Disseminated Coccidioidomycosis Among Children in Central California: A Retrospective Review

Background The burden of coccidioidomycosis in central California is significant among children. Yet, the literature on such infection is limited, particularly on disseminated coccidioidomycosis (DC) in children. Objectives Review the natural history, treatment and outcomes of DC in a tertiary children’s hospital. Methods Retrospective review of patients ≤21 years old with DC seen at our facility during 1/1/07–12/31/16. Results Eighty cases were identified. Median age was 8.5 years (IQR 4.3–14.6); majority was hispanic (66%) and without comorbid conditions (85%). Pulmonary disease with other organ involvement occurred in 69%; 19% had meningitis. Overall, 82% had resolved and/or stable disease (RS), whereas 14% experienced relapse and/or progressive disease (RP). Meningitis more commonly seen in older age group (14.3 vs. 6.9 years, P = 0.04) and had low eosinophil’s (0.8 vs. 2.1%, P < 0.01). More organ involvement (64% vs. 35%, P = 0.03) and RP disease (22% vs. 5%, P = 0.04) commonly seen in children 10 years or older. Non-Hispanics also found to be older than Hispanics (12.2 vs. 7.4 years, P < .01); received multiple drug therapy (48% vs. 18%, P = 0.02). Although not significant, Non-Hispanics were more likely to have meningitis (30% vs. 13%, P = 0.07), coccidioidal complement fixation (CF) titers ≥ 32 (92% vs. 73%, P = 0.07), and RP disease (24% vs. 7%, P = 0.06) than Hispanics. No significant association was found between gender and age, CF titers, and/or outcomes. Higher CF titers were seen with >1 organ involvement (1:256 vs. 1;64, P < 0.01) and more antifungal therapy (1:256 vs. 1:32, P < 0.01). Coccidioides EIA antibody was positive in 50% of cases and 48% with negative/indeterminate results were positive by Immunodiffusion. On multivariate analysis, age remained independently associated with RP (OR = 1.2, 95% CI 1.0–1.5, P = 0.02); age (OR = 1.1, 95% CI 1.0–1.3, P = 0.01) and more antifungal therapy (OR = 3.7, 95% CI 1.4–9.5, P < 0.01) with non-Hispanics. Conclusion To our knowledge this is the largest series for pediatric DC. We identify older age group, non-Hispanics and higher CF titers as potential risk factors for DC, which require early intervention. Prospective studies are needed to identify predictors for adverse outcomes in pediatric DC. Disclosures All authors: No reported disclosures.