Valley Fever: Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Prevention and Complications

Valley fever is caused by a fungus called coccidioides. Among other symptoms, fever, coughing, and exhaustion are possible manifestations.

Two varieties of coccidioides fungi are the cause of valley fever. These fungi are commonly found on earth in some places. The fungus can release its spores into the atmosphere by wind, building, farming, and other soil-agitating activities.

At that point, people can inhale the fungus. The fungi can produce a disease known as acute coccidioidomycosis, sometimes known as valley fever. When valley fever is minor, it usually goes away on its own. In more severe cases of infection, physicians treat patients with antifungal medications.

Causes Of Valley Fever

The specific fungal spores that cause valley fever are inhaled. The fungus that causes valley fever, Coccidioides immitis or Coccidioides posadasii, is found in the soil in some parts of Arizona, Nevada, Utah, New Mexico, California, Texas, and Washington. The San Joaquin Valley in California is where it gets its name. Furthermore, the fungi are commonly found in northern Mexico and Central and South America.

Like many other fungi, coccidioides species have a complex life cycle. When disturbed, their long filamentous mold, which forms in the soil, breaks apart to release airborne spores. The spores can then be breathed in.

Because the spores are so small, the wind can carry them quite far. Once the spores enter the lungs, they continue the sickness cycle.

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Symptoms Of Valley Fever

Valley fever is the initial sign of coccidioidomycosis infection. Potentially, this first, acute disease could develop into a more serious condition like widespread, chronic coccidioidomycosis.

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Acute Coccidioidomycosis

First or acute coccidioidomycosis usually presents with little or no symptoms. Signs and symptoms start to show up one to three weeks after exposure. They often mimic symptoms of the flu. Symptoms can range from moderate to severe and could include:

• Cough
• Fever 
• Exhaustion
• Breathlessness
• Feeling Cold
• Headache
• Nighttime sweats
• Joint and muscular pain
• Red, splotchy rash, usually on the lower legs but also on the arms, back, and chest

You won't get valley fever symptoms or get sick immediately away, so you might not get infected until much later. You may find out if a routine chest X-ray shows nodules, which are little areas of residual infection in the lungs, or if a skin or blood test comes up positive. Even while the nodules typically cause no problems, X-rays may reveal that they are malignant.

If you do have symptoms, especially if they are severe, the course of the illness is not predictable. Tiredness and joint pain could persist for a lot longer. Several factors, including your overall health and the amount of fungus spores present, influence the severity of the sickness.

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Chronic Coccidioidomycosis

A chronic form of pneumonia may arise if the initial bout of coccidioidomycosis infection does not fully resolve. This outcome is more likely to occur in those with weakened immune systems.

Some of the signs and symptoms include:

• Low-grade fever
• Reduction in weight
• Discomfort in the chest and cough
• Sputum that has a faint bloody tint (material released during coughing)
• Lung nodules

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Contagious Coccidiomycosis 

It is uncommon to have disseminated coccidioidomycosis, the most severe form of the disease. When an infection "disseminates," or moves from the lungs to other parts of the body, it results. 

These parts frequently include the skin, bones, liver, brain, and heart in addition to the meninges, which are membranes covering the brain and spinal cord.

Signs and symptoms of disseminated disease might vary depending on the affected body parts and may include:

• Occasionally, an early infection causes skin lesions such as ulcers, nodules, and swellings that are more harmful than the rash itself.
• Painful joints, especially in the ankles or knees
• Painful lesions in the bones, such as the spine or skull
• Edema
• Meningitis

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Risk Factors Of Valley Fever

Risk factors for valley fever include:

• Environmental exposure: Anyone who breathes in the spores that cause valley fever can become infected. Residents of areas where the fungus is common, especially those who spend a lot of time outside, are at higher risk. The most susceptible categories also include individuals whose jobs involve a lot of dust, like road, agricultural, and construction workers; ranchers; archaeologists; and military personnel taking part in field exercises.
• Race: A higher likelihood of serious fungal infections is observed in individuals of African and Filipino heritage, for unknown reasons.
• Pregnancy: A pregnant individual is more vulnerable to more serious infections if an infection develops during the third trimester of pregnancy. New mothers are vulnerable from the moment their children are born.
• Compromised immune system: A weakened immune system increases an individual's susceptibility to potentially fatal outcomes. People with acquired immunodeficiency syndrome (AIDS) and those receiving anti-rejection drugs, chemotherapy, and steroids after transplant surgery fall under this category. Infection risk is also increased in people using anti-tumor necrosis factor (TNF) drugs for autoimmune conditions such as rheumatoid arthritis or Crohn's disease.
• Diabetes: Diabetes patients may be more susceptible to severe lung infections.
• Age: Older people tend to get valley fever more frequently. The reason for this could be their compromised immune systems or other conditions that affect their overall health.

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Diagnosis Of Valley Fever

To diagnose valley fever, your doctor may look at your symptoms, indicators, and medical history. Based only on signs and symptoms, diagnosing valley fever can be difficult because the illness's symptoms are often vague and similar to those of other conditions. Not even a chest X-ray can help doctors differentiate valley fever from other kinds of lung diseases like pneumonia.

The following tests may be ordered by medical professionals to identify valley fever:

• Sputum culture or smear: These investigations search for coccidioides organisms in a sample of sputum, the substance formed when coughing is part of these tests.
• Blood examinations: The fungus that causes valley fever can be tested for antibodies by your doctor.
• Imaging Test: If your doctor suspects you have pneumonia connected to valley fever, they may also recommend imaging tests like a computed tomography (CT) scan, magnetic resonance imaging (MRI), or chest X-ray.
• Biopsy: If required, a sample of lung tissue may be obtained for examination by medical specialists.
• Sometimes, doctors will perform a skin test to see if you have gained immunity to valley fever.

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Treatment Of Valley Fever

For valley fever, supportive care is usually enough, although medication is sometimes needed as well. Patients with acute valley fever usually don't require medical care. However, doctors keep an attentive watch on patients who have valley fever.

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Antifungal medications

If you are more prone to suffer repercussions, your symptoms worsen, persist longer, or neither, your doctor may prescribe an antifungal medication such as fluconazole. Patients with chronic or extensive diseases are also offered antifungal medicines.

For all but the most severe cases of coccidioidomycosis disease, the antifungal drugs itraconazole or fluconazole are typically administered.

All antifungals have adverse effects that could be dangerous. However, these adverse effects typically go away if the medication is stopped. Among the adverse effects of fluconazole and itraconazole are vomiting, diarrhea, stomach pain, and nausea. 

The adverse effects of fluconazole include hair loss, dry lips, chapped lips, and dry skin.

First, for more serious infections, an injectable antifungal medication such as amphotericin B may be utilized.

Three additional modern medications, isavuconazonium sulfate, posaconazole, and voriconazole, can also be used to treat more serious infections.

For many people, a single valley fever bout can confer lifetime immunity. But if you have a seriously weakened immune system, you can get sick again or the sickness might return.

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Prevention Of Valley Fever

Vaccination is not a preventive measure for valley fever.

If you live in or visit areas where valley fever is common, take appropriate precautions. The dry season that comes after a wet season is when there is the most chance of infection.

Consider the following ideas:

• Wear a mask.
• Avoid very dusty areas, like construction sites.
• Remain inside when it's dusting.
• Avoid the dirt or moisten it before digging if you're more likely to get sick from it.
• Keep doors and windows tightly shut.
• Clean skin wounds with soap and water.

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Complications Of Valley Fever

Pregnant women, those with weakened immune systems (such as those with HIV/AIDS), and people of Filipino or African heritage are more susceptible to a more severe form of coccidioidomycosis.

Among the consequences of coccidioidomycosis are:

• Severe pneumonia: It normally goes away on its own when coccidioidomycosis causes pneumonia. Individuals of African and Filipino heritage, as well as those with weakened immune systems, may also become gravely ill.
• Ruptured nodules within the lungs: Lung cavities and nodules with thin walls occur in a very small percentage of people. Many of them eventually disappear without any problems, but some have the potential to rupture, which would pain the chest and make breathing difficult. For patients with ruptured lung nodules, surgical repair of the damage or insertion of a tube to remove air from the surrounding lung tissue may be required.
• Other disease: This is the most dangerous consequence of coccidioidomycosis, however uncommon. The fungus spreading throughout the body can cause skin ulcers, abscesses, bone lesions, severe joint pain, heart inflammation, urinary tract problems, and meningitis, a potentially fatal infection of the membranes and fluid around the brain and spinal cord.

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