Rising burden of severe pediatric coccidioidomycosis: a 25-year single-center study.

Abstract

Background: California's incidence of pediatric coccidioidomycosis has risen considerably in the last 25 years, particularly in the last 3 years. Disseminated coccidioidomycosis is rare but associated with substantial morbidity. Sharing our recent and longitudinal pediatric experience can aid clinicians as the area of endemicity for this infection spreads.

Methods: We performed a retrospective observational study of pediatric patients (0-17 years of age) with coccidioidomycosis evaluated at the University of California Los Angeles (UCLA) from January 1, 2000, to June 30, 2025.

Results: Pediatric coccidioidomycosis cases at our institution increased significantly during the study period. One hundred thirty-four patients met our initial search criteria with 81 patients included in our final cohort. Of these, 72% (n = 58) had primary coccidioidomycosis and 28% (n = 23) had disseminated coccidioidomycosis, with 44% of the disseminated cases occurring between 2023 and 2025. Patients with disseminated disease had significantly longer hospitalizations [mean 144 days (95% CI, 81-207) vs 10 days (95% CI, 2-18), P < .001] and longer treatment durations [mean 26 months (95% CI, 9-42) vs 6 months (95% CI, 3-8), P < .001]. Patients with disseminated disease were significantly more likely to undergo therapeutic modification or additional therapy beyond fluconazole with 34% (n = 24) of all treated patients requiring a mold-active triazole as their final anti-fungal agent. Patients with disseminated disease were also significantly more likely than those with primary coccidioidomycosis to undergo surgical intervention as part of disease management [74% (n = 17) versus 26% (n = 6) P < .001].

Conclusions: Our longitudinal experience as a regional referral center underscores the increasing clinical severity and resource burden of pediatric coccidioidomycosis in endemic areas, requiring multidisciplinary effort. This highlights the need for heightened clinical vigilance, earlier recognition of dissemination, advocating for subspecialty collaboration, and evaluation of optimal antifungal and adjuvant treatment strategies in children.