Pediatric coccidioidomycosis: misdiagnoses, treatment delays common

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Takeaway

  • Pediatric coccidioidomycosis is associated with substantial acute pulmonary and disseminated disease.
  • Misdiagnosis, delayed diagnosis, initial negative serology common.

Why this matters

  • Remain vigilant to ensure timely diagnosis and management, especially in children presenting with acute, prolonged respiratory symptoms not improving with antibiotic treatment.

Key results

  • 108 patients; 83% (90), 17% (18) with acute/pulmonary coccidioidomycosis, disseminated infection, respectively.
  • 65% (70) were initially diagnosed with another condition, mostly pneumonia (56%, 39).
  • Most commonly reported symptoms: fever (75%, 69), cough (54%, 50), rash (38%, 35), weight loss (29%, 27), median 5 lb (range: 2-20)/patient.
  • Disseminated disease associated with additional findings, including pain corresponding to disease sites.
  • 82% (72) received empiric antibiotics between symptom onset and diagnosis.
  • 29% (31) had negative serologic findings.
  • Disseminated infection likelier to have complement fixation titer >1:128 at diagnosis vs patients with acute/pulmonary infection (53%, 14%, respectively, P<.01>
  • 96% (104) treated with antifungals, 47% (51) visited an emergency department, 55% (59) were hospitalized (median stay 44 days [range, 1-272 days]).

Study design

  • Retrospective case series characterizing coccidioidomycosis clinical presentation, diagnosis, and management in pediatric infectious disease outpatients residing in a California area endemic for the disease.
  • Funding: None disclosed.

Limitations

  • Medical records-dependent.
  • Nongeneralizable.
  • Inability to correlate exposure to psychosocial effects.