Disseminated coccidioidomycosis in children.

In an effort to define the importance of extrapulmonary coccidioidomycosis in the pediatric age group, we have studied 14 cases and reviewed the literature. The available data suggest that children are as susceptible to dissemination as are adults. Most children with disseminated coccidioidomycosis have evidence, either by history or chest radiographs, of preceding or concurrent pulmonary infection. The most common sites of dissemination are skin, subcutaneous tissue, bone, and meninges. Coccidioides immitis may be detected in tissues or body secretions by microscopic examination or by appropriate culture. Serologic tests are also useful in making the diagnosis and in following the course of the infection. Skin tests are often negative. Infection is progressive in 60% without antifungal therapy. Coccidioidomycosis of bone, skin, or subcutaneous tissue can be managed effectively with combined surgical and antifungal therapy. Meningitis is much more difficult to treat and is fatal in 50% of cases even when treated with amphotericin B.