Symptomatic histoplasmosis in children

Symptomatic histoplasmosis in children is rare and presents difficulties both in differentiation from neoplasm and in the mode of therapy. Thirty-two children with an average age of 8.3 years were studied over a 10-year period for this disease. The most frequent symptoms were chronic fever (25 of the 32 patients), malaise (18 patients), significant weight loss (9 patients), and chest pain (6 patients). While physical evidence of a pneumonic process was present in 11 children, 19 had lymphadenopathy and 10 had hepatic or splenic enlargement or both. Chest roentgenograms demonstrated noncalcified masses and infiltrates in 29 children. Nine patients required operation, primarily for a presumptive diagnosis of neoplasm, including six thoracotomies, one liver abscess drainage, and two pericardiectomies. No operative deaths or morbidity occurred. Six children suffered significant morbidity from the disease.Unlike the chronic process in adults, histoplasmosis in children may strongly mimic neoplasm. Skin and serological testing, while beneficial, are of limited usefulness in endemic regions. Operative intervention is justified when careful patient evaluation cannot confirm the diagnosis.