Coccidioidomycosis, also called valley fever, is a fungal infection. Many people will clear the infection on their own, often without knowing they were infected in the first place. However, coccidioidomycosis can be worse among the elderly and immunocompromised patients.
The fungus which causes valley fever usually lives in North, Central, and South America. It can also be found in HIV patients as an opportunistic infection regardless of where they live. An opportunistic infection is a type of infection that most people’s immune system would fight off without difficulty. However, in patients whose immune systems are not working as well as they should, the fungus takes advantage of the patient’s weakened immune system to cause infection. HIV patients who have a high viral load (detectable disease), and particularly those who have progressed to AIDS (acquired immunodeficiency syndrome), are most susceptible to these types of infections. The good news is that once a patient starts responding to HIV medications, their risk goes back down.
There are three types of coccidioidomycosis:
For many people, symptoms of valley fever are mild. They may not know they’ve had the infection. If they do have symptoms, they can include:
If the infection progresses to chronic coccidioidomycosis, a person may have the following in addition to the symptoms mentioned above:
If the infection becomes disseminated coccidioidomycosis, symptoms will depend on where in the body the infection has spread.
Coccidioidomycosis is caused by the spores of a mould which grows in the soil. If the soil is moved (e.g., during construction work, farming or after a heavy rainstorm), some of the spores are released into the air. A person then breathes them in.
The risk factors for symptomatic valley fever include:
As valley fever isn’t very common, it may take some time to diagnosis. A healthcare provider may request blood tests, imaging such as a chest x-ray, and a sputum sample (sample of what has been coughed up).
The most serious complication of coccidioidomycosis is the disseminated type. Once the disease has moved to other areas of the body, severe infections such as meningitis (inflammation of the brain and spinal cord), painful nodules in the bone or skin, or swollen joints can occur. For patients with severe disease, it can take months to feel better, even with treatment.
Treatment for coccidioidomycosis is with antifungal medications. Depending on the severity of the disease, a patient may be given oral treatment (tablets or capsules) or medication via cannula. If the patient is found to have an underlying condition such as HIV, treatment for that will also be given.
Preventing coccidioidomycosis in HIV patients is best achieved by taking HIV medications exactly as prescribed and by going to regular checkups. If there is concern for valley fever at work, a person can wear an N95 mask to help filter the air.