Coccidioidomycosis

Definition of Coccidioidomycosis

Coccidioidomycosis is infection with the spores of the fungus Coccidioides immitis.

Alternative Names for Coccidioidomycosis

San Joaquin Valley fever; Valley fever

Causes, incidence, and risk factors

Infection is caused by inhaling the spores of the fungus Coccidioides immitis. This fungus is often found in desert regions. About 60% of infections cause no symptoms and are only recognized later by a positive coccidioidin skin test.

In the remaining 40% of cases, symptoms range from mild to severe. People with a compromised immune system tend to have more serious infections. Individuals with AIDS are at higher risk for lung (pulmonary) coccidioidomycosis, as well as for the disseminated (spread to many organs) and skin (cutaneous) forms of the disease.

The disease can have an acute, chronic, or disseminated form. Acute pulmonary coccidioidomycosis is almost always mild, with few or no symptoms, and goes away without treatment. The incubation period -- the time between breathing in the spores and becoming sick -- is 7 to 21 days.

Acute coccidioidomycosis is uncommon. In any given year, about 3% of people who live in an area where coccidiomycosis is commonly seen will develop the disease.

Chronic pulmonary coccidioidomycosis can develop 20 or more years after initial infection, which may not have been recognized, diagnosed, or treated at the time. Infections (lung abscesses) can form and rupture, releasing pus (empyema) between the lungs and ribs (pleural space). This disorder is even less common than the acute form.

In disseminated disease, infection may spread to the bones, lungs, liver, lining covering the brain and spinal cord (meninges), brain, skin, heart, and the sac around the heart (pericardium). Meningitis occurs in 30-50% of cases of disseminated disease. The disease may get worse quickly in immunosuppressed people.

Symptoms of Coccidioidomycosis

Symptoms of coccidioidomycosis can include:

• Blood-tinged sputum
• Change in mental status
• Chest pain (can vary from a mild sense of constriction to severe pain, may get worse when taking a deep breath)
• Chills
• Cough
• Fever
• Headache
• Joint stiffness
• Loss of appetite
• Muscle aches
• Muscle stiffness
• Neck stiffness or shoulder stiffness
• Night sweats
• Rash, may be painful, red nodules on lower legs (erythema nodosum)
• Sensitivity to light
• Sweating, excessive
• Weight loss
• Wheezing

Additional symptoms associated with this disease:

• Ankle, feet, and leg swelling
• Arthritis
• Enlarged or draning lymph nodes
• Joint pain
• Joint swelling

See also skin lesion of coccidioidomycosis.

Signs and tests

• CBC with differential
• Chest x-ray
• Coccidioidin or Spherulin skin test
• Serum coccidioides complement fixation titer
• Sputum culture
• Sputum smear (KOH test)

Treatment of Coccidioidomycosis

The acute disease almost always goes away without treatment. Bedrest and treatment of flu-like symptoms until fever disappears may be recommended.

Disseminated or severe disease should be treated with amphotericin B, ketoconazole, fluconazole, or itraconazole.

Support Groups for Coccidioidomycosis

Expectations (prognosis) for Coccidioidomycosis

How well the person does depends on the form of the disease they have and their overall health. The outcome in acute disease is likely to be good. With treatment, the outcome is usually good for chronic or severe disease (although relapses may occur). People with disseminated disease have a high death rate.

Complications of Coccidioidomycosis

• Complications from medications. In particular, amphotericin B may cause fever, chills, and nausea while it is being given, and may cause abnormal kidney tests after many doses.
• Pleural effusion
• Relapse (return) of infection
• Spread of the infection throughout the body

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of coccidioidomycosis.

Prevention of Coccidioidomycosis

Maintaining general good health will help keep the disease in the benign pulmonary form. Prevention of AIDS or other causes of damage to the immune system will usually prevent the more severe forms of the disease.

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References for Coccidioidomycosis

Galgiani, JN. Coccidioidomycosis. In: Goldman L, Ausiello D, eds. <i>Cecil Medicine</i>. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 354.