Coccidioidomycosis (Valley Fever)

Coccidioidomycosis is an infection caused by the fungus Coccidioides immitis. It is found in southern Arizona, central California, southern New Mexico, west Texas and parts of Central and Southern America. These are areas with a dry climate, alkaline soil, hot summers, few freezing temperatures in the winter and low levels of rain.

Infection occurs when a person breathes in the spores of the fungus. Once the spores are inside the lungs, they form ball-like cells called spherules. The infection they cause may stay just in the lungs or it may spread to other parts of the body and organs such as the brain and heart. About one out of four people who have coccidioidomycosis that has spread get meningitis, a serious disease of the linings of the brain and spinal cord that can be fatal. 

Symptoms

This disease has three forms:

• Acute pulmonary coccidioidomycosis is usually mild, has few or no signs and goes away without treatment. It occurs in one to three weeks after a person has been exposed to the fungus.
• Chronic pulmonary coccidioidomycosis. This form of infection can spread pus between the lungs and the ribs. It can appear 20 or more years after exposure to the fungus.
• Disseminated (widespread) coccidioidomycosis is a form of the infection that has spread to the bones, lungs, liver, linings of the brain and spinal cord (meninges), the brain, skin, heart and pericardium (the sac around the heart). Between a third to half of the people with this form of the disease develop meningitis. In people with HIV infection, the infection can spread quickly.

Symptoms of coccidioodomycosis can include:

• Cough
• Chest pain
• Shortness of breath
• Fever
• Fatigue
• Pneumonia
• Skins spots including a rash made of red welts that sometimes have purple or blistered areas in the center (erythema multiforme); tender, red bumps on the skins (erythema nodosum) or ulcers. These spots have the fungus in them. They are a sign of widespread fungal infection. They are often found on the face.
• Pain that moves from joint to joint
• Chills
• Night sweats
• Blood-tinged sputum

If a person loses a lot of weight and has night sweats for three weeks or more along with the above symptoms, a doctor should be called. If coccidioidomycosis infects the brain or its linings, meningitis may be developing. Signs of this include confusion, problems concentrating, signs of a change in mental status or sensitivity to light. Anyone with these symptoms should be taken to a doctor or an emergency room immediately.

Causes

The infection happens when a person breathes in the spores of the fungus. Outbreaks of coccidioidomycosis rise after dust storms, earthquakes or heavy digging. 

Risk Factors

The infection happens when a person breathes in the spores of the fungus. Outbreaks of coccidioidomycosis rise after dust storms, earthquakes or heavy digging. 

Diagnosis

After doing an examination and taking a person’s medical history, a doctor may do a sputum test, a blood test, a chest X-ray or a special skin test to check for signs of the fungus. In some cases, the doctor may need to get a sample from an affected organ or a skin eruption to look at under a microscope.

If there are signs that a person may have meningitis, a neurological examination may be done as well.

Treatment

Coccidioidomycosis is a serious disease that can be fatal for people with HIV infection. Treatment should be started as early as possible.
 
Drugs that fight fungi are used to treat coccidioidomycosis. Amphotericin B is often used first. It is a powerful drug, but it can cause kidney damage. Sometimes drugs like ketoconazole, fluconazole or itraconazole are used. Fluconzole and itraconazole are less likely to cause other problems. Treatment is usually continued for at least a year. Even so, the infection often comes back.