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Pediatric Coccidioidomycosis

Case Series From a California Pediatric Infectious Diseases Clinic

Lee, Lauren A., MD, MPH*; Sondermeyer Cooksey, Gail L., MPH*; Kim, Janice J., MD, MPH*; Kahal, Amandeep, MD; Gilliss, Debra, MD, MPH*; Naeem, Fouzia, MD, MS; McCarty, James M., MD; Vugia, Duc J., MD, MPH*

The Pediatric Infectious Disease Journal: February 2019 - Volume 38 - Issue 2 - p 115–121
doi: 10.1097/INF.0000000000002069
Original Studies

Background: Coccidioidomycosis is not as well described in the pediatric population as it is in the adult population. We describe clinical findings, diagnosis and management of coccidioidomycosis in 108 pediatric patients seen in an outpatient clinic in the California Central Valley, an area endemic for coccidioidomycosis.

Methods: We reviewed medical records of a convenience sample of pediatric patients (≤17 years of age) diagnosed with coccidioidomycosis who visited an infectious diseases clinic in Madera, CA, during January 1 to October 1, 2012. We described demographic characteristics, symptoms, diagnostic testing, extent of infection (acute/pulmonary or disseminated), treatment and management.

Results: Of 108 patients, 90 (83%) had acute/pulmonary coccidioidomycosis and 18 (17%) had disseminated disease. The median age at diagnosis was 9 years (range, 5 months to 17 years). Only 3 (3%) patients were immunocompromised. Before coccidioidomycosis diagnosis, 72 (82%) patients received antibiotics, and 31 (29%) had at least 1 negative coccidioidomycosis serology at the time of or before diagnosis. Coccidioidomycosis was diagnosed significantly later after symptom onset among patients with disseminated (median, 57 days) than with acute/pulmonary (median, 16 days) disease (p < 0.01). A total of 104 (96%) patients received antifungal therapy, 51 (47%) visited an emergency room and 59 (55%) were hospitalized with a median stay of 44 days (range, 1–272 days).

Conclusions: Substantial acute/pulmonary and disseminated coccidioidomycosis was seen among pediatric patients at this infectious disease clinic in California. In endemic areas, increased coccidioidomycosis awareness and vigilance among families and providers is necessary to facilitate early diagnosis and appropriate management.

From the *Infectious Diseases Branch, California Department of Public Health, Richmond, California

Division of Infectious Diseases, Valley Children’s Hospital, Madera, California

Department of Pediatrics, Stanford University School of Medicine, Stanford, California.

Accepted for publication March 22, 2018.

This investigation was partly supported by the Epidemiology and Laboratory Capacity for Infectious Diseases cooperative agreement 3U50CK000410 from the US Centers for Disease Control and Prevention.

The authors have no conflicts of interest to disclose.

Address for correspondence: Lauren A. Lee, MD, MPH, 850 Marina Bay Parkway, Building P, 2nd Floor, Richmond, CA 94804. E-mail: Burwell.lauren@gmail.com.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.