Valley Fever (medical name coccidioidomycosis or "cocci" for short) is an infection in the lungs caused by a fungus (scientific name Coccidioides immitis) that grows in the soil in the southern and central portions of California, Arizona, New Mexico, Texas and the southern portions of Nevada and Utah. Valley Fever is also found in parts of Mexico, Central and South America. These areas where the fungus grows in the soil are called endemic.
Valley Fever is acquired by inhaling one or more airborne spores of the fungus Coccidioides immitis. The spores are carried in dust particles from the soil by the wind when the desert soil is disturbed.
Symptoms usually develop within 7-28 days after exposure.
Yes. Patients with this manifestation present with chronic systemic symptoms such as low grade fever, weight loss, cough, chest pain and coughing blood. These symptoms are often slowly progressive and resemble tuberculosis when coupled with x-ray findings.
Dissemination is the spread of the fungal infection from the lungs to other parts of the body. The most common sites of dissemination in Valley Fever are skin, bones, joints and brain meninges. Cocci meningitis is the most lethal.
NO! Valley Fever is contracted only by the inhalation of the fungal spores. Valley Fever is NOT spread from human to human, or animal to animal, or animal to human or human to animal. The spores change form in tissues of the body and are not contagious in tissue form.
No. Researchers within our center and in the U.S. are working on the development of a prophylactic vaccine. We are also in the early phases of testing a drug that shows promise of a cure in the future.
Anyone who lives, visits, or travels through the areas where the fungus grows in the soil (these areas are called endemic) may acquire Valley Fever. Military personnel who may be training in these areas are also at risk. People working in certain occupations such as construction, excavation, archaeological digging and other occupations which disturb soil in endemic areas may be at increased risk of exposure. Persons who pursue recreational activities such as biking or driving ATVs or 4-wheel drive vehicles in the desert may also be at increased risk. Earthquakes that have occurred in endemic areas of California have also resulted in increased cases of Valley Fever. Various domestic animals such as dogs and horses as well as wild animals are also susceptible.
Usually a life-time immunity is acquired from an infection which means you don't get it again. However, occasionally, changes in the person's immune system brought about by other diseases or treatments which lower or suppress the immune system can allow a reactivation or reinfection.
While there are no racial or gender differences in susceptibility or who contracts the primary infection, there are differences in risk of dissemination. Men have a higher rate of dissemination than women. African Americans and Filipinos have several times higher rate of dissemination. Others at increased risk of disseminated disease are those with immune system deficiencies such as organ transplants, Hodgkin's disease patients, diabetics, pregnant women in their third trimester, patients on chronic corticosteroid therapy or chemotherapy, cancer patients and HIV/AIDS patients.
No. The risk of contracting Valley Fever is no greater because you have asthma. You must inhale the spores from the fungus in order to become ill.
No. The risk of contracting Valley Fever is no greater for a person with chronic obstructive pulmonary disease than anyone else.
Valley Fever is rare in newborn babies. Most babies who get Valley Fever probably acquire it during or shortly after birth, through inhaling fungal spores from the environment.
What are the symptoms?
Most cases (60%) have no symptoms or only very mild flu-like symptoms and do not see a doctor. When symptoms are present, the most common are fatigue, cough, fever, profuse sweating at night, loss of appetite, chest pain, generalized muscle and joint aches particularly of the ankles and knees. There may also be a rash that resembles measles or hives but develops more often as tender red bumps on the shins or forearms.
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Are hives associated with Valley Fever?
No. The rashes and bumps that are associated with Valley Fever are an immunologic response to the infection, not an allergic one. The rashes are called erythema nodosum and erythema multiforme depending upon the presentation.
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What is the Valley Fever skin rash like?
Valley Fever can cause rashes that look several different ways. A common presentation is as painful or tender, slightly elevated red nodules or bumps, which may change color to bluish to brown and often occur on the legs, but may occur on the chest, arms and back. Another common form of rash is a red raised rash which may have blisters or somewhat pointed pimple-like bumps. It's important to note that other diseases may also cause rashes that look the same. The names of the rashes are erythema nodosum (the most common) and erythema multiforme.
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How long will I be sick?
The length of illness depends on the severity of the infection. Most cases have no symptoms, others may take months to even more than a year to resolve. Persons frequently complain of fatigue and joint aches lasting months. The chronic forms of Valley Fever may last years, with a waxing and waning course.
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How is Valley Fever diagnosed?
Diagnosis is obtained by use of a specific blood test (called a coccidioidal or cocci serology) which measures the level or titer of antibodies to the fungus. A positive titer is usually measured or reported in dilutions of the patient's serum that continue to react to the fungal antigen. Titers are reported as 1:2, 1:4, etc. In early disease, the cocci serology must be repeated in 2-4 weeks if negative because the antibody level is too low to be detected. Culture of sputum, tissue, biopsies, or body fluids or histopathologic (microscopic) evidence from the same sources are diagnostic.
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How do I get a Valley Fever test?
The doctor must order the test for you.
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Will a skin test diagnose Valley Fever?
No, a skin test alone is not helpful in most cases. A skin test for cocci (usually called coccidioidin or spherulin) indicates exposure to the fungus, but not when it happened. Reactivity is lifelong. An individual living in an endemic area and having a positive skin test could have been exposed years before being tested. However, a positive skin test on a patient from a non-endemic area, having recently returned from the Southwest or other endemic areas, probably would indicate recent exposure. Generally, a skin test is not considered a means of diagnosis, but a tool of epidemiologic studies. The skin test is not currently commercially available.
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Is a chest x-ray necessary if a cocci serology blood test is drawn?
A chest x-ray is used to diagnose pneumonia (lung infection) due to Valley Fever. The doctor also uses the x-ray as a means of following the progress of the disease.
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Can Valley Fever be misdiagnosed?
Yes. Depending upon the symptoms, it may be confused with cancer, tuberculosis, chronic obstructive pulmonary disease, chronic fatigue syndrome and others. However, if the specific blood test to measure antibodies against the fungus is performed along with chest x-rays, travel history through the Southwest, and when appropriate skin test results are performed and considered, a diagnosis is made. The isolation in laboratory culture of the causative fungus from sputum, tissue or body fluids is diagnostic as is the presence of the diagnostic spherules as seen in histopathology.
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I have pneumonia. Will antibiotics help?
Coccidioidal pneumonia is not treated with routine antibiotics (such as penicillin, cephalosporin, erythromycin) because it is caused by a fungus and "regular" pneumonia is caused by bacteria. There are antifungal medications that may be used to treat Valley Fever.
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I have Valley Fever. Can I be in a clinical trial testing for a cure?
Per the requirements of the FDA, we have many criteria that study participants must meet in order to be eligible to be in one of our research studies. If you are interested in learning more, please call our hotline at (520) 626-6517.
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Why won't my doctor prescribe any medication when I feel really sick?
Before the availability of antifungal medications, at least 95% of patients with pumonary Valley Fever got better without any treatment. Studies have not been completed yet to determine if drug therapy hastens the resolution of immediate symptoms or prevents subsequent complications. The physician usually monitors the progress of the patient by chest x-rays, following the cocci serology (blood test) titer and the severity and duration of symptoms. This may require frequent visits to the doctor. If weight loss and night sweats continue, infiltrates in the lungs enlarge, and the inability to work persists, antifungal medication usually is considered.
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Which antifungal medications are used to treat Valley Fever?
The "azole" family of antifungal drugs are frequently used. These are oral preparations of ketoconazole, itraconazole and fluconazole. Each have various side-effects and may be expensive. The azoles do not kill the fungus but they control it. Amphotericin B is an antifungal medication that is used in serious and fulminant infections. It may be administered intravenously or intrathecally (injecting the medication directly into the fluid surrounding the brain).
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What are the side effects of the antifungal drugs?
The common side effects of ketoconazole are nausea and vomiting, gynecomastia (enlargement of male breasts) and decreased libido. The common side effects of itraconazole and fluconazole are nausea, headache, skin rash, vomiting, abdominal pain and diarrhea. Side effects resulting from treatment with the azoles usually resolve with the discontinuation of the drug. Amphotericin B may have several side effects, most of which may occur during administration and then pass. Newer forms of Amphotericin B have been developed to ease symptoms during administration. Amphotericin B may affect the kidneys and requires close monitoring. Additional side effects with all antifungal medications may occur. Consult with your doctor, pharmacist and/or package insert for further details.
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How long do I have to take antifungal medication?
The length of treatment depends on the severity of symptoms and disease and complications of the disease. Some patients take antifungal medication for a few months; others need life time therapy.
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I read about a "sulfur cure". Does it work?
There have been no studies to corroborate the claims made. The time period in which "cures" are claimed is probably the time that the body would recuperate on its own. The use of this product instead of medical care is not recommended.
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The doctor says I have a cavity. Do I need surgery?
Cavities occur in about 5% of patients with pulmonary cocci. The typical cocci cavity is thin-walled and solitary. Coccidioidal cavities are commonly asymptomatic (do not cause symptoms) and about 50% will disappear within 2 years of their occurrence. A cavity may persist for years with minor changes. About one-third of the patients with cavities may experience hemoptysis (coughing blood). The hemoptysis is often recurrent but generally not life-threatening. If rupture of the cavity is a large possibility, surgical removal may be necessary.
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How do I prevent getting Valley Fever?
There is no prevention or vaccine at this time. Avoiding activities associated with dust and airborne dirt of native desert soil is recommended, but it is not a certain means of prevention. Some occupations recommend wearing masks. Use common sense and stay out of the blowing dust.
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Will Valley Fever cause a positive TB (tuberculin PPD) skin test?
No. The tuberculosis and Valley Fever skin tests do not cross react. The presence of tuberculosis will not cause a positive cocci skin test nor will the presence of Valley Fever cause a positive tuberculin test.
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What kind of doctors know most about Valley Fever?
Infectious diseases specialists are probably the most familiar with the disease depending upon in which part of the country you live. Pulmonary specialists and most primary care and family practitioners in endemic areas are versed in the diagnosis and treatment. However, physicians in other parts of the country seldom see cases of Valley Fever and, therefore, may not consider it in diagnosis unless a travel history through the Southwest is given. The patient should emphasize he/she knows about Valley Fever and wants to be tested. Your physician may call our hotline at (520) 629-4777 to consult about diagnosis and treatment of Valley Fever with our specialist.
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I don't live in an endemic area, but I need a Valley Fever specialist. How do I find one?
Please use the American Medical Association DoctorFinder. If your doctor has diagnosed you with Valley Fever and you would like an appointment with a provider in Tucson, Arizona please contact the Valley Fever Evaluation and Management Center at (520) 694-8888, or toll free at (800) 524-5928.
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What are lung nodules and do they go away?
Lung nodules are the result of pneumonia caused by Valley Fever. Nodules are small residual patches of infection that generally appear as single lesions, typically one to one and one-half inches in diameter. Patients who have no symptoms as well as patients who do have symptoms may develop nodules. Approximately 5-7% of patients with cocci pneumonia will form sharply circumscribed singular nodules. If it is documented that the nodule is caused by Valley Fever, no other treatment is required. However, because the nodule may appear to be cancer, a biopsy or removal may be necessary. Nodules caused by cocci may remain a life-time.
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When a person contracts Valley Fever, will he/she always show a scar on a chest x-ray?
Scarring is frequently found and correlates to the severity of illness. Many persons have such a mild case they have no symptoms and no scarring.
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What does immunocompromised mean? How does this affect a Valley Fever infection?
A person is immunocompromised when his or her immune system (the body's defense against disease) is not intact. This may be the result of diabetes, chronic use of corticosteroids, cancer, chemotherapy, HIV/AIDS, organ transplantation, pregnancy or even aging. Usually the body is able to fight the fungus and recover without medication. If the immune system is compromised, it is unable to control the infection and allows the infection to spread from the lungs to other organs. The spread of infection from the lungs to other parts of the body is called dissemination.
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What are spherules?
Spherules are the form that the fungus takes in tissue. In nature the fungus grows in soil and appears in the mycelial form similar to bread mold. Portions of the hair-like mycelia break off into arthroconidia ("spores") and become airborne when the soil is disturbed. The arthroconidia are extremely small and light and may be carried many miles by the wind. Fifteen trillion of the arthroconidia would fit into a cubic inch. There has been documentation of a severe dust storm occurring in Bakersfield, California, an endemic area, blowing as far north as San Francisco where it is not normally found, and causing an epidemic in the Bay area. The life cycle of Coccidioides immitis is drawn at the beginning of our website. It demonstrates the two forms the fungus takes.
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Is Valley Fever contagious from an open lesion?
No. The tissue phase of the fungus Coccidioides immitis is a spherule. The infectious phase is when the "spores" are inhaled from the air.
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How can I boost my immune system?
Rest and good nutrition are recommended.
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Does the fungus lay dormant in the body?
In many cases the fungus does remain in the body. If the person's immune system is greatly immunocompromised, a reactivation of the disease may occur. This has been found to occur in many of the disseminated cocci patients with AIDS and disseminated Valley Fever.
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Do birds get Valley Fever?
In reviewing the records of the Arizona Veterinary Diagnostic Laboratory for the last 50 years and the scientific literature, we were unable to find a case of Valley Fever in any domestic, wild, or exotic avian species. From this, we conclude that Valley Fever does not cause disease in birds.
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Do pigeons spread Valley Fever?
No.
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Do chickens spread Valley Fever?
No.
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Is Valley Fever contagious from animal to animal or animal to human?
Valley Fever is considered a noncontagious disease. Even if multiple animals or humans are affected in a household, each infection was acquired by inhaling spores from the soil.
Coughing cannot spread it between animals or people. In the case of draining lesions, the form of the organism in the fluid is not considered to be infectious to people or animals. Nevertheless, such lesions are best handled by bandaging. Bandages should be changed daily or every other day and discarded in outside waste containers to minimize risk of contaminating the environment.
For immunocompromised persons living in a household with a pet that has a draining lesion, it is best to consult your physician regarding this issue.
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When does my dog need a Valley Fever test?
If your dog lives in a region where Valley Fever is typical, your dog could need a Valley Fever test for any illness that manifests the common clinical signs - coughing, fever, weight loss, etc. In addition, your dog will need some serum chemistries and white blood cell counts and sometimes x-rays to aid in diagnosing the illness. A positive test in and of itself is often not enough to diagnose Valley Fever.
For dogs that do not live in regions with Valley Fever but have traveled through or spent time in one, a Valley Fever test may be indicated for undiagnosed, unresolving illnesses. If your dog becomes ill outside the typical locations for Valley Fever, it is important to tell your veterinarian of your dog’s travel history.
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What is a Valley Fever test/titer and what does it mean for my dog?
A Valley Fever test, Cocci test, or Cocci titer checks the blood to see if your dog is making antibodies against the Valley Fever fungus. If the test is positive, it means your dog has been exposed to the fungus.
If the Valley Fever test is positive, the laboratory then performs a titer. The titer measures how much antibody your dog is making against the fungus. A titer is obtained by doubling dilutions of the positive blood (1:4, 1:8, 1:16, 1:32 . . .) until the test becomes negative. The titer that is reported to your veterinarian is the last positive dilution.
In broad terms, a higher titer is equated with more severe disease. However, some very sick animals have low titers, or even negative tests. For these dogs, other diagnostic tests are necessary for diagnosing the illness. X-rays, blood cell counts, biopsies, and microscopic examination of cellular specimens are a few of the tests your veterinarian may need to run.
Asymptomatic dogs (infected but not showing any illness) may also have low titers, such as 1:4 or 1:8, sometimes 1:16. The titer is helpful in diagnosing Valley Fever in sick dogs, but other tests are usually needed to confirm diagnosis.
Titers usually reduce over time as the animal’s disease regresses. Dogs that start with low titers (1:4 or less than 1:4) may undergo little change in the titer. This is probably not to be interpreted that your dog is not getting well. Monitoring your dog’s symptoms and other tests, such as blood counts and x-rays, will be better determinants of improvement in cases with low titers.
Some dogs will remain positive with a low titer for life. Continued treatment and monitoring of these animals needs to be determined by your veterinarian on a case by case basis.
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What is the best treatment for Valley Fever in animals?
Treatment choices vary by the individual veterinarian and patient. Reasons for choice of medication include practitioner’s experience with the drugs, costs, side effects, efficacy, severity of illness, and convenience to the owner. If one medication is unsuccessful, another will often be tried.
For disease of the brain and spinal cord, fluconazole (Diflucan) is the drug of choice. Fluconazole is also the only drug that penetrates tissues of the eye and should be employed in ocular cases.
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What is the proper dose of Valley Fever medications?
Your veterinarian is skilled in the diagnosis and treatment of your pet’s illness. Should you feel that your dog is not responding or may have side effects to the medicine, you should first discuss your concerns with your veterinarian. If the results are not satisfactory, you can seek a second opinion.
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What are the side effects of oral Valley Fever drugs (ketoconazole, itraconazole, and fluconazole) in dogs?
Ketoconazole (Nizoral) has the highest incidence of side effects. Loss of appetite is the most common and may be severe in some dogs. Others include lightening of the haircoat (may grey in blacks), vomiting, diarrhea, elevated liver enzymes, and reduced fertility of males. Giving the drug with food may reduce gastrointestinal side effects as well as improving absorption of the medicine.
The coat color effects reverse with discontinuation of the medication (with the exception of a few black dogs this author has heard about that have remained grey).
Liver enzymes are monitored by routinely testing your dog’s blood. If your veterinarian determines that they are significantly elevated, the medication may be stopped or the dose decreased.
Itraconazole (Sporanox) may also cause lack of appetite and GI signs, though with less frequency than ketoconazole. It may increase liver enzymes. Occasionally, itraconazole can cause ulcerated lesions of the skin. If this happens, a reduction in dose may clear it up, or your dog may need to be treated with a different medication. Monitoring of liver enzymes is as for ketoconazole.
Effects of itraconazole on coat color are unknown by this author but may be similar to ketoconazole in an occasional dog. Itraconazole is not known to affect fertility of males.
Fluconazole (Diflucan) has the fewest side effects. Gastrointestinal signs can occur, though are often mild, and elevations in liver enzymes are relatively uncommon. Unlike itraconazole and ketoconazole, fluconazole is mainly eliminated by the kidneys. Dose reductions may be needed in animals with poor kidney function. Liver enzymes also need to be monitored because of occasional problems with enzyme elevations. Fluconazole has minimal to no effect on male fertility.
All the oral Valley Fever drugs cause birth defects in fetuses and should be avoided in pregnant animals unless the benefit to the mother outweighs any risk to the fetuses.
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Are there vitamins, nutritional supplements, or alternative therapies for pets with Valley Fever?
Most ill dogs could receive a pet multivitamin supplement safely and possibly with benefit to overall well-being. Vitamin C is often prescribed to be administered with ketoconazole. This aids absorption of the drug by helping to acidify the stomach and may also “boost” the dog’s immune system. Use of the vitamin C should be checked with your veterinarian as high doses may cause gastrointestinal irritation.
Talk to your veterinarian about your dog’s overall nutrition status and the nutritional goals you need to meet while your pet is ill. The more ill your dog, the more important it is to discuss this issue with your vet.
For dogs that will eat nothing at all, force feeding may be an option to attempt to meet nutritional needs. For help in determining if this drastic measure should be taken and what food should be used to implement it, talk to your veterinarian. Force feeding is a big commitment and an unpleasant venture for both dog and owner, but in occasional situations it may mean the difference between recovery and loss of the dog. If the dog’s nutritional needs can’t be met any other way, surgical placement of a feeding tube may be an alternative.
Alternative therapies, such as herbs or acupuncture, have not been scientifically tested against Valley Fever. If you wish to pursue alternative treatments, this author recommends you consult a veterinarian trained in holistic medicine. These professionals are your best source of help.
For cats, it is highly recommended that no herbs or supplements be given without the guidance of a veterinarian. Cats have a much different metabolism than dogs and what might be harmless in a dog could prove very toxic to a cat. For cats that won’t eat at all while sick, surgical placement of a feeding tube may be necessary to make sure the cat does not develop fatty liver syndrome because of the lack of food intake.
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Can Valley Fever relapse and can dogs be reinfected?
Valley Fever is well known to relapse in both humans and dogs. In particular, cases of disseminated infection have a 30-50% rate of relapse in humans, no matter how well the initial infection was treated. It is not known how many canine cases of Valley Fever relapse, but relapses are not uncommon.
In the case of a relapse, a return to medication is usually enough to make symptoms subside, but the dog may require several additional months of treatment. Dogs that experience more than one relapse or get very sick with the relapse should probably have lifetime treatment with medication considered.
Reinfections in humans are documented only rarely. It is not known at this time whether dogs are susceptible to reinfection.
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