- 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.
- 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]).
- 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.
- Medical records-dependent.
- Inability to correlate exposure to psychosocial effects.