Coccidioidomycosis, or Valley fever, is increasingly prevalent in California, but cases in children are not as well described as those in adults. Two recent studiesdescribe the clinical features of the disease in pediatric patients and the clinical picture of treatment.

In the first study, from the Journal of the Pediatric Infectious Diseases Society, investigators from the University of California, Los Angeles (UCLA) say pediatric coccidioidomycosis cases have skyrocketed in California in the past three years. The endemic fungal infection is typically found in the southwestern United States, especially in California and Arizona.

In California the incidence of coccidioidomycosis among children and adolescents has dramatically increased .

“In California the incidence of coccidioidomycosis among children and adolescents has dramatically increased from 1.8/100,000 [children] in 2001 to 10.9/100,000 in 2024,” the authors wrote.

For more than 60% of pediatric patients, the fungus will cause no symptoms or very mild respiratory symptoms that may go unnoticed and will clear on their own. More moderate illness typically involves fever, cough, night sweats, and headaches.

Disseminated cases require multiple antifungals

Rarely, severe cases can disseminate, and cause serious inflammation of the joints, bones, and central nervous system. The authors said that, from 2000 to 2025, UCLA clinicians treated 81 pediatric patients who had Valley fever. Of those, 72% had primary coccidioidomycosis and 28% (23 patients) had disseminated coccidioidomycosis, with 10 of the disseminated cases (43%) occurring from 2023 to 2025.

Overall, patients with disseminated disease were older, less likely to have a cough, and more likely to present with central nervous system symptoms. All patients were treated with first-line antifungals, but patients with dissemination were significantly more likely to require multiple medications (83% versus 21%) than those with primary disease.

Patients with disseminated disease were also significantly more likely than those with primary coccidioidomycosis to undergo surgical intervention as part of disease management (74% versus 26%).

“Pediatric coccidioidomycosis at our institution has become increasingly common and increasingly severe, with a substantial rise in disseminated disease in recent years,” the authors concluded. “These trends emphasize the need for heightened clinical vigilance, early recognition of extrapulmonary disease, incorporation of a standardized classification system to guide evaluation, and proactive multidisciplinary management.”

Median treatment time: 150 days

In a study in Pediatrics,the authors used electronic health data from the Kaiser Permanente Southern California system to describe demographic characteristics, symptoms, diagnostic testing, and details of patient management in patients under 17.

Coccidioidomycosis was identified in 209 children from 2015 to 2021, with an incidence of 3.3 cases per 100,000 children. Only 10 patients (5%) had disseminated coccidioidomycosis.

Of the 199 patients without disseminated infections, 57 were observed without antifungal medical treatment, and 142 patients were treated with antifungals, with a median duration of 150 days (range, less than three months to more than two years).

After stopping treatment, three patients had recurrence of Valley fever.