Broadly multiplexed molecular amplification assays offer an unprecedented ability to diagnose gastrointestinal infection in immunocompromised patients. However, little data are available to compare the performance of such systems in this population. A total of 436 stool samples were collected from 199 predominantly immunocompromised pediatric oncology patients. Remnant samples were tested in parallel with the use of the premarket (investigational use only) versions of two broadly multiplexed PCR assays (BioFire and Luminex), and the results of samples corresponding to the first episode per patient were compared with those from laboratory-developed molecular assays, culture, and antigen detection. Overall performance of the multiplexed systems was comparable, with BioFire and Luminex detecting 94 and 99 positives (P = 0.34), respectively. Stratifying by analyte, BioFire assay detected 51 samples positive for Clostridium difficile, whereas Luminex assay detected 60 (P = 0.01). Biofire and Luminex detected 28 and 38 norovirus-positive samples (P = 0.002), respectively. Astrovirus- and adenovirus-positive samples were detected in higher numbers by in-house PCR than by BioFire; the same was observed for adenovirus with Luminex. Differences observed with other analytes were minimal, did not reach statistical significance, or lacked the numbers needed to detect a difference between systems. Broadly multiplexed PCR offers an effective means of detecting a variety of gastrointestinal pathogens in pediatric oncology patients, with assay performance comparable among the tests examined.
Background:The literature on pediatric extrapulmonary coccidioidomycosis is limited. We reviewed the clinical course, diagnostic studies, treatment and outcomes of children with extrapulmonary coccidioidomycosis followed at a tertiary care center in central California. Methods: Retrospective study of 78 patients ≤21 years old with extrapulmonary coccidioidomycosis diagnosed over 10 years (1/1/07-12/31/16). Results: The median age was 9.7 years (interquartile range, 4.5-14.8). The majority of patients were males (55%), Hispanic (65%) and without comorbid conditions (85%). Over two-thirds (68%) had concurrent pulmonary disease. Organ involvements included bones and joints (33%), mediastinum (19%), central nervous system (19%), cervical lymph nodes (15%), larynx (6%) and skin (5%). Most cases (84%) resolved and/or became stable on maintenance therapy, 14% experienced relapse and/or progressive disease, and 2% were fatal. Children ≥10 years of age tended to have >1 site of involvement (47% vs. 25%, P = 0.06), and more relapsed/progressive/fatal disease (21% vs. 5%, P = 0.06) compared with those <10 years. They also required longer durations of treatment (median, 611 vs. 349 days, P = 0.02). Non-Hispanics were more likely to require >1 drug therapy (85% vs. 70%, P = 0.04) and tended to have Coccidioides complement fixation titers ≥1:32 (89% vs. 72%, P = 0.04) compared with Hispanics. Conclusions: Extrapulmonary coccidioidomycosis in children can be severe and spread to multiple sites and requires prolonged treatment. Non-Hispanics and those ≥10 years of age are more likely to experience severe disease, suggesting a need for early recognition and intervention in these populations.
Most pediatric oncology patients in this study had 1 or more potential infectious causes for their diarrhea. Additional studies are warranted to understand the natural history of gastroenteritis in this patient population. Although broadly multiplexed PCR assays offer some advantages over conventional testing, there may be disadvantages to their use for the diagnosis of infectious gastroenteritis that are unique to pediatric oncology patients.
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BackgroundCoccidioidomycosis, a disease endemic to the southwestern United States, is associated with significant morbidity, especially in patients in the extremes of age and patients with immunodeficiency or other comorbidities. This review aims to study the disease burden in infants and young children.MethodsRetrospective review of coccidioidomycosis cases in patients younger than 2 years of age seen at Valley Children’s Hospital over a 10-year period, between June 1, 2007 and December 31, 2017.ResultsForty cases were identified. Median age was 10.9 months (IQR, 5.3– 15.8); majority were males (60%), Hispanic (80%), and without comorbid conditions (93%). Fever and cough were the most common symptoms occurring in 83% and 75% of the cases, respectively; Erythema nodosum was seen in only 10% of the patients. Forty percent of the patients had disseminated disease, while 58% had pulmonary disease alone. The most commonly involved extra-pulmonary sites were: bone (12%), central nervous system (10%), larynx (7%), and skin (7%). Majority of patients required hospitalization (75%) and received antifungal therapy (95%), with 55% of them requiring two or more drugs. Patients with disseminated disease presented at a younger age than those with pulmonary disease alone (median 6.7 vs. 12.5 months, P = 0.07); had higher coccidioidal complement fixation titer at the time of diagnosis (median 1:32 vs. 1:16, P = 0.05); required longer duration of hospitalization (median 79 vs. 2 days, P = 0.002); and were more frequently treated with combination antifungal therapy (87% vs. 36%, P = 0.001). In regards to outcome, disease resolution was achieved in 75% of the cases while 25% had active but stable disease on maintenance therapy. A relapse occurred in 5% of the cases. No deaths occurred in this cohort.ConclusionCoccidioidomycosis in children younger than 2 years of age is associated with significant morbidity and healthcare utilization. Disseminated disease is frequently encountered in this age group and should be considered when formulating the plan for treatment and diagnostic investigations.Disclosures All authors: No reported disclosures.
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