Coccidioidomycosis: Symptoms, Diagnosis, Treatment

Overview

Coccidioidomycosis, commonly referred to as “valley fever,” is an infection caused by a fungus (Coccidioides) found in the soil in the southwestern United States, northern Mexico, and parts of Central and South America. It is a common cause of pneumonia in Arizona and California but is also present in parts of Utah, Nevada, Texas, and New Mexico.

Individuals who either live in or travel through these areas are at risk of infection. It usually infects the lungs and can cause flu-like symptoms or pneumonia. In most people the infection will go away on its own but all persons with symptoms should see a healthcare provider. Although it can be difficult to prevent valley fever, the best way to reduce your risk is to avoid breathing in dirt or dust in areas where valley fever is common.

Causes

A fungus, Coccidioides, causes coccidioidomycosis. This fungus is present in the arid desert soils of southern Arizona, Nevada, northern Mexico and California’s San Joaquin Valley. They’re also endemic to New Mexico, Texas, and parts of Central and South America — areas with mild winters and arid summers.

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. The spores are extremely small and can be carried hundreds of miles by the wind. Once inside the lungs, the spores reproduce, perpetuating the cycle of the disease.

Risk Factors

Some risk factors may include

  • Environmental exposure. Anyone who inhales the spores that cause coccidioidomycosis is at risk of infection. People who have jobs that expose them to dust are most at risk — construction, road and agricultural workers, ranchers, archeologists, and military personnel on field exercises.
  • Race. For reasons that aren’t well-understood, people of Filipino and African heritage are more susceptible to developing serious infection with coccidioidomycosis.
  • Pregnancy. Pregnant women are vulnerable to more serious coccidioidomycosis during the third trimester, and new mothers are vulnerable right after their babies are born.
  • Weakened immune system. Anyone with a weakened immune system is at increased risk of serious complications. This includes people living with AIDS or those being treated with steroids, chemotherapy and anti-rejection drugs after transplant surgery. People with certain autoimmune diseases, such as rheumatoid arthritis or Crohn’s disease, who are being treated with anti-tumor necrosis factor (TNF) drugs also have an increased risk of infection.
  • Age. Older adults are more likely to develop coccidioidomycosis. This may be because their immune systems are less robust or because they have other medical conditions that affect their overall health.

Symptoms

Many people who are exposed to the fungus Coccidioides never have symptoms. Other people may have flu-like symptoms that go usually away on their own after weeks to months. If your symptoms last for more than a week, contact your healthcare provider.

Symptoms of Valley fever include:

  • Fatigue (tiredness)
  • Cough
  • Fever
  • Shortness of breath
  • Headache
  • Night sweats
  • Muscle aches or joint pain
  • Rash on upper body or legs

The symptoms of Valley fever usually last for a few weeks to a few months. However, some patients have symptoms that last longer than this, especially if the infection becomes severe. This complication is most common in people with weakened immune systems.

Signs and symptoms of long-lasting Valley fever include:

  • Low-grade fever
  • Weight loss
  • Cough
  • Chest pain
  • Blood-tinged sputum (matter discharged during coughing)
  • Nodules in the lungs

Diagnosis

Coccidioidomycosis is most commonly diagnosed by a blood test. This test examines the response of the immune system to the fungus. An abnormal blood test in the appropriate clinical setting is adequate to make the diagnosis. Early in the course of infection, with recent onset of symptoms, the initial test may be negative, and repeat testing is advised. A definitive diagnosis is made by demonstrating the presence of the fungus, either by examination of infected tissue with a microscope or by growth in a lab. Testing for coccidioidomycosis may include:

  • Blood tests
  • Sputum samples, produced by coughing or bronchoscopy
  • Chest X-ray and/or CT scan
  • Biopsy of the affected site, typically the lung

Treatment

Rest

Most individuals with coccidioidomycosis do not require specific treatment. Even when symptoms are severe, the best therapy for otherwise healthy adults is often bed rest and fluids — the same approach used for colds and the flu. Still, doctors carefully monitor people with coccidioidomycosis.

Antifungal medications

If symptoms don’t improve or become worse or if you are 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.

In general, the antifungal drugs fluconazole (Diflucan) or itraconazole (Sporanox, Onmel) are used for all but the most serious forms of coccidioidomycosis disease.

All antifungals can have serious side effects. However, these side effects usually go away once the medication is stopped. Possible side effects of fluconazole and itraconazole are nausea, vomiting, abdominal pain and diarrhea.

More serious infection may be treated initially with an intravenous antifungal medication such as amphotericin B (Abelcet, Ambisome, others).

Two newer medications — voriconazole (Vfend) and posaconazole (Noxafil) — may also be used to treat more serious infections.

In patients with depressed immune systems or with disease outside the lung (disseminated), lifelong therapy may be required. In very few individuals, surgery may be required to remove portions of infected or damaged lung.

If you have any problem, please contact your health care provider in time.


Keywords: coccidioidomycosis; valley fever; coccidioides.

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* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.