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De la Cerda-Vargas MF, Candelas-Rangel JA, Navarro-Dominguez P, Sandoval-Bonilla BA, Meza-Mata E, Muñoz-Hernandez MA, Segura-Lopez FK, Ramirez-Silva LH, Gonzalez-Martinez MDR, Delgado-Aguirre HA. Neurococcidiomycosis in children with hydrocephalus: assessment of functional outcome, quality of life and survival in relation to neuroimaging findings. Childs Nerv Syst 2024; 40:303-319. [PMID: 37819508 DOI: 10.1007/s00381-023-06166-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE Coccidioidal meningitis (CM) is an uncommon disease frequently misdiagnosed. Neuroimaging and mortality are not considered in detail in previous pediatric CM series. Our objective is to evaluate outcome of pediatric neurococcidiomycosis in relation to neuroimaging findings. METHODS We performed a prospective, observational, cross-sectional study in children with hydrocephalus and CM treated at Specialties Hospital in Torreon, Mexico (between 2015 and 2020). The outcome was evaluated by Hydrocephalus Outcome Questionnaire (HOQ) and the modified Rankin Scale (mRS). Follow-up was established at the first shunt surgery and survival since CM diagnosis confirmation. Neuroimaging was analyzed in relation to clinical data, outcome and survival. Kaplan-Meier analysis was performed with IBM-SPSS-25. RESULTS Ten pediatric cases with CM and hydrocephalus were reported. Aged 6-228 months, 60% were female. Mean number of surgeries was 4.3 SD ± 3 (range 1-15). Asymmetric hydrocephalus was the most common neuroimaging finding (70%), followed by cerebral vasculitis (20%) and isolated fourth ventricle (IFV) (20%). The mean HOQ overall score was 0.338 SD ± 0.35. A minimum follow-up of 18 months was reported. Mean survival was 13.9 SD ± 6.15 months (range 3-24). Poor survival was correlated with asymmetric hydrocephalus (p = 0.335), cerebral vasculitis (p = 0.176), IFV (p < 0.001), bacterial superinfection (p = 0.017), lower mRS scores at hospital discharge (p = 0.017) and during follow-up (p = 0.004). The mortality rate was 20%. CONCLUSIONS We report the largest series in Latin America of pediatric CM and hydrocephalus. Asymmetric hydrocephalus, IFV and cerebral vasculitis are complications that increase mortality and must be early diagnosed for a timely surgical and medical treatment. HOQ and mRS could be alternative scales to evaluate outcome in these patients. After a long follow-up (18 months), survival remained poor after diagnosis confirmation in our series.
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Affiliation(s)
- Maria F De la Cerda-Vargas
- Department of Neurosurgery and Neurotechnologie, Universitätsklinik Tübingen, Tübingen, Germany.
- Department of Neurosurgery, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon, Coahuila, Mexico.
| | - Jose A Candelas-Rangel
- Department of Neurosurgery, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon, Coahuila, Mexico
- Department of Neurosrugery, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon, Coahuila, Mexico
| | - Pedro Navarro-Dominguez
- Department of Neurosurgery, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon, Coahuila, Mexico
| | - Bayron A Sandoval-Bonilla
- Associated Professor, Department of Neurosurgery, Specialties Hospital, Centro Médico Nacional (CMN) Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Elizabeth Meza-Mata
- Head of Anatomical Pathology Department, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon, Coahuila, Mexico
| | - Melisa A Muñoz-Hernandez
- Department of Health and Research, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreón, Coahuila, Mexico
| | - F K Segura-Lopez
- Department of Health and Research, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreón, Coahuila, Mexico
| | - Luis H Ramirez-Silva
- Department of Neurosurgery, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon, Coahuila, Mexico
| | | | - Hector A Delgado-Aguirre
- Department of Transplants, Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon, Coahuila, Mexico
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Galgiani JN, Hsu AP, Powell DA, Vyas JM, Holland SM. Genetic and Other Determinants for the Severity of Coccidioidomycosis: A Clinician's Perspective. J Fungi (Basel) 2023; 9:554. [PMID: 37233265 PMCID: PMC10219288 DOI: 10.3390/jof9050554] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/30/2023] [Accepted: 05/06/2023] [Indexed: 05/27/2023] Open
Abstract
The endemic fungal infection, coccidioidomycosis, occurs after inhalation of one or very few Coccidioides spp. spores. Infections produce diverse clinical manifestations, ranging from insignificant to extremely destructive, even fatal. Approaches to understanding this range of consequences have traditionally categorized patients into a small number of groups (asymptomatic, uncomplicated self-limited, fibro-cavitary, and extra-thoracic disseminated) and then looked for immunologic differences among them. Recently, variants within genes of innate pathways have been found to account, in part, for infections that result in disseminated disease. This discovery raises the very attractive theory that, in patients without severe immunosuppression, much of the disease spectrum can be accounted for by various combinations of such deleterious variants in innate pathways. In this review, we summarize what is known about genetic determinants that are responsible for the severity of coccidioidal infections and how complex innate genetic differences among different people might account for the spectrum of disease observed clinically.
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Affiliation(s)
- John N. Galgiani
- Valley Fever Center for Excellence, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85721, USA;
- Department of Medicine, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85721, USA
- Department of Immunobiology, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85721, USA
- BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA
| | - Amy P. Hsu
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, MD 20892, USA; (A.P.H.); (S.M.H.)
| | - Daniel A. Powell
- Valley Fever Center for Excellence, College of Medicine-Tucson, University of Arizona, Tucson, AZ 85721, USA;
- BIO5 Institute, University of Arizona, Tucson, AZ 85721, USA
| | - Jatin M. Vyas
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Steven M. Holland
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, MD 20892, USA; (A.P.H.); (S.M.H.)
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Fahimuddin FZ, Etemadi K, Morgan B. A Quiescent Infection in a Premature Newborn. Clin Pediatr (Phila) 2022; 61:373-375. [PMID: 35120420 DOI: 10.1177/00099228221075885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Fatimah Z Fahimuddin
- University of California, San Francisco, Fresno Medical Education Program, Fresno, CA, USA
| | - Kimia Etemadi
- University of California, San Francisco, Fresno Medical Education Program, Fresno, CA, USA
| | - Brian Morgan
- University of California, San Francisco, Fresno Medical Education Program, Fresno, CA, USA
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Bittencourt CE, Okezie O, Tawansy K, Peterson EM, Minckler DS. Pediatric coccidioidal orbital granuloma. Am J Ophthalmol Case Rep 2022; 25:101302. [PMID: 35112028 PMCID: PMC8790595 DOI: 10.1016/j.ajoc.2022.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 07/14/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To report a case of orbital coccidiomycosis in an otherwise healthy 11-month-old male. Observations An 11-month-old male presented to his pediatrician with parental complaints of swelling, erythema, and pain of the right orbit that increased over ten days in the absence of constitutional symptoms. The child's parents reported an earlier fall onto a carpeted floor. After four weeks of conservative treatment and a course of oral cephalexin, he developed a fever, increased erythema, and palpable enlargement of a mass posterior to the lower eyelid. Ultrasound revealed an encysted mass in the inferior orbit, suggestive of an abscess. Urgent ophthalmic referral led to incision and drainage via orbitotomy. Culture, histopathology, and serological testing were positive for Coccidioides spp.. Blood studies revealed mild anemia and thrombocytosis. There was complete resolution of symptoms after surgical drainage and several weeks of oral fluconazole. Conclusion and importance We describe a patient with orbital coccidiomycosis without apparent systemic involvement, following what was most likely an unrelated minor trauma. Despite being rare, orbital coccidiomycosis should be considered as a primary manifestation of infection when ocular inflammation is encountered, especially in endemic regions.
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Abstract
BACKGROUND Coccidioidomycosis is common in adult and pediatric populations living in endemic areas of the United States but has rarely been reported in neonates. We reviewed recent cases of neonatal coccidioidomycosis treated at a tertiary care children's hospital in an endemic area and compared them with previously reported cases in the literature. METHODS We performed a retrospective chart review of infants 1 month old or less hospitalized with a diagnosis of coccidioidomycosis from January 1, 2014, to December 31, 2019. Additionally, we performed a literature review of all reported cases of neonatal coccidioidomycosis over the past 7 decades through PubMed. Infants born to mothers with confirmed or suspected active coccidioidomycosis were excluded. RESULTS Three cases of neonatal coccidioidomycosis were identified at our institution. Each presented in a unique manner and had an alternative diagnosis at the time of initial presentation. Two patients had negative coccidioidal screening tests upon admission but later seroconverted. All patients had extrapulmonary involvement, and all recovered after appropriate treatment. A review of the literature reveals that the presentations and outcomes of neonatal coccidioidomycosis vary widely. CONCLUSIONS There is significant variability in the presentation of coccidioidomycosis in the neonatal period, and diagnosis may be challenging. In endemic regions, healthcare providers should consider coccidioidomycosis in their differential diagnoses of ill-appearing neonates that do not respond to treatment.
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Bajwa AK, Rongkavilit C. Update on Coccidioidomycosis in the United States and Beyond. Glob Pediatr Health 2020; 7:2333794X20969282. [PMID: 33241083 PMCID: PMC7675861 DOI: 10.1177/2333794x20969282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/28/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022] Open
Abstract
Coccidioidomycosis is a fungal infection that is prevalent in western United States, Central America, and South America. The infection is acquired by inhalation. It can affect persons of all ages including infants and children. The majority of cases are asymptomatic and the incidence of infection is greater during a dry summer season after heavy rainfall in prior winter. For those with symptoms, they may experience a self-limiting influenza-like illness. However, some may progress toward pneumonia or disseminated diseases involving skeletal system and central nervous system. The diagnosis is based mainly on various serology testing. Antifungal treatment is generally not required for those with mild symptoms. For those with moderate to severe infections, the mainstay of treatment is azole, with fluconazole being often considered as the first line therapy. Currently there is no effective solution to prevent coccidioidomycosis. Those who work in high-risk conditions should be given appropriate protective equipment as well as education on proper precaution.
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Affiliation(s)
- Alisha K. Bajwa
- University of California San Francisco, Fresno Branch, Fresno, CA, USA
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Maza-Morales M, Rivas-Calderón MK, Barrón-Calvillo EE, García-Romero MT. Coccidioidomycosis in Children and Adolescents: an Update. CURRENT FUNGAL INFECTION REPORTS 2020. [DOI: 10.1007/s12281-020-00381-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Extrapulmonary Coccidioidomycosis Among Children in Central California: A Retrospective Review. Pediatr Infect Dis J 2019; 38:1189-1194. [PMID: 31738333 DOI: 10.1097/inf.0000000000002470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The literature on pediatric extrapulmonary coccidioidomycosis is limited. We reviewed the clinical course, diagnostic studies, treatment and outcomes of children with extrapulmonary coccidioidomycosis followed at a tertiary care center in central California. METHODS Retrospective study of 78 patients ≤21 years old with extrapulmonary coccidioidomycosis diagnosed over 10 years (1/1/07-12/31/16). RESULTS The median age was 9.7 years (interquartile range, 4.5-14.8). The majority of patients were males (55%), Hispanic (65%) and without comorbid conditions (85%). Over two-thirds (68%) had concurrent pulmonary disease. Organ involvements included bones and joints (33%), mediastinum (19%), central nervous system (19%), cervical lymph nodes (15%), larynx (6%) and skin (5%). Most cases (84%) resolved and/or became stable on maintenance therapy, 14% experienced relapse and/or progressive disease, and 2% were fatal. Children ≥10 years of age tended to have >1 site of involvement (47% vs. 25%, P = 0.06), and more relapsed/progressive/fatal disease (21% vs. 5%, P = 0.06) compared with those <10 years. They also required longer durations of treatment (median, 611 vs. 349 days, P = 0.02). Non-Hispanics were more likely to require >1 drug therapy (85% vs. 70%, P = 0.04) and tended to have Coccidioides complement fixation titers ≥1:32 (89% vs. 72%, P = 0.04) compared with Hispanics. CONCLUSIONS Extrapulmonary coccidioidomycosis in children can be severe and spread to multiple sites and requires prolonged treatment. Non-Hispanics and those ≥10 years of age are more likely to experience severe disease, suggesting a need for early recognition and intervention in these populations.
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