Related Experiment Videos
Histoplasmosis during childhood
J C Butler1, R Heller, P F Wright
1Department of Pediatrics, Vanderbilt University, Nashville, Tenn.
Abstract:
To define the clinical presentation of histoplasmosis among hospitalized children, we reviewed the charts of patients treated for histoplasmosis at Vanderbilt University Children's Hospital during the years 1968 through 1988. Thirty-five patients with histoplasmosis diagnosed by culture, pathologic examination, or serologic testing were identified, including 29 patients (83%) with pulmonary/mediastinal infection, 5 (14%) with disseminated disease, and 1 (3%) with primary cutaneous histoplasmosis. The most common symptoms included fever, present in 26 patients (74%), and cough, present in 20 (57%). Of 26 patients with fever, 18 (69%) had fever of > 2 weeks' duration and 7 (27%) had temperatures > or = 40.5 degrees C (> or = 105 degrees F). Abnormal physical findings were few, but 19 patients (54%) had wheezing. Chest radiographs were obtained in all cases except one; 31 (91%) showed abnormalities, including adenopathy in 25 cases (74%) and infiltrates in 19 (56%). Histoplasmin skin tests were positive for 22 (96%) of the 23 patients tested. No cases of classic disseminated histoplasmosis of infancy were identified. Histoplasmosis should be considered in the differential diagnosis when children living in endemic areas are evaluated for persistent fever, cough, and/or wheezing, particularly if adenopathy is seen on the chest radiograph.
Insights
Histoplasmosis in children often presents with prolonged fever and cough, sometimes with wheezing. Consider this fungal infection in endemic areas, especially with chest X-ray findings like adenopathy.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Pulmonology
Background:
- Histoplasmosis is a fungal infection endemic to certain regions.
- Clinical presentation in children can vary, necessitating clear diagnostic criteria.
- Understanding pediatric histoplasmosis is crucial for timely diagnosis and treatment.
Purpose of the Study:
- To define the clinical presentation of histoplasmosis in hospitalized children.
- To identify common symptoms, physical findings, and radiographic features.
- To aid in the differential diagnosis of pediatric respiratory illnesses.
Main Methods:
- Retrospective chart review of 35 pediatric patients diagnosed with histoplasmosis.
- Analysis of clinical symptoms, physical examinations, chest radiographs, and diagnostic test results.
- Inclusion criteria: diagnosis by culture, pathology, or serology between 1968-1988.
Main Results:
- Pulmonary/mediastinal infection was most common (83%), followed by disseminated (14%) and cutaneous (3%).
- Fever (>2 weeks) and cough were prevalent symptoms; wheezing was a common physical finding.
- Chest radiographs frequently showed adenopathy (74%) and infiltrates (56%).
Conclusions:
- Histoplasmosis should be considered in children from endemic areas presenting with persistent fever, cough, or wheezing.
- Radiographic adenopathy in children with these symptoms warrants further investigation for histoplasmosis.
- The study highlights the importance of considering fungal infections in pediatric differential diagnoses.