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Blastomycosis in children
1Pulmonary and Critical Care Division, Veterans Affairs Medical Center, Milwaukee, WI 53295, USA.
Insights
Pediatric blastomycosis is often acquired via respiratory inhalation, with many children remaining asymptomatic. Diagnosis relies on persistent respiratory symptoms, endemic area history, and imaging, with Amphotericin B as an effective treatment.
Area of Science:
- Mycology
- Pediatric Infectious Diseases
- Pulmonology
Background:
- Blastomycosis is a fungal infection primarily affecting the lungs.
- Children are susceptible, especially those in or traveling to endemic regions.
- Infection is typically acquired through respiratory inhalation of fungal spores.
Purpose of the Study:
- To summarize the clinical presentation, diagnosis, and treatment of blastomycosis in children.
- To highlight key differences in presentation and dissemination between pediatric and adult cases.
- To inform clinicians on diagnostic and therapeutic strategies for pediatric blastomycosis.
Main Methods:
- Review of existing literature on pediatric blastomycosis.
- Analysis of clinical symptoms, diagnostic methods, and treatment outcomes.
- Comparison of disease patterns in children versus adults and in different epidemiological settings.
Main Results:
- Many pediatric cases are asymptomatic or present with non-specific respiratory symptoms mimicking common infections.
- Extrapulmonary dissemination is more frequently reported in children than in adults, particularly in chronic or non-outbreak cases.
- Chest radiography may show infiltrates, consolidation, nodules, or cavitation.
- Diagnosis is suspected based on persistent symptoms, endemic exposure, and imaging findings, confirmed by microscopy and culture.
- Amphotericin B is the primary effective treatment, with limited data on oral azoles in children.
Conclusions:
- Pediatric blastomycosis requires a high index of suspicion, especially with persistent respiratory symptoms and relevant travel/residence history.
- Prompt diagnosis and treatment, often with Amphotericin B, are crucial for favorable outcomes.
- Further research on long-term outcomes and alternative treatments in children is warranted.
Abstract:
Children acquire blastomycosis, with rare exceptions, through the respiratory route. Nearly half of those who are infected may be asymptomatic. Cough is the most common symptom and is usually without sputum production, and hemoptysis is not noted. Other symptoms are chest pain (described as tightness or pain when breathing), weight loss, night sweats, and loss of appetite. The severity of illness is variable and may simulate an upper respiratory infection, bronchitis, pleuritis, or pneumonia. As in adults, an overwhelming infection may cause respiratory failure even in immunocompetent children and in immunocompromised children who live in or travel to endemic areas are susceptible to infection. Some reports based on consecutive cases note extrapulmonary dissemination commonly in children, whereas dissemination is rarely noted in outbreak cases. Chronicity of the disease favors extrapulmonary dissemination. Chest radiograph patterns are alveolar infiltrates, consolidation, and nodule(s), and these may be accompanied by cavitation. Diagnosis is suspected when the symptoms that mimic common respiratory infections persist for more than 2 weeks and by a history of residence or travel to an endemic area. Chest radiographic findings of nodule(s) or cavitation further increase the suspicion. Confirmation of diagnosis is by microscopic examination and culture of sputum. When expectorated sputum is unavailable, bronchoscopy with lavage and biopsy or percutaneous needle biopsy of lung is the appropriate next step. Disease that is progressive or severe or disseminated to other organs should be treated. Amphotericin B is effective and results in excellent cure rates. Experience using oral azoles is limited in children.
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