Pediatric Coccidioidomycosis: Case Series From a California Pediatric Infectious Diseases Clinic
Lauren A Lee1, Gail L Sondermeyer Cooksey1, Janice J Kim1
1From the Infectious Diseases Branch, California Department of Public Health, Richmond, California.
Insights
Pediatric coccidioidomycosis, or Valley fever, is often underdiagnosed. Early diagnosis and management are crucial for better outcomes in children with acute or disseminated Valley fever in endemic regions.
Area of Science:
- Infectious Diseases
- Pediatric Medicine
- Mycology
Background:
- Coccidioidomycosis (Valley fever) is less understood in children than adults.
- This study focuses on pediatric cases in the California Central Valley, an endemic area.
Purpose of the Study:
- To describe clinical features, diagnosis, and management of coccidioidomycosis in pediatric patients.
- To highlight challenges in early diagnosis and treatment of pediatric coccidioidomycosis.
Main Methods:
- Retrospective review of medical records for 108 pediatric patients (≤17 years) diagnosed with coccidioidomycosis.
- Data collected included demographics, symptoms, diagnostic tests, infection type, and treatment outcomes.
Main Results:
- Most pediatric patients (83%) had acute/pulmonary disease; 17% had disseminated disease.
- Diagnosis was delayed, especially for disseminated cases (median 57 days vs. 16 days).
- Most patients received antifungal therapy; many required emergency room visits and hospitalization.
Conclusions:
- Significant coccidioidomycosis burden exists in California pediatric populations.
- Increased awareness among healthcare providers and families is vital for timely diagnosis and management of pediatric coccidioidomycosis.
Background:
Coccidioidomycosis is not as well described in the pediatric population as it is in the adult population. We describe clinical findings, diagnosis and management of coccidioidomycosis in 108 pediatric patients seen in an outpatient clinic in the California Central Valley, an area endemic for coccidioidomycosis.
Methods:
We reviewed medical records of a convenience sample of pediatric patients (≤17 years of age) diagnosed with coccidioidomycosis who visited an infectious diseases clinic in Madera, CA, during January 1 to October 1, 2012. We described demographic characteristics, symptoms, diagnostic testing, extent of infection (acute/pulmonary or disseminated), treatment and management.
Results:
Of 108 patients, 90 (83%) had acute/pulmonary coccidioidomycosis and 18 (17%) had disseminated disease. The median age at diagnosis was 9 years (range, 5 months to 17 years). Only 3 (3%) patients were immunocompromised. Before coccidioidomycosis diagnosis, 72 (82%) patients received antibiotics, and 31 (29%) had at least 1 negative coccidioidomycosis serology at the time of or before diagnosis. Coccidioidomycosis was diagnosed significantly later after symptom onset among patients with disseminated (median, 57 days) than with acute/pulmonary (median, 16 days) disease (p < 0.01). A total of 104 (96%) patients received antifungal therapy, 51 (47%) visited an emergency room and 59 (55%) were hospitalized with a median stay of 44 days (range, 1-272 days).
Conclusions:
Substantial acute/pulmonary and disseminated coccidioidomycosis was seen among pediatric patients at this infectious disease clinic in California. In endemic areas, increased coccidioidomycosis awareness and vigilance among families and providers is necessary to facilitate early diagnosis and appropriate management.
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