{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:46:22Z","timestamp":1790934382475,"version":"4.1.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["U19 AI 166059"],"award-info":[{"award-number":["U19 AI 166059"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>California\u2019s incidence of pediatric coccidioidomycosis has risen considerably in the last 25\u00a0years, particularly in the last 3\u00a0years. 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective observational study of pediatric patients (0-17\u00a0years of age) with coccidioidomycosis evaluated at the University of California Los Angeles (UCLA) from January 1, 2000, to June 30, 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u00a0=\u200958) had primary coccidioidomycosis and 28% (n\u00a0=\u200923) had disseminated coccidioidomycosis, with 44% of the disseminated cases occurring between 2023 and 2025. Patients with disseminated disease had significantly longer hospitalizations [mean 144\u00a0days (95% CI, 81-207) vs 10\u00a0days (95% CI, 2-18), P\u00a0&amp;lt;\u2009.001] and longer treatment durations [mean 26\u00a0months (95% CI, 9-42) vs 6\u00a0months (95% CI, 3-8), P\u00a0&amp;lt;\u2009.001]. Patients with disseminated disease were significantly more likely to undergo therapeutic modification or additional therapy beyond fluconazole with 34% (n\u00a0=\u200924) 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\u00a0=\u200917) versus 26% (n\u00a0=\u20096) P\u00a0&amp;lt;\u2009.001].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jpids\/piag019","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T15:46:13Z","timestamp":1773330373000},"source":"Crossref","is-referenced-by-count":3,"title":["Rising burden of severe pediatric coccidioidomycosis: a 25-year single-center study"],"prefix":"10.1093","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2485-3927","authenticated-orcid":false,"given":"Sanchi","family":"Malhotra","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles , Los Angeles CA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Adachi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles , Los Angeles CA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1759-8788","authenticated-orcid":false,"given":"Ishminder","family":"Kaur","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles , Los Angeles CA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Arribas Garcia","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles , Los Angeles CA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Krogstad","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles , Los Angeles CA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"2026043010571078000_ref1","doi-asserted-by":"publisher","first-page":"e793","DOI":"10.1016\/S2542-5196(22)00202-9","article-title":"Effects of precipitation, heat, and drought on incidence and expansion of coccidioidomycosis in western USA: a longitudinal surveillance study","volume":"6","author":"Head","year":"2022","journal-title":"Lancet Planet Health"},{"key":"2026043010571078000_ref2","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1029\/2019GH000209","article-title":"Expansion of coccidioidomycosis endemic regions in the United States in response to climate change","volume":"3","author":"Gorris","year":"2019","journal-title":"Geohealth"},{"key":"2026043010571078000_ref3","article-title":"Valley fever in California dashboard","author":"California Department of Public Health"},{"key":"2026043010571078000_ref4","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1086\/313724","article-title":"Coccidioidin skin testing in Kern County, California: decrease in infection rate over 58 years","volume":"30","author":"Larwood","year":"2000","journal-title":"Clin Infect Dis"},{"key":"2026043010571078000_ref5","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/S0022-3476(39)80026-9","article-title":"Acute coccidioidomycosis with erythema nodosum in children","volume":"15","author":"Faber","year":"1939","journal-title":"J Pediatr"},{"key":"2026043010571078000_ref6","article-title":"An epidemic of coccidioidomycosis in the Pacific beach area of San Diego","volume":"101","author":"Ramras","year":"1970","journal-title":"Am Rev Respir Dis"},{"key":"2026043010571078000_ref7","article-title":"Coccidioidomycosis in San Fernando Valley; report of a study carried out in 1951-1952","volume":"79","author":"Cowper","year":"1953","journal-title":"Calif Med"},{"key":"2026043010571078000_ref8","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1097\/INF.0000000000002069","article-title":"Pediatric coccidioidomycosis: case series from a California pediatric infectious diseases clinic","volume":"38","author":"Lee","year":"2019","journal-title":"Pediatr Infect Dis J"},{"key":"2026043010571078000_ref9","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1093\/jpids\/piu091","article-title":"Coccidioidomycosis: experience from a Children\u2019s Hospital in an Area of endemicity","volume":"5","author":"Dimitrova","year":"2015","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2026043010571078000_ref10","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1097\/INF.0000000000002470","article-title":"Extrapulmonary coccidioidomycosis among children in Central California: a retrospective review","volume":"38","author":"Naeem","year":"2020","journal-title":"Pediatr Infect Dis J"},{"key":"2026043010571078000_ref11","doi-asserted-by":"publisher","DOI":"10.3390\/jof8111157","article-title":"Fluconazole failure in the treatment of Coccidioidal meningitis","volume":"8","author":"Gupta","year":"2022","journal-title":"J Fungi"},{"key":"2026043010571078000_ref12","doi-asserted-by":"publisher","first-page":"e515","DOI":"10.1093\/cid\/ciaf036","article-title":"Impact of fluconazole on outcomes of patients with primary pulmonary coccidioidomycosis: a commercial health insurance claims-based, propensity score matched analysis","volume":"81","author":"Benedict","year":"2025","journal-title":"Clin Infect Dis"},{"key":"2026043010571078000_ref13","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02634-16","article-title":"Large-scale evaluation of In vitro amphotericin B, triazole, and echinocandin activity against Coccidioides species from U.S. institutions","volume":"61","author":"Thompson","year":"2017","journal-title":"Antimicrob Agents Chemother"},{"key":"2026043010571078000_ref14","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02232-18","article-title":"Isavuconazole in the treatment of coccidioidal meningitis","volume":"63","author":"Heidari","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"2026043010571078000_ref15","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1007\/s40121-022-00606-y","article-title":"Coccidioidomycosis: a contemporary review","volume":"11","author":"Crum","year":"2022","journal-title":"Infect Dis Ther"},{"key":"2026043010571078000_ref16","doi-asserted-by":"publisher","first-page":"2047","DOI":"10.1128\/JCM.01843-09","article-title":"False-positive IgM serology in coccidioidomycosis","volume":"48","author":"Kuberski","year":"2010","journal-title":"J Clin Microbiol"},{"key":"2026043010571078000_ref17","doi-asserted-by":"publisher","first-page":"e112","DOI":"10.1093\/cid\/ciw360","article-title":"Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis","volume":"63","author":"Galgiani","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2026043010571078000_ref18","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofad597","article-title":"A clinicopathological categorization system for clinical research in coccidioidomycosis","volume":"10","author":"Krogstad","year":"2023","journal-title":"Open Forum Infect Dis"},{"key":"2026043010571078000_ref19","doi-asserted-by":"publisher","first-page":"2337","DOI":"10.1056\/nejmoa2000024","article-title":"Disseminated coccidioidomycosis treated with interferon-\u03b3 and dupilumab","volume":"382","author":"Tsai","year":"2020","journal-title":"N Engl J Med"},{"key":"2026043010571078000_ref20","doi-asserted-by":"publisher","first-page":"e02417","DOI":"10.1016\/j.idcr.2025.e02417","article-title":"A scalp to make you squirm: cutaneous myiasis hiding a unique presentation of disseminated coccidioidomycosis","volume":"42","author":"Duldulao","year":"2025","journal-title":"IDCases"},{"key":"2026043010571078000_ref21","doi-asserted-by":"publisher","first-page":"e414","DOI":"10.1097\/INF.0000000000004888","article-title":"Pearls and pitfalls of intrathecal amphotericin B therapy for refractory Coccidioidal meningitis in children: an illustrative Pediatric case series","volume":"44","author":"Malhotra","year":"2025","journal-title":"Pediatr Infect Dis J"},{"key":"2026043010571078000_ref22","doi-asserted-by":"publisher","DOI":"10.3390\/jof5030054","article-title":"Central nervous system infections due to coccidioidomycosis","volume":"5","author":"Jackson","year":"2019","journal-title":"J Fungi"},{"key":"2026043010571078000_ref23","doi-asserted-by":"publisher","DOI":"10.3390\/pharmaceutics15010075","article-title":"Isavuconazole pharmacokinetics and pharmacodynamics in children","volume":"15","author":"Elhence","year":"2023","journal-title":"Pharmaceutics"},{"key":"2026043010571078000_ref24","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.3201\/eid3105.241338","article-title":"Recent and forecasted increases in coccidioidomycosis incidence linked to hydroclimatic swings, California, USA","volume":"31","author":"Camponuri","year":"2025","journal-title":"Emerg Infect Dis"},{"key":"2026043010571078000_ref25","doi-asserted-by":"publisher","first-page":"101010","DOI":"10.1016\/j.lana.2025.101010","article-title":"Time series forecasting of valley fever infection in Maricopa County, AZ using LSTM","volume":"43","author":"Jin","year":"2025","journal-title":"Lancet Reg Health Am"},{"key":"2026043010571078000_ref26","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1097\/INF.0000000000003813","article-title":"Central nervous system coccidioidomycosis in children: a retrospective case series","volume":"42","author":"Naeem","year":"2023","journal-title":"Pediatr Infect Dis J"},{"key":"2026043010571078000_ref27","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/1755163","article-title":"Disseminated coccidioidomycosis presenting as fever of unknown origin and erythema nodosum in a 3-year-old child","author":"Mills","year":"2021","journal-title":"Case Rep Pediatr"},{"key":"2026043010571078000_ref28","article-title":"Pediatric coccidioidomycosis in a managed care system: considerations for improved management","author":"Michienzie","journal-title":"Pediatrics"},{"key":"2026043010571078000_ref29","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1093\/jpids\/piad075","article-title":"Pre-transplantation strategies for infectious disease mitigation and prevention","volume":"13","author":"Heald-Sargent","year":"2024","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2026043010571078000_ref30","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1097\/BPO.0000000000000147","article-title":"Diagnosis and initial management of musculoskeletal coccidioidomycosis in children","volume":"34","author":"Ho","year":"2014","journal-title":"J Pediatr Orthop"},{"key":"2026043010571078000_ref31","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1093\/cid\/ciac478","article-title":"Controversies in the Management of Central Nervous System Coccidioidomycosis","volume":"75","author":"Thompson","year":"2022","journal-title":"Clin Infect Dis"},{"key":"2026043010571078000_ref32","doi-asserted-by":"publisher","first-page":"2390","DOI":"10.1182\/blood-2012-01-403030","article-title":"Reversible skeletal disease and high fluoride serum levels in hematologic patients receiving voriconazole","volume":"120","author":"Gerber","year":"2012","journal-title":"Blood"},{"key":"2026043010571078000_ref33","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1093\/cid\/ciq188","article-title":"Fluoride excess and periostitis in transplant patients receiving long-term voriconazole therapy","volume":"52","author":"Wermers","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2026043010571078000_ref34","doi-asserted-by":"publisher","first-page":"1573","DOI":"10.1093\/cid\/cit113","article-title":"Treatment of pediatric refractory coccidioidomycosis with combination voriconazole and caspofungin: a retrospective case series","volume":"56","author":"Levy","year":"2013","journal-title":"Clin Infect Dis"}],"container-title":["Journal of the Pediatric Infectious Diseases Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jpids\/advance-article-pdf\/doi\/10.1093\/jpids\/piag019\/67317803\/piag019.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jpids\/article-pdf\/15\/4\/piag019\/67317803\/piag019.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jpids\/article-pdf\/15\/4\/piag019\/67317803\/piag019.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T14:57:16Z","timestamp":1777561036000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jpids\/article\/doi\/10.1093\/jpids\/piag019\/8516503"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,12]]},"references-count":34,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,3,20]]}},"URL":"https:\/\/doi.org\/10.1093\/jpids\/piag019","relation":{},"ISSN":["2048-7207"],"issn-type":[{"value":"2048-7207","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2026,3,12]]},"article-number":"piag019"}}