By Dr. Katherine Schlaerth, M.D.
In Kern County, Valley Fever is always on our radar. The disease can appear in many different ways. In more serious cases, it may show up as bone infection, meningitis, skin conditions, or even fluid buildup in the abdomen. Fortunately, most people who develop coccidioidomycosis recover without ever needing medical care.
In children and adolescents, one of the most common reasons for visiting a healthcare provider is fever. Many infections are actually mild and may go unnoticed. About 60 percent of people experience either no symptoms or only a mild upper respiratory illness. Others develop symptoms that feel more like the flu. The remaining patients are often the ones who seek medical care and may present with pneumonia, pleural effusions, or skin rashes.
In children, Valley Fever pneumonia can sometimes present with back pain that roughly corresponds to the part of the lung involved. Because of this, it may initially be treated as community acquired pneumonia. In areas such as Kern County, many clinicians are familiar with this pattern and may order Valley Fever testing at the same time they evaluate chest X ray findings.
The typical incubation period is about one and a half to two weeks, although symptoms can appear in less than a week or take nearly a month to develop. Since children and teens often spend time outdoors, it can be difficult to know exactly when the exposure occurred.
The most common symptoms parents notice in children and teens include:
Valley Fever often looks like a cold, the flu, or pneumonia, which is one reason it can be missed early on.
Rashes can provide an important clue. The rash most commonly associated with Valley Fever is erythema nodosum, which appears as tender red bumps, often on the lower legs. However, other rashes can also occur early in the infection. These may appear flat, raised, blotchy, or hive-like. Erythema nodosum may not appear until one or two weeks after symptoms begin.
A rare rash called sweet syndrome may also occur and sometimes requires a skin biopsy for diagnosis. Skin lesions containing the fungus itself are uncommon and are seen more often in adults.
Chest X ray findings can vary widely. The most common pattern is inflammation in the lungs, sometimes accompanied by enlarged lymph nodes in the chest.
Other findings may include lobar consolidation, patchy infiltrates, or pleural effusions, which are usually sterile.
Over time, some patients may develop nodules, thin walled cavities, bronchiectasis, or calcifications.
About five percent of patients diagnosed with Valley Fever pneumonia develop nodules or small cavities under six centimeters in size, though these often resolve on their own.
Fatigue is one of the longest lasting symptoms of Valley Fever. Children and teens may vary greatly in how long it takes them to feel fully recovered.
Certain factors may increase a clinician’s suspicion for Valley Fever when evaluating a child or teen with fever, especially if a rash is present. These factors include immune deficiency, steroid use, diabetes, treatment with TNF inhibitors, smoking exposure, Filipino or African ancestry, or a family history of Valley Fever. Of course, the most important risk factor is living in, or even briefly traveling through, an area where the fungus is common.
Although Valley Fever most often affects the lungs, it can spread to other parts of the body. The infection may involve bones, particularly the spine, the meninges surrounding the brain, or the skin. Even in these cases, classic signs such as neck stiffness may not always be present. This backyard fungus can sometimes travel almost anywhere in the body.
For healthcare providers in the Central Valley, maintaining awareness of Valley Fever is essential. The disease can take many forms, and recognizing its signs early helps ensure patients receive appropriate care.
Just as it is important for healthcare providers to recognize Valley Fever, it is equally important for our community to be aware of the signs and symptoms. In regions like ours, where the fungus is part of the environment, understanding when something may be more than a common cold or flu can make a meaningful difference. Early awareness can help individuals seek care sooner, ask the right questions, and ultimately support better health outcomes.
Dr. Katherine Schlaerth is a physician and educator with board certifications in family medicine, pediatrics, geriatric medicine, and pediatric infectious diseases. She combines her clinical work with a strong commitment to medical education and mentorship. At Clinica Sierra Vista, she is especially passionate about teaching and guiding residents as they develop the skills needed to serve their communities. Dr. Schlaerth also completed a fellowship in Guatemala, bringing a global perspective to her work in patient care and training the next generation of physicians.
An accomplished author, her latest book, The Ways Our Bodies Age, delves into the science of aging. To learn more about her journey and her new book, read her full bio at the link below.
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