What is the treatment for disseminated coccidioidomycosis with bone and joint involvement?

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

Vertebral involvement may also require surgical debridement and stabilization. Surgical intervention may also be indicated for debridement or draining of effusions or abscesses.

Bone and joint disease is treated as disseminated coccidioidomycosis, although itraconazole is thought to perform better than fluconazole in bone disease. In patients with chronic osteomyelitis, drainage of sequestrum in bones and debridement of adjacent purulent soft tissues often is necessary. Joint involvement can be managed by incision and drainage, although occasionally synovectomy and arthrodesis are needed. Immobilization of limbs affected by the disease may be necessary.

The benefit of irrigation and local instillation of amphotericin B to joints, cavities, or abscesses affected by coccidioidomycosis is controversial, and no clear data supporting this practice are available.


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