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Coccidioides organisms produce valley fever, which is a fungal infection. It can induce symptoms such as a fever, cough, and fatigue.
Valley fever is caused by two coccidioides fungus. These fungi are common in soil in some areas. The spores of the fungi can be pushed into the air by anything that disturbs the soil, such as farming, building, and wind.
The fungi can then be breathed into the lungs. Valley fever, also known as acute coccidioidomycosis, can be caused by the fungi. Mild valley fever cases normally resolve on their own. In more severe situations, doctors will use antifungal drugs to treat the infection.
WHAT ARE THE SYMPTOMS OF VALLEY FEVER?
Valley fever is the first stage of infection with coccidioidomycosis. This acute infection can progress to a more serious disease, such as chronic and disseminated coccidioidomycosis.
Acute coccidioidomycosis (valley fever)
The acute type of coccidioidomycosis is frequently mild, with few or no symptoms. One to three weeks after exposure, signs and symptoms appear. They are comparable to flu symptoms. Symptoms can range from minor to severe, and they include:
- Fever
- Cough
- Breathing difficulty
- Headache
- Chills
- Sweating at night
- Tiredness
- Aches and pains in the joints and muscles
- Red, patchy rash, primarily on the lower legs but also on the chest, arms, and back.
If you do not become unwell or exhibit symptoms of valley fever, you may not realize you have been infected until much later. If you have a positive skin or blood test, or if small pockets of residual infection in the lungs (nodules) show up on a routine chest X-ray, you may be diagnosed. The nodules rarely cause issues, but they sometimes resemble malignancy on X-rays.
If you acquire symptoms, especially severe ones, the disease's progression is unpredictable. It can take months to heal completely. Fatigue and joint pain can last much longer. The severity of the condition is determined by various factors, including your overall health and the amount of fungal spores inhaled.
Chronic coccidioidomycosis
If the coccidioidomycosis infection does not clear up entirely, it might proceed to a chronic type of pneumonia. This consequence is more likely in persons who have compromised immune systems.
Among the signs and symptoms are:
- Low-grade fever
- Loss of weight
- Cough
- Chest ache
- Sputum stained with blood (matter discharged during coughing)
- Nodules in the lungs
Disseminated coccidioidomycosis
Disseminated coccidioidomycosis, the most dangerous type of the disease, is uncommon. It happens when an infection spreads from the lungs to other parts of the body. The skin, bones, liver, brain, heart, and the membranes that protect the brain and spinal cord are frequently among these parts (meninges).
The following signs and symptoms of disseminated disease may occur depending on the body parts affected:
- Nodules, ulcers, and skin lesions that are more severe than the rash that occurs occasionally with other forms of the condition
- Lesions that cause pain in the skull, spine, or other bones
- Joint pain and swelling, particularly in the knees and ankles
- Meningitis, which is a condition in which the membranes and fluid around the brain and spinal cord become infected.
WHAT ARE THE CAUSES OF VALLEY FEVER?
Valley fever is induced by breathing spores of specific fungi. Coccidioides immitis or Coccidioides posadasii, the fungus that cause valley fever, exist in the soil in Arizona, Nevada, Utah, New Mexico, California, Texas, and Washington. It is called after California's San Joaquin Valley. The fungus are also common in northern Mexico, Central and South America.
Coccidioides species, like many other fungi, have a complicated life cycle. When the earth is disturbed, they grow as a mold with long filaments that break off into airborne spores. The spores can then be inhaled.
The spores are so minute that they can be blown far by the wind. Once within the lungs, the spores multiply, perpetuating the illness cycle.
WHAT ARE THE RISK FACTORS FOR VALLEY FEVER?
Environmental exposure: Anyone who inhales the valley fever spores is at danger of illness. People who reside in locations where the fungi are widespread, particularly those who spend a lot of time outside, are at a higher risk.
People who labor in dusty environments, such as construction, road, and agricultural workers, ranchers, archaeologists, and military personnel on field exercises, are particularly vulnerable.
- Race: People of Filipino and African ancestry are more prone to having significant fungal infections for unknown reasons.
- Diabetes: Diabetes may increase the risk of serious lung infections.
- Age: Valley fever is more common in older people. This could be because their immune systems are weaker or they have other medical disorders that have an impact on their general health.
- Pregnancy: During the third trimester, pregnant women are more vulnerable to dangerous infections. Right after their babies are born, new mothers are vulnerable.
- Weakened immune system: Anyone with a compromised immune system is more likely to have major problems. This includes persons living with AIDS or those receiving steroid, chemotherapy, and anti-rejection medications following transplant surgery. People with autoimmune disorders, such as rheumatoid arthritis or Crohn's disease, who are using anti-tumor necrosis factor (TNF) medicines, are also at a higher risk of infection.
WHAT ARE THE COMPLICATIONS OF VALLEY FEVER?
Some persons, particularly pregnant women, those with compromised immune systems, such as those living with HIV/AIDS, and those of Filipino or African ancestry, are at risk of acquiring a more severe type of coccidioidomycosis.
Coccidioidomycosis complications may include:
Pneumonia that is severe: Most people recover without complications from coccidioidomycosis-related pneumonia. Others, primarily persons of Filipino and African descent, as well as those with compromised immune systems, may become very ill.
Ruptured lung nodules: A few persons acquire thin-walled nodules (cavities) in their lungs. Many of them may gradually go away without creating any difficulties, but some will rupture, causing chest pain and difficulty breathing. A ruptured lung nodule may necessitate the insertion of a tube into the space around the lungs to remove the air, as well as surgery to repair the damage.
Disseminated disease: This is the most severe complication of coccidioidomycosis, however it is rare. If the fungus spreads throughout the body, it can cause skin ulcers, abscesses, bone lesions, severe joint pain, heart inflammation, urinary tract difficulties, and meningitis, a potentially fatal infection of the membranes and fluid that cover the brain and spinal cord.
HOW IS VALLEY FEVER DIAGNOSED?
Your doctor may examine your medical history as well as your signs and symptoms to determine the cause of valley fever. Valley fever is difficult to diagnose based on symptoms because they are frequently nonspecific and similar to those seen in other infections. Even a chest X-ray cannot distinguish between valley fever and other lung disorders.
Doctors may conduct one or more of the following tests to diagnose valley fever:
- Culture or sputum smear: These tests look for the presence of coccidioides organisms in a sample of the waste expelled during coughing (sputum).
- Blood tests: Your doctor can screen your blood for antibodies against the fungus that causes valley fever.
If doctors suspect you have valley fever-related pneumonia, they may prescribe imaging tests such as a CT scan, MRI, or chest X-ray.
If necessary, doctors may take a tissue sample from the lungs for testing.
In certain circumstances, doctors may perform a skin test to determine if you've previously had valley fever and developed immunity.
WHAT ARE THE TREATMENTS FOR VALLEY FEVER?
Valley fever is often treated with supportive care and, on occasion, medicines.
Rest
The vast majority of persons with acute valley fever do not require treatment. Even when symptoms are severe, bed rest and hydration consumption are frequently the best treatments for otherwise healthy adults. Despite this, doctors closely monitor patients suffering from valley fever.
Antifungal medications
If your symptoms do not improve or worsen, or if you are at elevated risk of problems, your doctor may prescribe fluconazole, an antifungal medicine. People with persistent or disseminated disease may also benefit from antifungal medicines.
Fluconazole (Diflucan) or itraconazole (Sporanox, Onmel, Tolsura) are antifungal medicines that are commonly used to treat all but the most severe cases of coccidioidomycosis disease.
All antifungals have the potential for significant adverse effects. However, after the medicine is stopped, these adverse effects normally go away. Fluconazole with itraconazole may cause nausea, vomiting, stomach pain, and diarrhea.
In more severe cases, an intravenous antifungal medicine such as amphotericin B may be used initially (Abelcet, Ambisome, others).
To treat more serious infections, three newer drugs — voriconazole (Vfend), posaconazole (Noxafil), and isavuconazonium sulfate (Cresemba) — may also be used.
Antifungals suppress the fungus but do not always kill it, thus relapses can occur. A single case with valley fever leads in permanent immunity for many people. However, if your immune system is sufficiently weakened, the disease can be reactivated or you can be reinfected.
HOW CAN VALLEY FEVER BE PREVENTED?
There is no vaccination available to protect against valley fever.
Take common-sense precautions if you reside or visit locations where valley fever is frequent, especially during the summer months when the risk of infection is highest.
Consider the following suggestions:
- Put on a mask.
- Avoid regions that are extremely dusty, such as construction sites.
- Close all doors and windows tightly.
- Soap and water should be used to clean skin injuries.
- During dust storms, stay inside.
- If you're at a higher risk of infection, wet the soil before digging in it.