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In a 25-year retrospective study of pediatric coccidioidomycosis (Valley fever) at the University of California Los Angeles, researchers found a rise in the number of cases and in the severity of cases, with numbers surging in the past 3 years. Patients were classified to have either: primary coccidioidomycosis, which were patients that were asymptomatic or had localized pulmonary infection; or disseminated coccidioidomycosis, which were patients with a site of extra-pulmonary disease. Among the 81 patient cases studied from January 1, 2000, to June 30, 2025, 23 (28%) had disseminated disease, with 44% of those cases occurring between 2023–2025, as published in the Journal of the Pediatric Infectious Diseases Society. Disseminated infections were associated with longer hospital stays (mean 144 days vs 10 days) and prolonged treatment durations (26 months vs 6 months). Most patients with coccidioidomycosis received antifungals—90% of which were prescribed fluconazole initially, although some patients were transitioned to other therapies. Three deaths were attributable to coccidioidomycosis: 2 from meningitis and 1 from pulmonary disease with acute respiratory distress syndrome.
Clinical vigilance: Patients with primary coccidioidomycosis were significantly more likely to present with cough and chest pain compared to those with disseminated disease. Patients with disseminated disease were more likely to present with central nervous system symptoms, skin lesions, or cervical lymphadenopathy. The authors say pediatric coccidioidomycosis has become increasingly common and increasingly severe, calling for more clinical vigilance in suspecting the disease. A testing algorithm is available on the Centers For Disease Control and Prevention website.