VALLEY FEVER

General Information

DEFINITION--A pulmonary infection caused by a fungus whose spores are found in soil. Valley fever is not contagious from person to person.

BODY PARTS INVOLVED--Lungs; may spread to skin, bones, membranes of brain.

SEX OR AGE MOST AFFECTED--Both sexes; all ages.

SIGNS & SYMPTOMS--

The infection is usually so mild that it produces no symptoms. In a few cases the symptoms may be quite severe. They include:

• Cough; sore throat; chills and fever.
• Chest pain; headache; muscle and joint aches; shortness of breath.
• Skin rash.
• General ill feeling; depression; sweating at night.
• Weight loss; stiff neck (sometimes).

CAUSES--Infection by the fungus, Coccidioides immitis, which thrives in soil, especially soil that lines rodent burrows. Susceptible persons become infected when they breathe the dust from such soil and the fungi lodge in the lungs. Incubation is 1 to 4 weeks after exposure.

RISK INCREASES WITH

• Geographic location. The disease is most common in California's San Joaquin Valley, scattered regions in southern and central Arizona and southwest Texas.
• Occupational or environmental exposure to dust, such as from construction.
• Illness that has lowered resistance, especially uremia, diabetes mellitus, chronic lung disease (asthma), tuberculosis, AIDS, Hodgkin's disease, leukemia or severe burns.
• Use of immunosuppressive drugs, cortisone drugs or antimetabolites.
• Genetic factors. African Americans and Hispanics are more likely to have severe complications from valley fever.

HOW TO PREVENT--Cannot be prevented at present. Face masks offer limited protection against the infinitesimal spores. Efforts to develop a vaccine are unsuccessful so far.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Diagnostic tests may include skin test, laboratory blood studies, sputum cultures and chest x-ray. If diagnosis in doubt, further tests may include bronchoscopy (see Surgery section) and biopsy (See Glossary) of skin, lung, liver or bone.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Treatment usually involves supportive care at home; hospitalization only for severe cases.

POSSIBLE COMPLICATIONS--Spread of infection throughout the body and severe illness, especially in the brain or membranes that cover the brain.

PROBABLE OUTCOME--Spontaneous recovery in 3 to 6 weeks. Most persons continue to feel ill for 3 to 6 weeks after signs of infection disappear. Antifungal drugs are reserved for persons with severe, widespread infection, in which case they are life-saving.

How To Treat

GENERAL MEASURES--

• Use a cool-mist, ultrasonic humidifier, without medicine added, to increase moisture and help relieve a cough and sore throat. Clean humidifier daily.
• Keep a daily weight chart.

MEDICATION--

• Medicine is usually not necessary for mild cases. However, you may use non-prescription nonsteroidal anti-inflammatory medicine for pain, and antitussives for cough if needed.
• For disseminated infection (spread outside the lungs) and for certain patients (infants, patients with pneumonia, coexisting congenital or acquired immunodeficiency, diabetes or pregnancy) ketoconazole, fluconazole or amphotericin B should be prescribed.

ACTIVITY--Stay as active as your strength allows. Rest often.

DIET--No special diet.

Call Your Doctor If

• You have symptoms of valley fever.
• The following occurs during treatment: Continued weight loss. Fever. Diarrhea that cannot be controlled. Stiff neck with severe headache.