Valley fever (coccidiomycosis)

January 2007     View PDF
Reprinted from University of Arizona’s Valley Fever Center for Excellence, US

What are the symptoms?

Most cases of Valley Fever are very mild. It is thought that over 60% of infected people have either no symptoms or experience flu-like symptoms and never seek medical attention. Of those patients seeking medical care, the most common symptoms are fatigue, cough, chest pain, fever, rash, headache and joint aches. Some people develop painful red bumps on their shins or elsewhere that gradually turn brown (the medical term for these is “erythema nodosum”). These symptoms are not unique to Valley Fever and can be caused by other illnesses. Therefore, identifying Valley Fever as the cause of illness requires specific laboratory tests.

Most commonly reported symptoms:

     fatigue,
     cough,
     chest pain,
     fever,
     rash,
     headache and
     joint aches

The usual course of disease in otherwise healthy people is complete recovery within six months. In most cases, the body’s immune response is effective and no specific course of treatment is necessary. About 5% of cases of Valley Fever pneumonia (infection of the lungs) result in the development of nodules in the lung. These are small residual patches of infection that generally appear as solitary lesions, typically one to one and a half inches in diameter, and often produce no symptoms. On a chest x-ray, these nodules resemble lung cancer. Unfortunately, it is usually not possible to make a definite diagnosis without removing a part or all of the nodule by bronchoscopy, needle-aspiration or surgery.

Another five percent of patients develop lung cavities after their initial infection with Valley Fever. These cavities occur most often in older adults, usually without symptoms, and about 50% of them disappear within two years. Occasionally, these cavities rupture, causing chest pain and difficulty breathing, and require surgical repair.

Range of cases:

     inapparent: 60%;
     mild to moderate: 30%;
     complications: 5–10%;
     and fatal: <1%.

Of those patients with Valley Fever that seek medical attention, 1–2% develop disease that has spread (disseminated) to other parts of the body. The most common site of dissemination is the skin. Biopsies of skin lesions may reveal Coccidioides immitis when grown in culture. Bones and joints (especially the knees, vertebrae, and wrists) are other frequent sites of dissemination. The changes in bones and joints due to Valley Fever infection can be seen on x-rays and in CT-scans of the affected body part. Meningitis is the most serious and lethal complication of disseminated disease. Symptoms include headache, vomiting, stiff neck, and other central nervous system disturbances. A spinal tap is required for a definite diagnosis of meningitis.

Introduction

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