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Blastomycosis in children
G E Schutze1, S L Hickerson, E M Fortin
1University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, USA.
Abstract:
Infections due to Blastomyces dermatitidis are not commonly encountered in children and adolescents. Knowledge of the diagnosis and treatment of this disease is largely based upon experience with adult patients. We recently reviewed our experience with blastomycosis to evaluate the difficulties in diagnosis and treatment of this disease in the pediatric population. Ten patients with blastomycosis were identified during our review, and five had pulmonary disease alone. Of these five patients, four required open-lung biopsy for diagnosis, even though three had previously undergone bronchoalveolar lavage. The response to treatment with the oral azole antifungal agents (ketoconazole, fluconazole, and itraconazole) was limited, and the agent with the greatest success remains amphotericin B. Until more data are available, amphotericin B should be used for complicated and life-threatening cases of blastomycosis. If oral azole agents are used for non-life-threatening cases, patients should be followed closely, and if clinical deterioration occurs or serum levels of medications are not adequate, then amphotericin B should be substituted for the oral azole agent.
Insights
Pediatric blastomycosis is rare, posing diagnostic and treatment challenges. Amphotericin B remains the most effective treatment, especially for severe cases, while oral azoles require close monitoring in children.
Area of Science:
- Mycology
- Pediatric Infectious Diseases
- Clinical Medicine
Background:
- Blastomycosis, a fungal infection caused by Blastomyces dermatitidis, is infrequently seen in pediatric populations.
- Current understanding of blastomycosis diagnosis and treatment primarily derives from adult patient data.
- This study addresses the diagnostic and therapeutic challenges of pediatric blastomycosis.
Observation:
- A review identified ten pediatric blastomycosis cases, with five presenting solely with pulmonary disease.
- Four of these five pediatric pulmonary blastomycosis cases necessitated open-lung biopsy for definitive diagnosis.
- Previous bronchoalveolar lavage procedures were insufficient for diagnosis in three of these patients.
Findings:
- Pediatric blastomycosis diagnosis can be challenging, often requiring invasive procedures like lung biopsy.
- Oral azole antifungal agents (ketoconazole, fluconazole, itraconazole) demonstrated limited efficacy in treating pediatric blastomycosis.
- Amphotericin B exhibited the highest success rate and remains the preferred agent for severe pediatric cases.
Implications:
- Amphotericin B is recommended for complicated and life-threatening pediatric blastomycosis cases.
- Non-life-threatening pediatric cases treated with oral azoles require vigilant clinical monitoring.
- Treatment adjustment to amphotericin B is crucial if clinical deterioration or inadequate serum drug levels occur with oral azoles.