Of 1,141 adult patients in Arizona hospitalized for community-acquired pneumonia, 76% were tested for Coccidioides infection, and 10% had positive results, Mayo Clinic Phoenix researchers report in Open Forum Infectious Diseases.
The researchers reviewed the medical records of CAP patients admitted to Mayo Clinic Hospital from November 2024 through October 2025 to determine the rate and patterns of coccidioidomycosis testing and positivity over time.
The fungal infection coccidioidomycosis (valley fever) is endemic to the southwestern United States, Washington state, and Central and South America. It accounts for 15% to 30% of CAP in endemic areas such as Arizona.
Common symptoms include fever, cough, shortness of breath, rash, chest pain, weight loss, and fatigue. But these symptoms are often absent or similar to those of other CAP-causing pathogens, often slowing diagnosis and treatment. Even otherwise healthy patients can develop severe disease.
“Although the Centers for Disease Control and Prevention (CDC) report 10,000 to 20,000 coccidioidomycosis cases annually, the true incidence is likely much higher because of (1) state-based differences in reporting practices and (2) probable missed diagnoses,” the authors wrote.
Call for universal testing
Coccidioides was the most commonly identified pathogen in CAP patients. Positive testing rates were highest in November and December 2024 and October 2025 (range, 13% to 21%) and in March 2025 (15%), consistent with the disease’s seasonal variation.
A shorter LOS could be an institutional incentive to test all patients with CAP for coccidioidal infection.
Most patients were tested if they had concerning chest radiographs, fatigue, fever, and/or shortness of breath. Those with a history of coccidioidomycosis and those with rash, night sweats, headache, or high white blood-cell count were most likely to test positive.
The authors called for testing all CAP patients for Coccidioides. When Coccidioides was identified early, hospital length of stay (LOS) was shorter than that with noncoccidioidal CAP.
“A shorter LOS could be an institutional incentive to test all patients with CAP for coccidioidal infection,” they wrote. “Missed diagnoses can potentially prolong symptoms and hospitalization, as well as unnecessarily exposing patients to antibacterial therapy or invasive diagnostic testing that may contribute to patient anxiety.”