Learn about symptoms and treatment for valley fever — an infection caused by fungi found in the soil of America's desert regions.
Valley fever is a fungal infection caused by coccidioides (kok-sid-e-OY-deze) organisms. It can cause signs and symptoms such as a fever, cough and tiredness.
Two coccidioides fungi species cause valley fever. These fungi are commonly found in soil in specific regions. The fungi's spores can be stirred into the air by anything that disrupts the soil, such as farming, construction and wind.
People can then breathe the fungi into their lungs. The fungi can cause valley fever, also known as acute coccidioidomycosis (kok-sid-e-oy-doh-my-KOH-sis). Mild cases of valley fever usually resolve on their own. In more-severe cases, doctors treat the infection with antifungal medications.
Valley fever is the initial form of coccidioidomycosis infection. This initial, acute illness can develop into a more serious disease, including chronic and disseminated coccidioidomycosis.
The initial, or acute, form of coccidioidomycosis is often mild, with few or no symptoms. Signs and symptoms occur one to three weeks after exposure. They tend to be similar to flu symptoms. Symptoms can range from minor to severe, including:
If you don't become ill or have symptoms from valley fever, you may only find out you've been infected later. You may find out when you have a positive skin or blood test or when small areas of residual infection in the lungs (nodules) show up on a routine chest X-ray. The nodules typically don't cause problems, but they can look like cancer on X-rays.
If you develop symptoms, especially severe ones, the course of the disease is highly variable. It can take months to fully recover. Fatigue and joint aches can last even longer. The disease's severity depends on several factors, including your overall health and the number of fungus spores you inhale.
If the initial coccidioidomycosis infection doesn't completely resolve, it may progress to a chronic form of pneumonia. This complication is most common in people with weakened immune systems.
Signs and symptoms include:
The most serious form of the disease, disseminated coccidioidomycosis, is uncommon. It occurs when the infection spreads (disseminates) beyond the lungs to other parts of the body. Most often these parts include the skin, bones, liver, brain, heart, and the membranes that protect the brain and spinal cord (meninges).
Signs and symptoms of disseminated disease depend on the body parts affected and may include:
Seek medical care if you are over 60, have a weakened immune system, are pregnant, or are of Filipino or African heritage, and you develop the signs and symptoms of valley fever, especially if you:
Be sure to tell your doctor if you've traveled to a place where valley fever is common and you have symptoms.
Valley fever is caused by a person inhaling spores of certain fungi. The fungi that cause valley fever — Coccidioides immitis or Coccidioides posadasii — live in the soil in parts of Arizona, Nevada, Utah, New Mexico, California, Texas and Washington. It's named after the San Joaquin Valley in California. The fungi can also often be found in northern Mexico and Central and South America.
Like many other fungi, coccidioides species have a complex life cycle. In the soil, they grow as a mold with long filaments that break off into airborne spores when the soil is disturbed. A person can then inhale the spores.
The spores are extremely small and can be carried far by the wind. Once inside the lungs, the spores reproduce, continuing the disease cycle.
Risk factors for valley fever include:
Environmental exposure. Anyone who inhales the spores that cause valley fever is at risk of infection. People who live in areas where the fungi are common—especially those who spend a lot of time outdoors — have a greater risk.
Also, people who have jobs that expose them to dust are most at risk — construction, road and agricultural workers, ranchers, archaeologists, and military personnel on field exercises.
Some people, especially pregnant women, people with weakened immune systems — such as those living with HIV/AIDS — and those of Filipino or African heritage are at risk of developing a more severe form of coccidioidomycosis.
Complications of coccidioidomycosis may include:
There is no vaccine to prevent valley fever.
If you live in or visit areas where valley fever is common, take common-sense precautions, especially during the summer months when the chance of infection is highest.
Consider these tips:
To diagnose valley fever, your doctor may evaluate your medical history and review your signs and symptoms. Valley fever is difficult to diagnose based on the signs and symptoms, because symptoms are usually vague and similar to those that occur in other illnesses. Even a chest X-ray can't help doctors see the difference between valley fever and other lung diseases.
To diagnose valley fever, doctors may order one or more of the following tests:
If doctors think you may have pneumonia associated with valley fever, they may also order imaging tests, such as a CT scan, MRI or chest X-ray.
If needed, doctors may remove a sample of tissue from the lungs for testing.
In some cases, doctors may do a skin test to find out if you've had valley fever in the past and have developed immunity.
Valley fever usually involves supportive care and sometimes medications.
Most people with acute valley fever don't require treatment. Even when symptoms are severe, the best therapy for otherwise healthy adults is often bed rest and fluid intake. Still, doctors carefully monitor people with valley fever.
If symptoms don't improve or become worse, or you're at increased risk of complications, your doctor may prescribe an antifungal medication, such as fluconazole. Antifungal medications are also used for people with chronic or disseminated disease.
The antifungal drugs fluconazole (Diflucan) or itraconazole (Sporanox, Onmel, Tolsura) are generally used for all but the most serious forms of coccidioidomycosis disease.
All antifungals can have serious side effects. But these side effects usually go away once the medication is stopped. Possible side effects of fluconazole and itraconazole are nausea, vomiting, stomach pain and diarrhea.
More serious infection may first be treated with an intravenous antifungal medication such as amphotericin B (Abelcet, Ambisome, others).
Three newer medications — voriconazole (Vfend), posaconazole (Noxafil) isavuconazonium sulfate (Cresemba) — may also be used to treat more-serious infections.
Antifungals control the fungus, but sometimes don't destroy it, and relapses may occur. For many people, a single bout of valley fever results in lifelong immunity. But the disease can be reactivated, or you can be reinfected if your immune system is significantly weakened.
Make an appointment with your doctor if you develop signs or symptoms of valley fever and are in or have recently returned from a region where this condition is common.
Here's some information to help you get ready and know what to expect from your doctor.
The list below suggests questions to raise with your doctor about valley fever. Don't hesitate to ask more questions during your appointment.
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:
December 22nd, 2020