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Acute pulmonary blastomycosis in children: clinical course and follow-up
Abstract:
The clinical courses of 14 children with acute pulmonary blastomycosis were studied. All the patients had a remarkably similar illness limited to the lungs with fever, malaise, and respiratory symptoms (cough, sputum production, chest pain, and vomiting). Despite eventual recovery with treatment in all instances, 13 of the 14 children persisted in having abnormal roentgenograms. Three children have demonstrated persistent mild obstructive airway disease for two to 12 months after completion of therapy. These data suggest that the initial illness following childhood infections with Blastomyces dematitidis is usually an acute pulmonary disease without systemic dissemination. Evidence of residual lung abnormalities conflicts with the recent concept of this being a benign, self-limited illness. Our findings suggest the importance of long-term follow-up as well as a need for more complete understanding of the full clinical spectrum and prognosis of acute pulmonary blastomycosis.
Insights
Acute pulmonary blastomycosis in children often leads to lasting lung abnormalities, even after recovery. Long-term follow-up is crucial for understanding the full clinical course and prognosis.
Area of Science:
- Pediatric Infectious Diseases
- Pulmonology
- Mycology
Background:
- Blastomycosis is a fungal infection caused by Blastomyces dermatitidis.
- Acute pulmonary blastomycosis in children is not well-characterized.
- Current understanding may underestimate the long-term sequelae of childhood blastomycosis.
Purpose of the Study:
- To describe the clinical course of acute pulmonary blastomycosis in children.
- To identify potential long-term complications of childhood blastomycosis.
- To evaluate the completeness of recovery after treatment.
Main Methods:
- Retrospective study of 14 children diagnosed with acute pulmonary blastomycosis.
- Clinical data collection including symptoms, treatment, and follow-up.
- Analysis of chest roentgenograms and pulmonary function tests.
Main Results:
- All patients presented with similar pulmonary symptoms (fever, cough, chest pain).
- 13 of 14 children had persistent abnormal chest roentgenograms post-treatment.
- Three children developed persistent obstructive airway disease for up to 12 months.
Conclusions:
- Childhood acute pulmonary blastomycosis is typically confined to the lungs without systemic spread.
- Residual lung abnormalities and airway disease are common, challenging the notion of a benign, self-limited illness.
- Long-term follow-up is essential for a comprehensive understanding of blastomycosis prognosis in children.