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Pediatric Laryngeal Coccidioidomycosis: A Case Series in an Endemic Region
Fouzia Naeem1,2, James McCarty2, Mark R Rowe3
1From the Division of Infectious Disease, Department of Pediatrics, Valley Children's Healthcare, Madera, California.
Insights
Laryngeal coccidioidomycosis in children is rare but serious, often presenting with stridor and airway obstruction. Early diagnosis and aggressive treatment, including surgery and antifungals, lead to favorable outcomes.
Area of Science:
- Infectious Diseases
- Pediatric Pulmonology
- Otolaryngology
Background:
- Laryngeal coccidioidomycosis is a rare, life-threatening fungal infection.
- Pediatric data on this condition are scarce, primarily limited to case reports.
Purpose of the Study:
- To review the characteristics of laryngeal coccidioidomycosis in pediatric patients.
- To improve understanding and clinical awareness of this rare pediatric condition.
Main Methods:
- Retrospective review of pediatric patients (≤21 years) diagnosed with laryngeal coccidioidomycosis.
- Data collected included demographics, clinical presentation, laboratory findings, and treatment outcomes from January 2010 to December 2017.
Main Results:
- Five pediatric cases were analyzed; all patients were Hispanic.
- Common symptoms included fever, stridor, cough, and vocal changes, with 80% experiencing airway obstruction requiring intervention.
- Diagnosis often required laryngeal tissue culture/histopathology due to low serological titers; all patients underwent surgical debridement and antifungal therapy.
Conclusions:
- Pediatric laryngeal coccidioidomycosis typically presents with severe airway obstruction, stridor, or dysphonia.
- Comprehensive diagnosis and aggressive multidisciplinary management (surgical and medical) are crucial for favorable outcomes.
- Increased physician awareness is vital for early detection in children from or visiting endemic areas presenting with relevant symptoms.
Background:
Laryngeal coccidioidomycosis is a rare but life-threatening manifestation of coccidioidomycosis. Data in children are sparse and limited to case reports. We conducted this study to review the characteristics of laryngeal coccidioidomycosis in children.
Methods:
We performed a retrospective review of patients ≤21 years of age with laryngeal coccidioidomycosis who were treated from January 2010 to December 2017. We collected demographic data, clinical and laboratory studies and patient outcomes.
Results:
Five cases of pediatric laryngeal coccidioidomycosis were reviewed. All children were Hispanic and 3 were female. The median age was 1.8 years and the median duration of symptoms before diagnosis was 24 days. The most common symptoms included fever (100%), stridor (60%), cough (100%) and vocal changes (40%). Airway obstruction requiring tracheostomy and/or intubation for airway management was present in 80%. The most frequent location of lesions was the subglottic area. Coccidioidomycosis complement fixation titers were frequently low and culture/histopathology of laryngeal tissue was necessary to make a definitive diagnosis. All patients required surgical debridement and were treated with antifungal agents. None of the patients had recurrence during the follow-up period.
Conclusions:
This study suggests that laryngeal coccidioidomycosis in children presents with refractory stridor or dysphonia and severe airway obstruction. Favorable outcomes can be achieved with a comprehensive diagnostic work-up and aggressive surgical and medical management. With the rise in cases of coccidioidomycosis, physicians should have a heightened awareness regarding the possibility of laryngeal coccidioidomycosis when encountering children who have visited or reside in endemic areas with stridor or dysphonia.
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