Valley fever

Description

Valley fever is a fungal infection caused by coccidioides (kok-side-OY-deze) organisms. Can cause signs and symptoms such as fever, cough, and fatigue.

Two coccidioides species of fungi cause valley fever. These fungi are commonly found in soil in specific regions. The fungi, the spores can be mixed into the air by anything that disrupts the soil, such as farming, construction and wind.

People can breathe in the fungus in the lungs. Fungi can cause valley fever, also known as acute coccidioidomycosis (kok-side-oy-doh-my-KOH-sis). Mild cases of valley fever usually resolve on their own. In the most serious cases, doctors treat the infection with antifungal medications.

Symptoms

Valley fever is the initial form of coccidioidomycosis infection. This initial, acute phase of the disease may become more severe illness, including chronic and disseminated coccidioidomycosis.

Acute coccidioidomycosis (valley fever)

The initial or acute, the form of coccidioidomycosis is often mild, with few or no symptoms. Signs and symptoms of one to three weeks after exposure. They tend to be similar to the symptoms of the flu. The symptoms may vary from mild to severe, including:

  • Fever
  • Cough
  • Fatigue
  • Shortness of breath
  • Headache
  • Chills
  • Night sweats
  • Pain in the joints and muscle pain
  • Red, blotchy rash, mainly on the lower part of the legs, but sometimes on the chest, arms and back

If you are not sick or have symptoms of valley fever, you may just find that you have been infected later. You can find when you have a positive skin or blood, or when small areas of residual infection in the lungs (nodules) are displayed in a routine chest X-ray. The nodules do not usually cause problems, but it can look like cancer on x-rays.

If you develop symptoms, especially severe, the disease course is highly variable. It can take months to completely recover. The fatigue and pain in the joints can last even longer. The disease severity depends on several factors, including your overall health and the number of spores of fungi that you inhale.

Chronic coccidioidomycosis

If the initial coccidioidomycosis infection does not resolve completely, it can progress to a chronic form of pneumonia. This complication is more common in people with weakened immune systems.

Signs and symptoms include:

  • Low-grade fever
  • Weight loss
  • Cough
  • Pain in the chest
  • Blood-tinged sputum (matter discharged during coughing)
  • The nodules in the lungs

Disseminated coccidioidomycosis

The most severe form of the disease, coccidioidomycosis, is very rare. Occurs when the infection spreads (spread) beyond the lungs to other parts of the body. Most often these parts include the skin, the bones, the liver, the brain, the heart, and the membranes that protect the brain and spinal cord (meninges).

The signs and symptoms of disseminated disease depend on the body parts affected and may include:

  • Nodules, ulcers and skin lesions that are more serious than the rash that sometimes occurs with the initial infection
  • Painful lesions in the skull, spine or other bones
  • Painful inflammation of the joints, especially the knees or ankles
  • Meningitis (an infection of the membranes and fluid that surrounds the brain and spinal cord

When to see a doctor

Seek medical attention if you are over 60, have a weakened immune system, are pregnant, or are of Filipino or African heritage, and presents the signs and symptoms of valley fever, especially if you:

  • Live in or have recently traveled to an area where this disease is common
  • Have symptoms that are not improving

Be sure to tell your doctor if you have traveled to a place where valley fever is common and has symptoms.

Causes

Valley fever is caused by a person to the inhalation of spores of certain fungi. The fungi that cause valley fever — Coccidioides immitis or Coccidioides posadasii — live in the soil in some parts of Arizona, Nevada, Utah, New Mexico, California, Texas, and Washington. It is named after the San Joaquin Valley in California. Fungi can also often be found in the north of 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 the air spores when the soil is disturbed. A person may inhale the spores.

The spores are very small and can be carried away by the wind. Once inside the lungs, the spores to reproduce, continuing the cycle of the disease.

Risk factors

The risk factors for valley fever include:

  • The exposure of the environment.Anyone who breathes in the spores that cause valley fever is at risk of infection. The people who live in areas where the fungi are common — especially those who spend a lot of time outdoors — have a higher risk. In addition, people who have jobs that expose them to dust are at increased risk for the construction, road and agricultural workers, farmers, archaeologists and military personnel in the field exercises.
  • Of the race. For reasons that are not well understood, the people of the philippines and the African heritage are more susceptible to developing serious fungal infections.
  • Pregnancy. Pregnant women are more vulnerable to-severe infections if they contract the infection during the third quarter. New mothers are vulnerable to the right after the birth of their babies.
  • Weakened immune system. Any person with a weakened immune system that is at a greater risk of serious complications. This includes people living with acquired immunodeficiency syndrome (AIDS) or who are being treated with steroids, chemotherapy, and anti-rejection drugs after the 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.
  • Diabetes. People with diabetes may have an increased risk of serious lung infections.
  • Age. Older adults are more likely to develop valley fever. This may be due to their immune systems are less robust or because they have other medical conditions that affect your overall health.

The exposure of the environment. Anyone who breathes in the spores that cause valley fever is at risk of infection. The people who live in areas where the fungi are common — especially those who spend a lot of time outdoors — have a higher risk.

In addition, people who have jobs that expose them to dust are at increased risk for the construction, road and agricultural workers, farmers, archaeologists and military personnel in the field exercises.

Complications

Some people, especially pregnant women, people with weakened immune systems, such as those living with the human immunodeficiency virus (HIV)/ AIDS, and the Filipino or African heritage are at risk of developing a more severe form of coccidioidomycosis.

The complications of coccidioidomycosis may include:

  • Severe pneumonia. The majority of people recover from the coccidioidomycosis-related pneumonia without complications. Others, like the people of the philippines and the African heritage, and those with weakened immune systems, can become seriously ill.
  • The rupture of the pulmonary nodules. A small percentage of people have thin walls of the nodules (cavities) in their lungs. Many of these, finally, disappear without causing any problems, but some may break, causing chest pain and difficulty breathing. A rupture of the pulmonary nodule may require the placement of a tube into the space around the lungs to remove the air or surgery to repair the damage.
  • The spread of the disease. This is the most serious complication of coccidioidomycosis, but it is uncommon. If the fungus spreads (spread) throughout the body, it can cause problems such as skin ulcers, abscesses, bone lesions, severe joint pain, heart inflammation, urinary tract problems and meningitis, a potentially fatal infection of the membranes and fluid that covers the brain and spinal cord.

Prevention

There is no vaccine to prevent valley fever.

If you are visiting or live in areas where valley fever is common, take common-sense precautions, especially during the dry season after a season of rains, when the risk of infection is greater.

Keep these tips in mind:

  • Wear a mask.
  • Avoid dusty areas, such as construction sites.
  • Stay inside during dust storms.
  • Moisten the soil before digging in it, or avoiding the floor, if you are at a higher risk of infection.
  • Keep doors and windows tightly closed.
  • Clean skin lesions with soap and water.

Valley fever

Diagnosis

To diagnose valley fever, your doctor may evaluate your medical history and review of your signs and symptoms. Valley fever is difficult to diagnose based on signs and symptoms, because the symptoms are usually vague and similar to those that occur in other diseases. Even a chest x-ray can't help the doctors see the difference between the valley fever and other forms of lung infections such as pneumonia.

To diagnose valley fever, doctors may order one or more of the following tests:

  • Sputum smear or culture. These tests check a sample of matter that is discharged, while coughing (sputum) to detect the presence of coccidioides organisms.
  • Blood tests. Through a blood test, your doctor can check for antibodies against the fungus that causes valley fever.

If the doctors think you may have pneumonia due to valley fever, which may also order imaging tests, such as computed tomography (CT), Magnetic resonance imaging (MRI) or X-ray of the chest.

If necessary, doctors can remove a sample of tissue from the lungs to the test.

In some cases, doctors can do a skin test to find out if you have had valley fever in the past and have developed immunity.

Treatment

Valley fever generally involves supportive care and, sometimes, medication.

Rest

The majority of people with acute infection of the valley fever do not require treatment. Still, doctors carefully monitor people with valley fever.

Antifungal medications

If the symptoms do not improve, they last a long time, or they get worse, or you are at a higher risk of complications, your doctor may prescribe an antifungal medication such as fluconazole. Antifungal medications are also used for people with chronic disease or disseminated disease.

The antifungal drugs fluconazole (Diflucan), itraconazole (Sporanox, Tolsura) are generally used for all but the most serious forms of coccidioidomycosis of the 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. Side effects of fluconazole may be the loss of hair, dry skin, dry mouth and chapped lips.

The more serious infection may first be treated with an intravenous antifungal medication, such as amphotericin B (Abelcet, Ambisome, other).

Three new drugs — voriconazole (Vfend), posaconazole (Noxafil), isavuconazonium sulfate (Cresemba) — can also be used to treat more serious infections.

For many people, a single episode of fever of the valley of the results in immunity for life. But the disease may become active, or you can re-infect if your immune system is weakened considerably.

Preparing for your appointment

Make an appointment with your doctor if you have signs or symptoms of valley fever and are or have recently returned from a region in which this condition is common.

Here's some information to help you to be prepared and know what to expect from your doctor.

Collection of information by advance

  • Pre-appointment restrictions. At the time of making your appointment, ask if there are any restrictions you need to follow in the time prior to your visit.
  • Symptom of the story. Write down any symptoms you've been experiencing, and for how long.
  • Recent exposure to possible sources of infection. Your doctor will be especially interested in knowing if you have recently traveled, and where.
  • History of medicine. Make a list of your key medical information, including other conditions for which you are being treated and any medications, vitamins or supplements you are currently taking.
  • Questions to ask your doctor. Write down your questions in advance so that you can make the most of your time with your doctor.

The following list suggests questions to ask your doctor about the valley fever. Do not hesitate to ask more questions during your appointment.

  • What is the most likely cause of my symptoms?
  • What kinds of tests do I need?
  • What treatment approach do you recommend, if any?
  • I have these other health conditions. How can I best manage these conditions?
  • If you are recommending medications, there are possible side effects?
  • How much time do you expect a full recovery to take, and will I need a follow-up appointment?
  • Am I at risk of long-term complications of this condition?

What to expect from your doctor

Your doctor may ask you a series of questions. Be ready to answer them may reserve time to go over any points you want to talk in-depth. Your doctor may ask:

  • What are your symptoms?
  • When did you first begin experiencing symptoms?
  • The symptoms worsened over time?
  • Have you traveled recently? Where and when?
  • Does your work or recreational activities that involve spending time in the open air environments?
  • Are you pregnant?
  • Have you been diagnosed with any other medical condition?
  • Are you currently taking any medications, including over-the-counter and prescription medications, as well as vitamins and supplements?
Symptoms and treatment of Valley fever