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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.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|March 1, 1996
PubMed
Summary
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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.

Related Experiment Videos

  • 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.