Drexel University College of Medicine

Diseases and Conditions

Coccidioidomycosis

Definition

Coccidioidomycosis is infection with the spores of the fungus Coccidioides immitis.

Alternative Names

San Joaquin Valley fever; Valley fever

Causes, incidence, and risk factors

Coccidioidomycosis is a fungal infection most commonly seen in the desert regions of the southwestern United States, and in Central and South America. You get it by breathing in fungal particles from soil. The infection starts in the lungs.

There are three forms of coccidioidomycosis: acute, chronic, or disseminated.

• Acute pulmonary coccidioidomycosis. It almost always mild, with few or no symptoms, and goes away without treatment. The incubation period -- the time between breathing in the spores and becoming sick -- is 7 to 21 days.
• Chronic pulmonary coccidioidomycosis can develop 20 or more years after initial infection. Infections (lung abscesses) can form and rupture, releasing pus (empyema) between the lungs and ribs (pleural space).
• Disseminated coccidioidomycosis is a widespread form of the disease. Infection spreads to other parts of the body, including the skin, brain, bones, and heart. Meningitis occurs in up to half of all people with disseminated coccidioidomycosis.

Traveling to an area where the fungus is commonly seen raises your risk for this infection. You are more likely to develop a serious infection if:

• You are of Native American, African or Philippine descent
• You have a weakened immune systems due to AIDS, diabetes, or medications that suppress the immune system.

Symptoms

Most people with this infection never have symptoms. Others may have cold- or flu-like symptoms or symptoms of pneumonia. If symptoms occur, they typically start 5 to 21 days after being exposed to the fungus. They include:

• Change in mental status
• Chest pain (can vary from mild to severe)
• Cough, possibly producing blood
• Fever
• Headache
• Joint stiffness and pain
• Loss of appetite
• Muscle aches
• Neck stiffness
• Night sweats
• Painful, red lumps on lower legs (erythema nodosum)
• Sensitivity to light
• Weight loss
• Wheezing

Additional symptoms associated with this disease:

• Ankle or feet swelling
• Enlarged or draning lymph nodes
• Joint swelling

For information on skin rashes associated with this infection, see: Skin lesion of coccidioidomycosis.

Signs and tests

• Blood test to check for signs of coccidioides infection
• Bronchoscopy with lavage
• Complete blood count (CBC) with differential
• Chest x-ray
• Lymph node or lung biopsy
• Sputum culture
• Sputum smear (KOH test)

Treatment

The acute disease almost always goes away without treatment. Bedrest and treatment of flu-like symptoms until fever disappears may be recommended.

Disseminated or severe disease should be treated with amphotericin B, ketoconazole, fluconazole, or itraconazole.

Expectations (prognosis)

How well the person does depends on the form of the disease they have and their overall health. The outcome in acute disease is likely to be good. With treatment, the outcome is usually good for chronic or severe disease (although relapses may occur). People with disseminated disease have a high death rate.

Complications

Disseminated coccidioidomycosis is a serious complication that is more likely if you have a weakened immune system due to:

• Anti-tumor necrosis factor (TNF) therapy
• Cancer
• Chemotherapy
• Diabetes
• Glucocorticoid medications (prednisone)
• Heart-lung (cardiopulmonary) conditions
• HIV
• Organ transplants (and associated medicates)
• Pregnancy (especially the first trimester)

Other complications of coccidioidomycosis include:

• Pleural effusion
• Return of the infection (relapse)

Medications used to treat this infection may also cause side effects, including fever, chills, and nausea.

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of coccidioidomycosis or if your condition does not improve with treatment.

Prevention

Maintaining general good health will help keep the disease in the benign pulmonary form. Prevention of AIDS or other causes of damage to the immune system will usually prevent the more severe forms of the disease.

References

Galgiani JN. Coccidioidomycosis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 354.

Physician Reference

International Classification of Diseases, 9^th Revision (ICD9)

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