Mediastinal Lymphadenopathy in Children With Histoplasmosis

Area of Science:

• Pediatric Infectious Diseases
• Pulmonology
• Medical Mycology

Background:

• Mediastinal lymphadenopathy (ML) in children has diverse causes, including malignancy, infection, and rheumatic conditions.
• Histoplasmosis is an endemic fungal infection that can present with ML in pediatric populations.
• Understanding the clinical course of histoplasmosis-related ML is crucial for appropriate management.

Purpose of the Study:

• To describe the clinical presentation and natural history of histoplasmosis in children with ML.
• To evaluate the effectiveness of antifungal and steroid treatments for histoplasmosis-related ML.
• To assess the diagnostic yield of biopsies in children with ML.

Main Methods:

• Retrospective study of children (<21 years) with proven or suspected histoplasmosis and ML over 5 years.
• Inclusion criteria: positive serology or clinical suspicion with negative TB tests and benign outcomes.
• Data collected: demographics, symptoms, lab results, treatment, imaging, and follow-up visits.

Main Results:

• 44 children with ML were included; 27 had proven and 19 suspected histoplasmosis.
• Antifungal or steroid therapy did not significantly impact readmission or symptom recurrence rates.
• Steroid use was linked to airway narrowing and higher readmission rates; biopsies were rarely diagnostic.

Conclusions:

• Histoplasmosis-causing ML in children is generally self-limiting and manageable with symptomatic treatment.
• The benefit of antifungals and steroids is uncertain and may not alter the disease's natural course.
• Avoidance of invasive procedures like biopsies is recommended due to low diagnostic yield.