Coccidioidomycosis

Definition

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

Alternative Names

San Joaquin Valley fever; Valley fever

Causes

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

Symptoms of coccidioidomycosis can include:

Additional symptoms associated with this disease:

See also skin lesion of coccidioidomycosis.

Exams and Tests

Treatment

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.

Outlook (Prognosis)

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.

Possible Complications

  • 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

When to Contact a Medical Professional

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

Prevention

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.

References

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


Review Date: 12/3/2008
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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