634 - Eleven Years of Experience with Pediatric Histoplasmosis at a Tertiary Children’s Hospital in an Endemic Area

Histoplasma capsulatam infects persons living in/visiting endemic areas causing disease ranging from asymptomatic to severe disseminated. Most current histoplasmosis data are from adults.

Objective:

To describe a cohort of children with histoplasmosis at a tertiary pediatric care center in an endemic area.

Design/Methods:

Using histoplasmosis-related ICD9/10 codes, we identified 127 patients 0-21 years of age diagnosed with Histoplasmosis at our institution between January 1, 2010 and August 15, 2022. We divided groups into disseminated (Dis) (N=48), acute pulmonary (AP) (N=64), and asymptomatic (Asx) (N=15) based on initial ICD coding, lab results, and imaging. Chart reviews yielded demographic, clinical, laboratory, and treatment data. We performed descriptive analysis and select univariate analyses.
 

Results:

Overall median age was 14.5 years (range 0.6-19 y). Most were non-Hispanic White (77.1%) and resided in cities (57%).  No seasonality was noted. We saw no differences between groups for age, race, ethnicity, residence or environmental factors. When comparing to the AP group, Dis had a short time from symptom onset to diagnosis (median 40.3 vs 78.5, p < 0.001), and days in-hospital until diagnosis (10.4 vs 19.6, p = 0.004). Compared to both groups, Dis were more likely to be hospitalized, p< 0.001. Non-asthma risk factors were seen in over half of Dis but < 20% of AP or Asx (Table 1). Fever and abdominal symptoms were more common in Dis; chest pain more common in AP. Chest radiographs were done more often in Dis (94%) than AP (77%) or Asx (47%), but Cat Scan use did not differ (~80% for each). Dis had infiltrates most often, while AP had both chest mass/adenopathy and calcifications most often. Dis had lower Hemoglobin, absolute lymphocyte count and CD4 but higher alanine aminotransferase and inflammatory markers than AP or Asx (Table 2). Histoplasma antigen (both blood and urine) was detected more often in Dis (60%) than AP (5%) or Asx (0%) (P= 0.001). Antibody detection varied (H bands most often in Dis (33%); yeast phase CF most often in AP (92%). Most Dis received amphotericin-B plus itraconazole; all AP received itraconazole alone. Neither of the 2 deaths were from histoplasma.
 

Conclusion(s):

Pediatric histoplasmosis, similar to adult disease, shows differences between Dis and AP as to presentations, risk factors, use and results of diagnostics, and therapy.