How is coccidioidomycosis manifested in the joints?

Updated: Aug 27, 2019
  • Author: Duane R Hospenthal, MD, PhD, FACP, FIDSA, FASTMH; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Although arthritis is usually monoarticular, it can be migratory in nature. Knees are the most common joints involved, followed by ankles and wrists. Physical findings are not helpful in differentiating coccidioidomycosis from other causes of monoarthritis or oligoarthritis.

Arthrocentesis samples typically reveal an exudative effusion. The presence of organisms varies, and reports suggest that direct visualization of organisms is rare but can occur in up to half of cases.

Coccidioidomycosis also affects joints, causing synovitis. Infection of the bone typically causes a chronic osteomyelitis, often draining to soft tissue and creating fistulae. Long bones, as well as bones of the hands, feet, pelvis, and skull, may be involved. Approximately 60% of incidents of coccidioidomycosis are limited to a single bone, with 20% involving 2 bones and 10% involving 3 bones. Vertebral osteomyelitis can affect any part of the vertebra, sparing the disc, but putting the patient at risk of meningitis. [40]

Although osteomyelitis can occur from direct inoculation of bone from contaminated penetrating objects, it is more commonly due to hematogenous spread and disproportionately affects the vertebra; paraspinal abscesses are a possible complication. Local pain and tenderness may be evident with vertebral osteomyelitis or paraspinous abscesses. Progressive bony destruction in the vertebrae can lead to spinal cord compression that may require urgent surgical intervention.

Other common sites of involvement include the tibia, femur, skull, and bones of the hands and feet. Other complications of osteomyelitis include contiguous joint arthritis, draining sinus formation, and subcutaneous abscess formation in adjacent soft tissue.


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