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Mediastinal mass in a 27-year-old man. Extrapulmonary Coccidioides immitis.

Department of Pathology, Orlando Regional Health Care, Orlando, Fla 32806, USA.
Archives of pathology & laboratory medicine (Impact Factor: 2.88). 06/2005; 129(5):699-700. DOI: 10.1043/1543-2165(2005)129<0699:MMIAYM>2.0.CO;2
Source: PubMed
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    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 1/1/10 to 9/1/11. Results. Thirty three children, 6 month to 17 years of age, were hospitalized during the study period. These included patients with pneumonia (28), pleural effusion (13), pleural empyema (4), lung abscess (7), pericarditis (2), osteomyelitis (5), meningitis/cerebritis (2) and vocal cord infection (1). Mediastinitis, with radiographic evidence of purulence and necrotic/abscessed lymph nodes in the mediastinum, was present in seven 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 median 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 median 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.
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