Infectious Disease Section, University of Arizona College of Medicine, Tucson, 85724-5039, USA.
Am J Med. 2012 Mar;125(3):304-14. doi: 10.1016/j.amjmed.2011.10.018.
Vertebral involvement is a severe complication of infection caused by Coccidioides species.
We conducted a retrospective review of patients diagnosed with vertebral coccidioidomycosis at an academic medical center between 1996 and 2009.
We identified 39 cases of vertebral coccidioidomycosis. Thirty-four patients (79%) were male, and 23 patients (61%) were black. Black patients were overrepresented in comparison with all other patients by a 50-fold odds ratio (95% confidence interval, 26-95). Only 8 patients (20%) were immunocompromised, including 7 who had received systemic steroids. The number of infected vertebrae ranged from 1 to 24; 8 patients (21%) had epidural involvement. All patients received a triazole as part of medical therapy, and 20 patients also received amphotericin B, typically early in the course. Twenty-six patients (67%) required surgery, 18 of whom also required hardware placement. The most common indication for surgery was pain, but 7 patients had neurologic compromise. No patients developed recurrent or refractory infection at the site of surgical debridement, but 6 patients experienced disease relapse after stopping antifungal therapy.
Vertebral infection caused by Coccidioides species requires a multispecialty approach that always includes medical therapy and frequently requires surgical intervention for debridement or stabilization. A favorable outcome can usually be achieved, but discontinuation of medical therapy is associated with a high risk of relapse, which can occur years later.
脊椎受累是由粗球孢子菌引起的感染的严重并发症。
我们对 1996 年至 2009 年期间在学术医疗中心诊断为脊椎球孢子菌病的患者进行了回顾性研究。
我们共发现 39 例脊椎球孢子菌病患者。34 例患者（79%）为男性，23 例患者（61%）为黑人。黑人患者的患病率是所有其他患者的 50 倍（95%置信区间，26-95）。仅有 8 例患者（20%）存在免疫抑制，包括 7 例接受过全身皮质类固醇治疗的患者。受累脊椎数量从 1 个到 24 个不等；8 例患者（21%）存在硬膜外受累。所有患者均接受了唑类药物治疗，20 例患者还接受了两性霉素 B 治疗，通常在病程早期。26 例患者（67%）需要手术，其中 18 例还需要植入内固定物。手术的主要适应证是疼痛，但 7 例患者存在神经功能障碍。在手术清创部位没有患者发生复发性或难治性感染，但在停止抗真菌治疗后，有 6 例患者疾病复发。
由粗球孢子菌引起的脊椎感染需要多学科的治疗方法，始终包括药物治疗，且经常需要手术干预以进行清创或稳定。通常可以获得良好的结局，但停止药物治疗与高复发风险相关，复发可在多年后发生。
