Coccidioidomycosis

Coccidioidomycosis (also called San Joaquin Valley Fever) is a disease caused by breathing in airborne fungus spores.

CAUSES

The spores that cause this disease come from the fungus Coccidioides immitis. This fungus only contaminates the soils of certain dry regions in the Western Hemisphere. In the U.S., this includes southwestern Texas and the southern regions of California, Arizona, and New Mexico. This fungus is also relatively common in dry areas in Mexico, Central America, and the northern countries of South America.

The fungus is usually inhaled following a disturbance of contaminated soil by:

  • Activities that involve digging in the soil, such as building or remodeling projects.

  • Dust storms and windstorms.

  • Earthquakes.

SYMPTOMS

The majority of infections result in no symptoms or symptoms that are so mild they do not require medical attention. In the remaining cases, symptoms range from mild to severe. When symptoms occur, they usually begin gradually, about 1 to 3 weeks after the spore is breathed into the lungs. The most common symptoms include:

  • Cough.

  • Fever.

  • Shortness of breath.

  • Sometimes, chest discomfort.

A small percentage of people are left with a nodule or spot on their lungs from the infection. A chest X-ray taken many months or years later can detect this.

Long-lasting (chronic) pulmonary coccidioidomycosis is much less common. People with diabetes or preexisting chronic lung disease appear to be more likely to have this complication. It can develop many years after the fungal infection occurred. In addition to having the above problems for many months, symptoms can include:

  • Night sweats.

  • Weight loss.

Groups at high risk of developing very serious infections and problems include:

  • African Americans.

  • Asians.

  • Pregnant women during the third trimester.

  • People with poor immune function due to other diseases (HIV/AIDS) or their treatment (organ transplants, steroids, immune-suppressing drugs).

Infection among these patients may result in severe pneumonia infecting both lungs, or the infection may spread to other areas of the body. Infection of the lining around the brain (meningitis) occurs in 30% to 50% of cases where the disease has spread. This may lead to permanent neurological damage. Others may develop infection in the skin, bones, or joints.

DIAGNOSIS

If there are no symptoms, infections are diagnosed by a positive coccidiodin skin test. Among people living in areas where the fungus is common, 10% to 50% test positive for the infection. For people who have symptoms, necessary tests may include:

  • X-rays.

  • Culture tests.

  • Tests to detect antibodies in the blood, fluid surrounding the brain (cerebrospinal fluid), or other fluids.

TREATMENT

In general, people with mild cases do not benefit from antifungal medicine. Bed rest and treatment of symptoms such as cough, fever, or chest discomfort may be advised. For chronic pulmonary infections and forms of the disease that have spread to other areas of the body, antifungal medicine is prescribed. The length of drug treatment depends on the patient's immune status and the site of infection.

PROGNOSIS

The outlook for mild cases is excellent. However, chronic infection of the lungs and infections in other areas of the body can be serious or even life-threatening. This is especially true in people with weakened immune systems or meningitis.

PREVENTION

Fungal spores cannot be killed by disinfectant. They cannot be removed from the environment. The only way to prevent infection and disease due to this fungus is to avoid travel to areas where it is present in the soil.

HOME CARE INSTRUCTIONS

  • Follow all your caregiver's instructions.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as instructed by your caregiver.

SEEK MEDICAL CARE IF:

  • You have an oral temperature above 102° F (38.9° C).

  • Your fever does not respond to anti-fever medicines after 3 to 4 days, or your fever gets worse.

  • Your other symptoms seem to be getting worse rather than better or new symptoms develop.