球虫的肺外感染。,虽然罕见,可以通过传播发生,影响单个或多个站点,包括皮肤和肌肉骨骼系统.骨骼受累通常表现为骨髓炎,特别是在轴向骨架。本系统评价评估所有记录的骨骼球孢子菌病病例,以评估诊断和治疗策略以及结果。从对163例核实病例的分析中得出见解。根据PRISMA指南进行的系统评价确定了所有报告球虫属骨骼感染的研究。从PubMed和Scopus数据库到2023年。合格的研究评估了球藻属的骨关节感染。数据提取包括人口统计,微生物数据,诊断方法,和治疗结果。在最初确定的501条记录中,来自69项研究的163例患者符合纳入标准.大多数病例来自美国,主要是男性,而人口的中位年龄为36岁。糖尿病是常见的合并症(14.7%)。C.immitis是最常见的病原体。脊柱和手部是常见的感染部位(17.5%和15.1%,分别)。球虫骨髓炎。被诊断出来,在大多数情况下,通过阳性培养(n=68;41.7%),while,49(30.9%),组织学检查和培养都产生了真菌。80.9%的病例进行了手术清创。共有118例(72.3%)患者接受单药治疗,而在45例(17.7%)中报道了两种或两种以上抗真菌药物的联合治疗。两性霉素B(脂质体或脱氧胆酸)是51例(31.2%)患者中最常用的单一治疗药物,30例(18.4%)患者接受伊曲康唑单药治疗。手术清创患者的感染率较高(79.5%),与仅用抗真菌药物治疗的患者相比(51.6%,p=0.003)。治疗结果显示74.2%的患者完全消退,死亡率为9.2%。球虫骨性感染提出了诊断和治疗挑战。手术干预通常是必要的,补充抗真菌治疗。警惕球虫。感染,尤其是在地方性地区,是至关重要的,特别是当细菌培养产生阴性结果。
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\'s 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.