology, Metropolitan Hospital of Neon Faliron, 18547 Athens, Greece"},{"name":"School of Medicine, University of Crete, 71003 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1289-4959","authenticated-orcid":false,"given":"Enejd","family":"Veizi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Y\u0131ld\u0131r\u0131m Beyaz\u0131t University, Ankara City Hospital, 2367 Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios V.","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"2nd Academic Department of Orthopaedics, School of Medicine, National & Kapodistrian University of Athens, 14233 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.26574\/maedica.2023.18.2.209","article-title":"Spinal Infections Caused by Coccidioides Species","volume":"18","author":"Koutserimpas","year":"2023","journal-title":"Maedica"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1080\/15572536.2003.11833250","article-title":"Molecular and phenotypic description of Coccidioides posadasii sp. nov., previously recognized as the non-California population of Coccidioides immitis","volume":"94","author":"Fisher","year":"2002","journal-title":"Mycologia"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Koutserimpas, C., Naoum, S., Raptis, K., Vrioni, G., Samonis, G., and Alpantaki, K. 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