Coccidioidomycosis: A Disease of Substantial Consequence in Children

The incidence of coccidioidomycosis has increased during the past decade. Although infection is frequently asymptomatic, disseminated disease involving lungs, bones, and the central nervous system can occur. The disease burden among children living in endemic areas is under-recognized, resulting in diagnosis and treatment delays. Two case series help fill this knowledge gap.

In a retrospective case series from the epicenter of disease –– California's Central Valley ––investigators identified 33 children with coccidioidomycosis (age range, 6 months–17 years) admitted to a single hospital between January 2010 and September 2011. None of the patients were immunocompromised. Median duration of symptoms prior to diagnosis was 17 days, and the most common presenting symptoms were fever and cough (82% and 73%, respectively). Most patients (85%) had pneumonia, and one third of these children had pleural effusions. Seven children (primarily young) had necrotizing mediastinitis due to multiple abscessed lymph nodes. Five patients had osteomyelitis (most often multifocal). Two patients had meningitis and one of these children died. Overall, 76% of cases responded to initial antifungal therapy (liposomal amphotericin B or fluconazole) and 47% required salvage therapy for progressive disease. Mean length of hospitalization was 54 days. Another case series of 9 patients in California with refractory coccidioidomycosis reported successful salvage therapy with voriconazole and caspofungin.