Coccidioidomycosis, a disease endemic to the southwestern United States, is associated with significant morbidity, especially in patients in the extremes of age and patients with immunodeficiency or other comorbidities. This review aims to study the disease burden in infants and young children.
Retrospective review of coccidioidomycosis cases in patients younger than two years of age seen at Valley Children’s Hospital over a 10-year period, between 6/1/07 and 12/31/17.
Forty cases were identified. Median age was 10.9 months (IQR, 5.3- 15.8); majority were males (60%), Hispanic (80%) and without comorbid conditions (93%). Fever and cough were the most common symptoms occurring in 83% and 75% of the cases respectively; Erythema nodosum was seen in only 10% of the patients. 40% of the patients had disseminated disease, while 58% had pulmonary disease alone. The most commonly involved extra-pulmonary sites were: Bone (12%), central nervous system (10%), larynx (7%), and skin (7%). Majority of patients required hospitalization (75%) and received antifungal therapy (95%), with 55% of them requiring two or more drugs. Patients with disseminated disease presented at a younger age than those with pulmonary disease alone (median 6.7 vs. 12.5 months, P=0.07); had higher coccidioidal complement fixation titer at time of diagnosis (median 1:32 vs. 1:16, P=0.05); required longer duration of hospitalization (median 79 vs. 2 days, P=0.002); and were more frequently treated with combination antifungal therapy (87% vs 36%, P=0.001).
In regards to outcome, disease resolution was achieved in 75% of the cases while 25 % had active but stable disease on maintenance therapy. A relapse occurred in 5% of the cases. No deaths occurred in this cohort.
Coccidioidomycosis in children younger than two years of age is associated with significant morbidity and health care utilization. Disseminated disease is frequently encountered in this age group and should be considered when formulating the plan for treatment and diagnostic investigations.
C. Rongkavilit, None
M. N. Mhaissen, None