Applied Evidence
Community-acquired pneumonia in children: A look at the IDSA guidelines
This review of the guidelines can help you adjust your care according to your patient’s age and disease severity.
A 2009 prospective cohort study of 35 patients with CAP in Phoenix, Arizona found that 6 patients (17%) tested positive for coccidioidomycosis. Only 1 statistically significant risk factor was identified—half of patients with coccidioidomycosis exhibited a rash, while there were no rashes in the group without the disease (P=.002).4
Other common signs and symptoms
A retrospective cohort study in San Diego, California in 2004 evaluated and stratified 223 patients with known coccidioidomycosis for presenting symptoms, exam findings, and radiographic findings. The most common signs and symptoms at time of seropositive testing were cough (74%), fever (56%), night sweats (35%), pleuritic chest pain (33%), chills (28%), weight loss (21%), rash (14%), and arthralgia or myalgia (13% and 12%, respectively).5
Airspace opacity was the most common radiographic abnormality (58.8%); the second most common was pulmonary nodules (22.8%).5 The study didn’t compare the frequency of these findings with noncoccidioidal pneumonia.
RECOMMENDATIONS
In 2005 guidelines, the Infectious Diseases Society of America (IDSA) stated that the “management of coccidioidomycosis first involves recognizing that a coccidioidal infection exists, defining the extent of infection, and identifying host factors that predispose to disease severity.”6 The IDSA didn’t give specific recommendations regarding how to diagnose or differentiate coccidioidal infection from CAP.