Variation in Management of Children With Coccidioidomycosis

Coccidioidomycosis (CM) is not as well described in children as it is in adults. The Kaiser Permanente Southern California (KPSC) system provides care within an endemic region for CM, affording the opportunity to describe the diagnosis, management, and outcomes of CM in a large pediatric cohort.

This study is a retrospective manual medical record review of patients aged 17 years or younger with a new diagnosis of CM between January 1, 2015, and December 31, 2021. We extracted demographic characteristics, symptoms, diagnostic testing, and details of patient management.

CM was identified in 209 patients. The incidence was 3.3 cases per 100 000 children but varied within the area covered by KPSC. Common symptoms were fever, cough, and rash (>59% for each). Disseminated CM was present in 10 patients (4.8%). Of the 199 patients without disseminated infections, 57 were observed without antifungal treatment; 1 (1.2%) eventually required treatment. For the remaining 142 patients treated with antifungals, the median duration of treatment was 150 days (ranging from <3 months to >2 years). After stopping treatment, 3 (2.1%) had recurrence. Recurrence was identified primarily based on symptoms rather than serologic testing, and all responded well to treatment.

Wide clinician variability in the management of pediatric coccidioidomycosis was observed. Recurrence after treatment or failure of observation without antifungals was rare. Results from serologic testing outside of the initial diagnosis in asymptomatic patients typically did not change clinical management, while symptomatic follow-up was important for management.