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Variation in Management of Children With Coccidioidomycosis
Chiara Michienzie1, John Galgiani2,3, Sean P Fitzwater4
1Department of Pediatrics, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
Pediatrics
|March 12, 2026
Summary
Pediatric coccidioidomycosis (CM) management shows variability, but outcomes are generally good. Recurrence of fungal infection after treatment or observation without antifungals is rare in children.
Area of Science:
- Pediatric Infectious Diseases
- Mycology
- Epidemiology
Background:
- Coccidioidomycosis (CM) is less understood in pediatric populations compared to adults.
- The Kaiser Permanente Southern California (KPSC) system offers a unique setting to study pediatric CM due to its location in an endemic region.
Purpose of the Study:
- To describe the diagnosis, management, and outcomes of coccidioidomycosis in a large cohort of children.
- To identify patterns and variability in clinical decision-making for pediatric CM.
Main Methods:
- Retrospective review of medical records for pediatric patients (≤17 years) diagnosed with CM between 2015 and 2021.
- Data extraction included demographics, symptoms, diagnostic tests, and treatment details.
Main Results:
- 209 pediatric CM cases were identified, with an incidence of 3.3 per 100,000 children.
- Fever, cough, and rash were common symptoms; disseminated CM occurred in 4.8% of patients.
- Recurrence after antifungal treatment or observation without antifungals was rare (1.2% and 2.1%, respectively).
Conclusions:
- Significant variability exists in the clinical management of pediatric coccidioidomycosis.
- Observation without antifungal treatment is often successful, and recurrence rates are low.
- Symptomatic follow-up is crucial for managing pediatric CM, while serologic test results in asymptomatic patients rarely alter management.
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