Jaclyn H. Chu, MHS¹, Theoklis E. Zaoutis, MD¹, Jesse Argon², and Chris Feudtner, MD, PhD, MPH². (1) Division of Infectious Diseases, Children's Hospital of Philadelphia, 3535 Market Street, 15th Floor, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, 267-426-5629, chuj@email.chop.edu, (2) Division of General Pediatrics, Children's Hospital of Philadelphia, 3535 Market Street, 15th Floor, The Children's Hospital of Philadelphia, Philadelphia, PA 19104

Background: The national incidence and epidemiology of endemic fungal infections in children have not been fully reported and have only been discussed in smaller case studies. Objectives: To determine the incidence of endemic fungal infections among children hospitalized in the U.S. and to report demographic and regional characteristics of those infected. Design/Methods: A cross-sectional study using the 2000 Kids’ Inpatient Database, an 80% weighted sample of all hospital pediatric admissions in 27 states during 2000. Endemic fungal infections and comorbidities were defined by ICD-9-CM codes. Results: The estimated national incidence of histoplasmosis in children was 3 cases per 100,000 pediatric admissions (95% CI: 1, 4), 2/100,000 (95% CI: 1, 4) for blastomycosis, and 3/100,000 (95% CI: 1, 6) for coccidioidomycosis. There was one reported case of paracoccidioidomycosis. The highest regional incidences of histoplasmosis and blastomycosis occurred in the Midwest, with rates of 5 (95% CI: 0, 11) and 10/100,000 (95% CI: 2, 17), respectively, and in the West for coccidioidomycosis with 13/100,000 (95% CI: 2, 23). The median age of all cases was 12 years (IQR: 7, 14). The presence of chronic comorbidities was negligible in the blastomycosis group. Eleven percent of children with histoplasmosis and 25% with coccidioidomycosis had a neoplasm, and 4-5% of both groups had a hematological or immunological deficiency. Deaths occurred among 4% of children with coccidioidomycosis. Conclusions: This nationally representative report of pediatric endemic fungal infections highlights the regional impact of these infections on children, who often do not have immunological deficiencies or underlying illnesses.

Learning Objectives: At the conclusion of the session, the participant will be able to

• Describe the national epidemiology of endemic fungal infections in children, including the burden to the pediatric population and who is affected.
• Articulate the procedure for generating national estimates from a large database.
• Recognize endemic fungal pathogens as a health burden among children in endemic regions of the United States and apply the new knowledge in the clinical setting.

Keywords: Infectious Diseases, Children's Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.