title: Pediatric coccidioidomycosis in central California: a retrospective case series.
abstract: BACKGROUND
  Coccidioidomycosis, an endemic fungal infection seen throughout the southwestern United States, is not well described in children.
  
  
  METHODS
  We performed a retrospective observational study of all children admitted to Children's Hospital Central California with coccidioidomycosis from 1 January 2010 to 1 September 2011.
  
  
  RESULTS
  Thirty-three children, aged 6 months to 17 years, were hospitalized during the study period. These included patients with pneumonia (n = 28), pleural effusion (n = 13), pleural empyema (n = 4), lung abscess (n = 7), pericarditis (n = 2), osteomyelitis (n = 5), meningitis/cerebritis (n = 2), and vocal cord infection (n = 1). Mediastinitis, with radiographic evidence of purulence and necrotic/abscessed lymph nodes in the mediastinum, was present in 7 patients (21%) and tended to occur more often in younger children (median age, 3 years [range, 0.5-11 years] vs 7 years [range, 0.6-17 years] for non-mediastinitis patients; P = .10). Seven patients were admitted to the intensive care unit and 10 required surgical intervention. One patient died of meningitis. Hospitalizations were longer for patients with mediastinitis (median, 130 days [range, 58-200 days] vs 43 days [range, 3-273 days for non-mediastinitis patients]; P < .01) and those with maximum coccidioidal complement fixing antibody titers ≥1:128 (median, 174 days [range, 53-273 days] vs 33 days [range, 3-200 days] for those with maximum titers <1:128; P < .01).
  
  
  CONCLUSIONS
  Coccidioidomycosis causes a substantial disease burden in the children of central California. Mediastinitis is common and tends to occur in younger children. Patients with mediastinitis or elevated coccidioidal complement fixation titers require longer hospitalizations. Further research is needed on the prevention and treatment of this disease.
authors: Department of Pediatrics, Children's Hospital Central California, Madera, CA 93638, USA. jmccarty@childrenscentralcal.org
authors: James M
authors: JM
authors: McCarty
authors: Lindsey C
authors: LC
authors: Demetral
authors: Lukasz
authors: L
authors: Dabrowski
authors: Amandeep K
authors: AK
authors: Kahal
authors: Anna M
authors: AM
authors: Bowser
authors: Julianne E
authors: JE
authors: Hahn
mesh_terms: D000293:Adolescent; D000908:Antibodies, Fungal / Q000097:blood; D000935:Antifungal Agents / Q000627:therapeutic use; D002140:California; D002648:Child; D002675:Child, Preschool; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000908:Antibodies, Fungal; D000935:Antifungal Agents
keywords: coccidioidomycosis; complement fixation; mediastinitis; pediatric