[Coccidioidomycosis in children]

Coccidioides immitis is the cause of coccidioidomycosis, the fungus has been found extensively in the Southwestern United States, and Mexico, and certain areas of Central and South America. Some climatic conditions, such as hot summers with little winter frost, combined with arid, alkaline soils produce ideal circumstances for preservation of the arthroconidia. Children and other human groups are infected by dustbone arthroconidia or by contact with infected soils. There has been limited epidemics of infantile coccidioidomycosis, however, only very few have been verified as to the source of the outbreak by the soil-culture of the fungus. The primary pulmonary infection is usually asymptomatic, but it may resemble influenza with cough, fever, and chest pain. Chronic pulmonary lesions are rare in children. Erythema multiforme an erythema nodosum have been described, namely in females. Arthralgias occurs in some patients. The disseminated form is similar to tuberculosis with lungs, lymph nodes, bones, joints, abdominal organs and skin being the frequently affected sites. Meningitis and limited dissemination to one of few sites is more common in mexican children than adults. Serologic tests are very useful in moderate to severe illnesses. Precipitins can be easily detected by immunodifusion. Higher and persistent complement fixation titers are observed in severe and disseminated infection. Conversion of a skin test with coccidioidin or spherulin from negative to positive strongly suggest coccidioidomycosis. Most cases do not require treatment, but amphotericin B or ketoconazol, are the standard therapy in severe pulmonary disease or disseminated forms, and surgery has been advocated for localized, persistent or drug-resistant, progressive lesions.(ABSTRACT TRUNCATED AT 250 WORDS)