Coccidioidomycosis, or Valley fever, is a fungal infection caught by breathing in Coccidioides spores from desert soil in the southwestern United States. Most people get a flu-like lung illness that clears, but some develop chronic lung disease or spread to skin, bone or the brain.
Key symptoms
- Fever, cough and chest pain that lasts weeks
- Marked fatigue that can last months
- Night sweats and weight loss
- Joint aches, sometimes called desert rheumatism
- Painful red bumps on the shins or a widespread rash
What you find on exam
- Tender red nodules on the shins (erythema nodosum)
- Lung exam often normal; sometimes crackles or a pleural rub
- Skin lesions, swollen lymph nodes or bone tenderness suggest spread
- Neck stiffness or confusion suggests meningitis
- Ask about travel to or living in Arizona or California's Central Valley
Tests
- Coccidioides serology: enzyme immunoassay with immunodiffusion and complement fixation titer
- Chest X-ray: patchy infiltrate, hilar nodes, nodule or thin-walled cavity
- Blood count may show eosinophilia
- Fungal culture or stain of sputum or tissue; lumbar puncture if headache
Treatment basics
- Mild disease in healthy people: often no antifungal, with close follow-up
- Fluconazole for moderate or prolonged illness and high-risk patients
- High risk: immunosuppression, diabetes, pregnancy, or extensive lung disease
- Liposomal amphotericin B for severe or disseminated disease
- Meningitis needs lifelong fluconazole
Red flags
- Headache, confusion or neck stiffness
- Low oxygen or worsening breathing
- New bone pain, skin sores or enlarging nodes in a weakened immune system
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.