Coccidioidomycosis: Experience From a Children’s Hospital in an Area of Endemicity

The incidence of coccidioidomycosis is increasing, and published pediatric experience is limited. This study further characterizes pediatric coccidioidomycosis by describing experience with 64 patients cared for at Children’s Hospital of Los Angeles over 20 years, with focus on sites of involvement and severity, as well as serologic profiles of affected children. Key words. disseminated coccidioidomycosis; pulmonary coccidioidomycosis. Coccidioidomycosis is caused by Coccidioides immitis/ posadasii and is an endemic mycosis of the Southwestern United States and certain arid areas of Mexico and Central and South America [1, 2]. Although most infec-tions are asymptomatic or self-limiting, clinical progression may include severe pulmonary compromise with or with-out dissemination to extrathoracic sites such as bone, joints, skin, soft tissue, or central nervous system (CNS), while dissemination can occur even in the absence of signif-icant respiratory disease [2]. Recent epidemiologic data suggest an increasing incidence and distribution of this in-fection, and 10 % of older adults are diagnosed in nonen-demic locales and have no history of residence in an endemic area [3–5]. Coccidioidomycosis in adults has been well studied; recently, growing interest in coccidioidal infection in children has resulted in clinical reports of pertinent data [6–8]. In 2002, over 40 % of hospitalized children with coccidioidomycosis were inpatients in a non-endemic area, underscoring the importance of expanding reported experience in pediatrics to inform physicians car-ing for children [6]. This study was undertaken to provide further characteriza-tion of the sites of involvement, predisposing factors, clinical course, and progression in children with coccidioidomycosis