PEDIATRICS Vol. 2 No. 6 December 1948, pp. 709-721
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Round Table Discussion

SYSTEMIC MYCOSES, COCCIDIOIDOMYCOSIS AND HISTOPLASMOSIS

J. C. PETERSON M.D.

Chairman Peterson: In this discussion we will attempt to clarify concepts concerning the use of skin testing material in the diagnosis of these two fungus infections. We will also attempt to show the relationship of minimal mild infections to the more serious infections.

Until the recent past, most of us have considered fungus infections to play a very minor or unimportant role in the production of disease process in children. All of us have been more or less aware of the fact that thrush and certain dermatomycoses are commonplace in early infancy and childhood respectively but serious infections are so rare that they are of little significance. In general, fungus infections have seemed to play an unimportant role in the spectrum of disease processes; only occasional rare severe infections being recognized.

In recent years we have been forced to the realization that fungus infection—generalized fungus infections—are much more common than we had previously suspected and that many of these infections have remained unrecognized or they have masqueraded under false pretenses and have been classified as other diseases.

The study of coccidiomycosis in California first pointed out the fungus infections, which have been recognized only as a generalized serious infection, might also exist in a much more benign form and might have a course which is entirely asymptomatic or nearly asymptomatic. In most of the fungus infections the recognition of the severe form of infection has antedated the recognition of the benign forms of infection. That is true of both of the fungus infections which we will discuss today.

The discussion of coccidioidomycosis will be led by Dr. Russel Mapes of Beverly Hills, Calif., who—though he is a practicing pediatrician—has had extensive experience with coccidioidomycosis in his work in the Army.

Dr. Mapes: Coccidioidomycosis is an infection caused by the fungus Coccidioides immitis. It may occur as a mild, even inapparent infection, or in the more common pulmonary form which is self-limited and without sequalæ, or it may appear as the progressive disseminated disease known as coccidioidal granuloma. The history and background of this disease is interesting.