What is Valley Fever?

Valley fever is an infection caused by inhaling the microscopic spores of a particular fungus that lives in the arid soil of Arizona and California. For some, the infection is completely asymptomatic, while for others the disease can be fatal.

My Story

I was first diagnosed with valley fever 3 1/2 years ago. The fungal infection filled half of my right lung, sent “satellite” sperules to settle on the outskirts of both lungs, and invited some bacterial pneumonia to join the party. I slept upwards of 20 hours per day, took eight weeks of short-term disability, and watched as 16% of my body weight melted away. I was generally young and healthy, so the doctor suggested I rest in lieu of treatment–a standard, well-accepted, and typically effective course of action. I was under the assumption that, like chicken pox, I would be forever immune.

Two months ago, after six months of bizarre neurological and muscular symptoms, and 3 1/2 years of recurring infections, my doctors discovered that the initial valley infection had been growing and disseminating throughout my body, completely unchecked for four years. I’m dealing with a particularly stubborn and well-established strain, which my body is struggling to fight, but I have a great team of doctors.

Despite doing my research upon my initial diagnosis, I realize now how little I truly understood. I didn’t know that valley fever could linger, lie dormant, and silently spread across the landscape of one’s flesh. I am doing everything within my power to manage and mitigate my own infection, but I desperately want to empower others who visit or live in the Southwest US to recognize the symptoms of valley fever and gain the confidence to act as their own biggest advocate.

If you live in Arizona, California, or any surrounding area, I implore you to become familiar with the symptoms and risks factors, so you can better protect yourself and your family.

Valley Fever Overview

Coccidioidomycosis, more commonly referred to as valley fever, is an infection caused by a fungus that lives in the soil. Approximately 10,000 cases are reported in the US each year, primarily in Arizona and California. Valley fever is often misdiagnosed, and thus mistreated, because its symptoms are so similar to other illnesses.

Cause: It Only Takes One Breath

The fungi that cause valley fever–coccidioides immitis or coccidioides posadasii–thrive in the arid desert soils of southern Arizona, Nevada, northern Mexico and California’s San Joaquin Valley. The fungi are also endemic to New Mexico, Texas, parts of Central and South America, and parts of Washington — areas with mild winters and arid summers.

The coccidioides fungi have a complex life cycle. In the rid desert soil, they grow as a mold with long filaments that break off into airborne spores when the soil is disturbed. Working construction, hiking, and simply being outdoors during a dust storm put you at risk of inhaling the spores.

The spores are extremely small and can be carried hundreds of miles by the wind. Even the highest quality particulate respirator can’t protect you from the microscopic spores. Once inhaled into the lungs, the spores reproduce to perpetuate the cycle of the disease.

Valley fever can only be contracted by inhalation and does not spread from person to person.

Common Symptoms = Delayed Diagnosis

The initial, or acute form, of valley fever is often mild, with few, if any, symptoms. Symptoms appear one to three weeks after expose and tend to resemble those of a common cold or severe case of the flu.

If you do develop symptoms, especially severe ones, the course of the disease is highly variable. It can take months or years to resolve, and the fatigue and joint pain can last even longer. The severity of the disease depends on several factors, including overall health and the number of fungal spores inhaled.

Acute Valley Fever

Though 60% of those exposed to coccidioides spores will never experience symptoms, another 40% may have flu-like symptoms, lasting a median of three months. These include:

• Fatigue (tiredness)
• Cough
• Fever
• Chills
• Shortness of breath
• Chest pain
• Headache
• Night sweats
• Muscle aches or joint pain
• Red, spotty rash no legs

Many patients experience delays in diagnosis and treatment because the symptoms mimic other common illnesses. Presence of the disease can be verified by a complement fixation blood test with titres above 1:2 or chest CT revealing sperules in the lung. Note that the blood test looks for cocci antibodies, not necessarily the disease itself. Additionally, keep in mind that valley fever is often missed by radiologists, so be sure your medical team knows what they’re looking for.

One-third of those afflicted will recover without any treatment after a few weeks up to several months. Those who are at particularly high risk for dissemination may be prescribed anti-fungal medications to reduce symptoms or prevent the infection from worsening.

Chronic Valley Fever

If the initial coccidioidomycosis infection doesn’t completely resolve, it may progress to a chronic form of pneumonia. This complication is most common in people with weakened immune systems, such as those suffering from HIV or autoimmune diseases. Some signs and symptoms of chronic valley fever include:

• Low-grade fever
• Weight loss
• Cough
• Chest pain
• Blood-tinged sputum (matter discharged during coughing)
• Nodules in the lungs
• High complement fixation titres

It may be wise to continue occasional lab work for valley fever after your initial reaction resolves to confirm that in infection does not return.

Disseminated Valley Fever

The most serious form of the disease is disseminated coccidioidomycosis, which occurs when the infection spreads beyond the lungs to other parts of the body. The most common areas for the infection to spread include: the skin, bones, joints, liver, brain, heart, and the membranes that protect the brain and spinal cord.

The signs and symptoms of disseminated disease depend on which parts of your body are affected, but may include:

• Nodules, ulcers and skin lesions that are more serious than the rash that sometimes occurs with other forms of the disease
• Painful lesions in the skull, spine or other bones
• Painful, swollen joints, especially in the knees or ankles
• Neck stiffness and headaches, which may signify meningitis
• High complement fixation titres (> 1:16) that are non-responsive to treatment

Coccidioidal meningitis can be

Treatment

The treatment for valley fever is dependent on many factors, including the patient’s age, general health, risk factors, and severity of symptoms. Most people with acute valley fever do not require treatment.

Rest

Even when symptoms are severe, the best treatment for otherwise healthy adults is often bed rest and fluids–the same approach used for colds and the flu. Still, doctors should carefully monitor patients with valley fever to ensure symptoms are continually improving.

Antifungal Medications

If symptoms don’t improve or worsen, or if you are at an increased risk of complications, your doctor may prescribe an antifungal medication, such as fluconazole or itraconazole. Antifungal treatment is typically limited to those who have a chronic or disseminated form of the disease since antifungal prescriptions can have serious side effects. The most common side effects–nausea, vomiting, abdominal pain and diarrhea–usually go away once the medication is stopped.

Serious infections that are either life-threatening or not responding to the first-line antifungals may be treated with an intravenous antifungal medication, such as amphotericin B. Two newer medications–voriconazole and posaconazole–may also be used to treat more serious infections.

Antifungal medications control the fungus, but don’t always destroy it, so relapses may occur. For many people, a single bout of valley fever results in lifelong immunity, but the disease can be reactivated, or you can be reinfected if your immune system is significantly weakened.

Risk Factors

So, who can get valley fever? Anyone who lives or travels to an area where the fungus lives can become infected. Valley fever can affect people of any age, but is most common in adults ages 60 and older. Certain groups of people may be at higher risk for developing the severe forms of the disease, including:

• People who have weakened immune systems, for example, people who:
  • Have HIV/AIDS
  • Have had an organ transplant
  • Are taking medications such as corticosteroids or tumor necrosis factor (TNF) inhibitors
• Women in their third trimester or pregnancy and post-partum
• People who have diabetes
• People who are African American or Filipino
• People who have jobs that expose them to dust (construction, agriculture, military personnel)

Possible Complications

Some people, particularly those with the risk factors listed above, may develop a more severe form of coccidioidomycosis. Complications may include:

• Severe pneumonia
• Raptured lung nodules
• Disseminated diesease

Prevention: Awareness is Key

In endemic areas, such as Arizona and California, it’s difficult to completely avoid exposure to the fungus because it’s present throughout the environment. There is no vaccine to prevent infection, so learning about valley fever is one of the most important ways to avoid delays in diagnosis and treatment.

People who experience valley fever symptoms and live in or have visited an area where the fungus is common should ask their doctors to test them for valley fever, especially if their current treatment regiment doesn’t seem to be working. Healthcare providers should be aware of the similarities between valley fever and other respiratory illnesses, and consider testing patients that may have been exposed to coccidioides.

If you live in or visit areas where valley fever is common, take commonsense precautions, especially during the summer months when the chance of infection is highest. Consider staying inside during dust storms, wetting the soil before digging, and keeping doors and windows closed when not in use.

If you’ve already recovered from valley fever, remember you will always have the spores in your body, whether or not you remain symptomatic, so ask to be retested on occasion.

Moving Forward

Raising Awareness

The Center for Disease Control is working closely with state and local health departments, as well as other agencies to educate the public and healthcare providers about Valley fever to reduce delays in diagnosis and treatment and to improve people’s health outcomes.

Increasing Surveillance

In many states, healthcare providers and laboratories are required to report valley fever cases to public health authorities. Disease reporting helps government officials and healthcare providers understand why outbreaks occur and allows them to monitor trends in Valley fever cases. This surveillance allows epidemiologists to recognize patterns, researchers to back up requests for added funding, and the general public to gain awareness of the disease.

Advanced Molecular Detection

The Center for Disease Control has been developing new tools that make it faster and easier to detect coccidioides in the environment. The organization is also using whole genome sequencing to investigate new areas where coccidioides may be living and causing illness.

Researching Treatments

Valley Fever is considered an “orphan disease” because at any one time fewer than 200,000 people in the United States are sick from this infection. However, about two-thirds of the infections are in Arizona. For those affected, the disease can be life-shattering. The “rare diseases” market is expect to grow 25% between 2015 and 2022, so orphan diseases–like valley fever–are experiencing a huge uptick in funding (from $121.6 billion in 2015 to an anticipated $576.9 billion by 2022)

The National Institutes of Health (NIH) is sponsoring a $9 million randomized controlled trial to learn more about Valley fever treatment. The University of Arizona is working to develop a valley fever vaccine, and the University of Texas at San Antonio just received a $1.9 million grant to research the same. In early 2019, the Valley Fever Center of Excellence at the University of Arizona will be starting Phase IIa trials of Nikkomycin Z, a promising antifungal drug that inhibits chitin synthase.

Conclusion

Valley fever is an infection caused by inhaling coccidioides spores that reside in the Southwest US. Though the disease is rare, localized, and typically asymptomatic, it’s important to be aware of its symptoms since the infection is potentially fatal. If you live in or visit Arizona or California, make an effort to minimize your exposure to dust and mention valley fever to your doctor if you’re experiencing flu-like symptoms.

Mandatory disclaimer: I am not a physician or healthcare professional. Everything mentioned above is based purely upon my personal experience with valley fever, information shared by my doctors, and facts presented by the CDC and other organizations working to help diagnosis, treat, and develop vaccinations for valley fever. If you suspect you may have valley fever, please see a medical professional.

My current diagnosis is disseminated coccidioidomycosis, which has brought with it a host of tangent health problems. I’ve been through all stages of the disease–acute, chronic, and disseminated–so feel free to ask any questions, either in the comments or via my contact form. It’s been, and continues to be, a very long journey for me, and I’d like to help anyone I can. If you’re not comfortable reaching out, this guide has been a great resource for me.