PAEDIATRIC COCCIDIOIDOMYCOSIS INCREASED NEARLY SIX-FOLD IN CALIFORNIA FROM 2000 TO 2012
December 19 2016
In the first study of its kind, Gail Sondermeyer et al from Stanford Medical Centre provide an overview of coccidioidomycosis burden of disease and epidemiology specifically in Californian children (age ≤ 17 years) from 2000 to 2012,
Coccidioidomycosis (Valley fever) is an infection caused by the inhalation of Coccidioides fungi endemic in dirt and soil in the southwestern United States and Central and South America. Primary inoculation is rare. Human disease can be asymptomatic or can range from a mild febrile illness to severe pulmonary manifestations to disseminated disease in approximately 40% of those who develop symptoms.
Sondermeyer’s analysis showed that paediatric coccidioidomycosis increased nearly 6-fold with infection and hospitalization occurring throughout California.The percentages of reported cases, hospitalizations and deaths occurring in children were 10% (n=3453), 5% (n=841) and 1% (n=11) of the total coccidioidomycosis cases, hospitilizations and deaths respectively. Case and hospitalization annual rates were highest in male children, those in the 12–17 years age group and in endemic region residents.
From the data available, racial–ethnic differences consistent with previous studies were evident. Hospitalization (but not reported cases) was significantly higher among African-American than white children (relative risk = 1.43 (95% CI 1.10 – 1.85), P = 0.01), with a greater percentage of African-American children hospitalized with forms of progressive coccidioidomycosis. Approximately 12.0% of those hospitalized and 27% of those who died had an immunocompromising condition.
Although the majority (nearly 90%) of reported cases were from the endemic counties, only about 60% of hospitalisations were in patients from endemic area probably reflecting better case reporting in endemic areas, hospitalisation of some patients outside endemic areas or higher proportion of severe disease in less endemic areas as a result of delayed diagnosis and treatment.
In addition to the potential physical and psychological toll on children with lengthy and severe illness, paediatric coccidioidomycosis resulted in substantial hospital charges with an estimated annual average of $3 million.
Similar to recent increases among adults, this analysis revealed that paediatric coccidioidomycosis has increased significantly from 2000 to 2012 throughout California. The authors call for providers and parents, especially in endemic counties, to familiarise themselves with the recognition and management of coccidioidomycosis in children. Education around travel and dust related activities in areas of endemnicity, as well as symptom recognition is essential to minimise risk and facilitate early diagnosis and management of this potentially devastating disease.
Sondermeyer GL et al. 2016. Pediatr Infect Dis J 35(2):166-71. DOI: 10.1097/INF.0000000000000952