Retrospective Investigation of Pediatric Histoplasmosis Diagnosed at a Tertiary Children's Hospital in an Endemic Area over 11 years.

Background: Most histoplasmosis data are from adults. We describe pediatric histoplasmosis diagnosed at a tertiary pediatric care center in an endemic area.

Methods: We performed a retrospective chart review of patients birth-18 years seen in our institution (January 1, 2010 - August 15, 2022) with histoplasmosis identified by International Classification of Disease (ICD) codes. We performed descriptive and univariate analyses of demographic, historical, clinical, laboratory, and treatment data.

Results: Of 122 patients, 26 had disseminated DH, 71 pulmonary/thoracic (P/T) disease, 21 had histoplasmosis as an incidental finding, and 4 were classified as other. Median age was 14 years (range 0.3-18.7 y); most were non-Hispanic White (70.5%) and city dwellers (77.1%). We noted neither seasonality nor disease category differences for age, race and ethnicity, residence, or environmental factors. Compared to P/T, DH more frequently had complex chronic conditions (73.1% vs 12.7%, p<0.001), fever (88.5% vs 52.1%, p<0.001), fatigue (76.9% vs 46.5%, p=0.01), vomiting (53.8% vs 25.3%, p=0.01), anemia (hemoglobin median 10.05 g/dL vs 12.5 g/dL, p<0.001), elevated sedimentation rate values (median 31 mm/h vs 29 mm/h, p=0.02), blood and urine Histoplasma antigen detection (63.6/84.6% vs 20.0/14.8%, p<0.001), and antifungal treatment (100% vs 70.4%, p<0.001). Patients with DH had longer antifungal treatment courses (399d vs 84d, p<0.001). Exposures were rarely recorded, but the most common was chickens. Chest radiographs were less likely to show adenopathy in DH compared to P/T (8.7% vs 55%, p<0.001).

Conclusion: Presentations, risk factors, diagnostics use/results, and therapy for pediatric histoplasmosis most often parallel those in adults.