Valley Fever (Coccidioidomycosis) Mortality: Reported Deaths and Underestimation

Valley fever, caused by Coccidioides spp. fungi endemic to southwestern US soils, is frequently underdiagnosed.

Reported Mortality (CDC, 1995–2019)

• 62 deaths with coccidioidomycosis listed on death certificate.
• Annual average: ~2–3 deaths/year.

Why True Mortality Is Higher

• Non‑specific symptoms (pneumonia, flu‑like) → missed diagnosis.
• Many cases asymptomatic or mild; only severe disseminated cases come to attention.
• Death certificates often list immediate cause (sepsis, respiratory failure) without underlying coccidioidomycosis.
• Surveillance limited to 26 reporting states; not nationally notifiable until 1995.

High‑Risk Groups for Severe Disease

• Immunocompromised (HIV, transplant, TNF‑α inhibitors).
• Pregnancy (3rd trimester).
• Filipino, African American, Native American ancestry.
• Diabetes.
• Age >60.

Clinical Takeaway

Consider Valley fever in compatible illness with exposure history (travel/residence in AZ, CA Central Valley, NM, TX, UT, NV). Early antifungal treatment (fluconazole, itraconazole) reduces dissemination risk.