Valley Fever

Signs and symptoms of valley fever vary depending on its type.

Valley fever or coccidioidomycosis is an infection caused by any of the two types of a soil-bound fungus called coccidioides.

Symptoms include:

• fever
• chest pain
• coughing

The spores of fungi spread into air when the soil is disrupted by activities, such as:

• farming
• construction
• wind

You can get valley fever by if you inhale the contaminated air. Mild cases usually require no medications whereas severe valley fever may be treated with antifungal medications.

Signs and symptoms of valley fever vary depending on its type.

Coccidioides causes acute infection which can later develop into serious, chronic and disseminated coccidioidomycosis.

1. Acute coccidioidomycosis (valley fever): Acute coccidioidomycosis is usually mild and causes no or few symptoms. Signs and symptoms appear one to three weeks after being exposed to the fungus.

Signs and symptoms are often similar to that of flu and include: 

• Fever
• Cough
• Chest pain
• Chills
• Night sweats
• Headache
• Fatigue
• Pain in joint
• Red, spotty rash: The rashes may be painful and can later turn brown. The rashes are seen mostly in lower extremities but sometimes it can appear in your trunk and arms. Few people may have rash with blisters that resembles pimple.
• You may not experience any symptoms even if you have valley fever. Infection may be detected while having skin, blood test or routine chest X-ray where your doctor finds nodules in lungs. Nodules are similar to cancer on X-rays but are non-problematic. If you experience severe symptoms, it may take months to get rid of the infection, and fatigue and joint aches can persist for even longer. Your general health status and the quantity of inhaled fungal spores determine the severity of symptoms.

2. Chronic coccidioidomycosis: Unresolved acute coccidioidomycosis infection may develop into a chronic form of pneumonia, especially if you have compromised immune system.

Signs and symptoms are:

• Mild fever
• Loss of weight
• Cough
• Chest pain
• Sputum mixed with blood
• Nodules in the lungs

3. Disseminated coccidioidomycosis: Disseminated coccidioidomycosis develops as the infection spreads to other parts of the body such as skin, bones, liver, brain, heart, and the covering of your brain and spinal cord (meninges).

The signs and symptoms vary depending upon which part of your body is affected and may include:

• Skin lesions more serious than normal rashes
• Painful lesions in the skull, spine or other bones
• Pain and swelling in the knee or ankle joint
• Meningitis, inflammation of protective covering of brain and spinal cord

When to see a doctor?

Make an appointment with your doctor if you experience signs and symptoms of valley fever and if you:

• Are older than 60 years
• Have impaired immune system
• Are pregnant
• Are black or Filipino
• Live in areas where this disease is endemic or have recently traveled to such area
• Your symptoms persist

Valley fever is caused by Coccidioides immitis or Coccidioides posadasii which are found in the dry desert soils of:

• southern Arizona,
• Nevada,
• northern Mexico,
• California's San Joaquin Valley.

They also dwell in places with mild winters and dry summers, such as New Mexico, Texas, and parts of Central and South America. During its growth in soil, coccidioides develops long filaments which can dislodge into small spores when the soil is disrupted.

Those small spores can be carried hundreds of miles away by the wind. Once it enters your lungs, it continues its life cycle.

Making a diagnosis of valley fever is done by performing several tests.

You will probably visit your doctor after you experience signs and symptoms that worry you. Here are some tips on what you can do.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful. List out all the symptoms. Write down your key medical information. Mention about your visit to the affected areas, if any. Write down the names of all your medications, vitamins or supplements.

Ask a friend or a family member to accompany you during the visit. Make a list of the questions to ask your doctor.

Some typical questions can be: 

• What could be the most probable cause of my symptoms?
• What are the tests needed?
• What treatment approach is beneficial to me?
• Can medications help me? If so, what are the side effects?
• When will I recover?
• Do I need a follow-up visit?
• What are my chances of developing long-term complications from this condition?

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor.

Your doctor might ask you typical questions like:

• Can you describe about your symptoms?
• When did they start appearing?
• Have the symptoms changed with time?
• Do you have a recent travel history? Where and when?
• Are you exposed to dust during your work or other activities?
• Are you pregnant?

Diagnosis is often difficult due to absence of disease-specific symptoms. A chest X-ray is useless when it comes to diagnosing valley fever. Diagnosis is confirmed if the fungus is detected in tissue, blood or other body secretion.

Following tests may provide definitive diagnosis:

• Sputum Smear or Culture: Your sputum (mixture of saliva and mucus that's discharged while coughing) is analyzed to detect if any coccidioides organisms are present.
• Blood tests: Blood tests are performed to see if your body contains antibodies against coccidioides organism.

Most cases of acute valley fever resolve on their own without any treatment. Healthy individuals with severe symptoms are recommended bed rest and plenty of fluids.

Antifungal medications are prescribed only when the infection persists or you have increased risk of complications. If you have developed chronic or disseminated condition, you may need antifungal medications such as fluconazole or itraconazole.

Fluconazole and itraconazole may cause nausea, vomiting, abdominal pain and diarrhea. More severe cases are treated by injectable antifungal medication, such as amphotericin B or newer antifungals, voriconazole and posaconazole.

Even after a successful treatment, the infection can come back again. Reinfection occurs mostly in immune compromised individuals.

If you visit or live in places where valley fever is endemic, take preventive measures. Exercise extra caution during summer.

Some of the measures to prevent valley fever are:

• Wear a mask
• Stay inside home during dust storms
• Close the door and windows so that spores don’t get inside your home
• Wet the soil before digging

There are several risks and complications associated with valley fever.

Risks

Your risk is increased if you:

• Are pregnant
• Are older
• You work in dusty areas
• Have impaired immune system, such as in HIV/AIDS
• Are Filipino, Hispanic, of African or Native American descent

Complications

• Severe pneumonia
• Ruptured lung nodules: In some cases, the lung nodules can rupture, and lead to chest pain and breathing problems. Surgery may be recommended to treat the ruptured nodules.
• Disseminated disease: Disseminated coccidioidomycosis is the most serious complication of valley fever in which the fungus spreads to the other parts of the body. Disseminated fungus may cause skin ulcers, bone lesions and abscesses, severe joint aches, urinary tract problems, heart inflammation and meningitis (inflammation of covering of your brain and spinal cord).