Coccidioidomycosis may occur initially as a mild acute diseases referred to as “Valley fever” but can later progress into a more serious form of the disease that may be in chronic or disseminated form. The symptomatology of coccidioidomycosis and its presentation vary considerably depending on the stage of the disease. These signs and symptoms of coccidioidomycosis are seen in the following stages of the disease:

Acute coccidioidomycosis

The initial form of coccidioidomycosis appears to be mild with a few signs and symptoms. Onset of symptomatology often occurs one to three weeks after the spore exposure. Complains of flu-like symptoms like: fever, chills, cough, headache, arthralgia, and fatigue. Cutaneous spotty rashes may occur in the thorax and the extremities. Severe constricting chest pain may also occur resembling that of a heart attack.

Chronic coccidioidomycosis

This condition progresses from acute form when symptoms fail to resolve during the acute phase of the disease. Chronicity of coccidioidomycosis most of the time progress to pneumonia which are commonly seen in immunocompromised hosts. The following signs and symptoms are commonly seen in chronic coccidioidomycosis: Weight loss, low grade fever, recurrent cough, persistent chest pain, blood tinged expectorations, and nodules in the lungs.

Disseminated coccidioidomycosis

This condition is the most severe form of coccidioidomycosis, where the infection has already gone beyond the lungs to infect other organs like the skin, bones, liver, brain, meninges and the heart. Symptomatology depends on the organ where the infection affects and commonly presents as: Nodules and ulcers of the skin, painful lesions of the skull, bones and spine, swollen ankle and knee joints, and meningitis which is the most deadly among its complications.

• Fever

  Persons at risk for Valley Fever or for getting severe illness from Valley Fever should avoid exposure to dusty air in areas where Valley Fever is common. [web.archive.org]

  Overview Valley fever is a fungal infection caused by coccidioides (kok-sid-e-OY-deze) organisms. It can cause fever, chest pain and coughing, among other signs and symptoms. Two species of coccidioides fungi cause valley fever. [mayoclinic.org]

  Background Researchers estimate that each year more than 150,000 people nationwide contract an airborne fungus known as valley fever, or coccidioidomycosis. People can contract valley fever by breathing in cocci fungal spores. [californiahealthline.org]

  Valley fever is a fungal lung infection that can be devastating. Learning about Valley fever can help you and your doctor recognize the symptoms early. Valley fever is an infection caused by a fungus that lives in the soil. [cdc.gov]

  Earthquakes that have occurred in endemic areas of California have also resulted in increased cases of Valley Fever. Around 4 million people live in areas where the Valley Fever fungus is prevalent in the soil. [vfce.arizona.edu]

• Pain

  They tend to resemble those of the flu, and can range from minor to severe, including: Fever Cough Chest pain Chills Night sweats Headache Fatigue Joint aches Red, spotty rash The rash that sometimes accompanies valley fever is made up of painful red [mayoclinic.org]

  Our case presented with several years of back pain and a pelvic mass mistaken for possible malignancy by image study. [ncbi.nlm.nih.gov]

  They may include: skin lesions skull lesions, which are often painful lesions in the spine and other bones swollen joints, which are usually painful meningitis, or inflammation of the membranes around the brain and the spinal cord muscle aches and stiffness [medicalnewstoday.com]

• Fatigue

  Patients were also asked to indicate their level of fatigue on a 10-point scale in an attempt to correlate levels of fatigue to use of specific integrative medicine modalities. [ncbi.nlm.nih.gov]

  It can take months to fully recover, and fatigue and joint aches can last even longer. The severity of the disease depends on several factors, including your overall health and the number of fungus spores you inhale. [mayoclinic.org]

  Mexico, and Central America and that may be asymptomatic or present as a mild to serious flu-like illness marked chiefly by fever, cough, sore throat, headache, fatigue, and pneumonia but sometimes becoming disseminated beyond the lungs especially [merriam-webster.com]

  (Day 20-23) ] The Modified Scoring System for Evaluating Treatment Response in Early Coccidioidal Pneumonia (FLEET CAP) score is a clinical scoring system that allows a constellation of clinical symptoms to be quantified and scored over time: cough, fatigue [clinicaltrials.gov]

• Weight Loss

  The patient had nonspecific symptoms of pulmonary infection, including weakness, anorexia, and weight loss. Both spherules and endospores of Coccidioides immitis were seen histologically after a transbronchial biopsy of a cavitary lesion. [ncbi.nlm.nih.gov]

  The initial symptoms are often non-specific, but pulmonary involvement characterized by cough, fever, malaise and weight loss - and confirmed by radiological evidence of pulmonary interstitial infiltrates - can be prominent. [apps.who.int]

• Chills

  He denied cough, fever, chills, night sweats, weight loss, joint/bone pain, or prior trauma to the area. [ncbi.nlm.nih.gov]

  When symptoms occur, they resemble symptoms of influenza or pneumonia: fever, chills, headache, severe pain in the joints, chest pain, and coughing. In a few instances after recovery there are solid lesions or cavities in the lungs. [britannica.com]

  The first case was diagnosed in a Finnish man in his mid 50s who developed chills and fever in mid October, followed by severe respiratory symptoms. [eurosurveillance.org]

  HISTORY This 17-year-old Filipino female in the southern San Joaquin Valley of California presented with a 3 week history of progressive dyspnea on exertion and orthopnea accompanied by fever, chills, pleuritic chest pain, weight loss, and general debilitation [hcplive.com]

• Cough

  Signs and symptoms include: Low-grade fever Weight loss Cough Chest pain Blood-tinged sputum (matter discharged during coughing) Nodules in the lungs Disseminated coccidioidomycosis The most serious form of the disease, disseminated coccidioidomycosis [mayoclinic.org]

  In this study, a 71-year-old Chinese male presented to our hospital with chronic cough and malaise, and was found to have a mass in the middle lobe of right lung. He had been visiting Arizona, USA for four months before admission. [ncbi.nlm.nih.gov]

• Pleural Effusion

  Manifestations of chronic disease include residual nodules, chronic cavities, persistent pneumonia with or without adenopathy, pleural effusion, and regressive changes. [ncbi.nlm.nih.gov]

  Pleural Effusion.—Pleural effusion occurs in approximately 15%–20% of patients with acute coccidioidomycosis (3,10,32). [pubs.rsna.org]

  […] imitus, a soil fungus endemic to the Southwest (San Joaquin Valley) • Primary coccidioidomycosis • Most are asymptomatic • Clinically, may have arthralgias, skin rash Imaging • Patchy infiltrates mainly in lower lobes (80%) • Hilar adenopathy (20%) • Pleural [learningradiology.com]

• Hemoptysis

  Hemoptysis or the threat of rupture into the pleural space occasionally necessitates surgery. [msdmanuals.com]

  Pneumothorax accounted for 24 % of complications with 7 % of pneumothoraces requiring chest tube. 1.5 % were complicated by hemoptysis but none required blood transfusions. [ncbi.nlm.nih.gov]

  Patients with mild or self-limiting infections will present with: Low-grade fever with chills and night sweats Fatigue Pain (headaches, sore throat, chest pain) A cough, with possible sputum production and hemoptysis Lower limb/foot swelling Loss of appetite [dermnetnz.org]

  The more common symptoms of primary infection includes : Fever Cough Chest pain Fatigue Shortness of breath Chills Sputum production Coughing up of blood (hemoptysis) Sore throat Other symptoms that may also be seen in primary coccidioidomycosis includes [healthhype.com]

• Dyspnea

  The three patients were immunocompetent adult males, hunters of armadillos (Dasypus novemcinctus), with complaints of cough, fever, dyspnea and pleuritic pain. [ncbi.nlm.nih.gov]

  Modified Scoring System for Evaluating Treatment Response in Early Coccidioidal Pneumonia (FLEET CAP) score is a clinical scoring system that allows a constellation of clinical symptoms to be quantified and scored over time: cough, fatigue, chest pain, dyspnea [clinicaltrials.gov]

  Illness and treatment: Symptoms can include fever, fatigue, cough, dyspnea, headache, night sweats, myalgias, and rash. Typical presentations are shortness of breath and pneumonia. [doh.wa.gov]

• Dry Cough

  We describe the case of a previously healthy man presenting to a Dublin hospital with fever, dry cough and chest pain, following a visit to the western USA. [ncbi.nlm.nih.gov]

  Symptoms can last weeks to months and include Fever Cough, which can be a dry cough, a cough with phlegm, or a cough with bloody phlegm Flu-like symptoms such as muscle pain, joint pain, headache, and fatigue Rash The diagnosis of valley fever is based [jamanetwork.com]

  The clinical presentation includes dry cough, pleuritic chest pain, myalgia, arthralgia, fever, sweats, anorexia, and weakness. An erythematous rash, erythema multiforme, and erythema nodosum may be seen. [visualdx.com]

  Symptoms of acute coccidioidomycosis include fever, headache, rash, muscle aches, dry cough, weight loss, and malaise. [cdc.gov]

• Loss of Appetite

  We report the case of a 58 year old male patient with nonproductive coughing, fever, vomiting and loss of appetite, beginning at the moment that he returned back home from a 2 week holiday in California. [ncbi.nlm.nih.gov]

  Symptoms you may experience with the acute form include: cough loss of appetite fever shortness of breath Symptoms of the chronic form are similar to those of tuberculosis. [healthline.com]

  appetite Rattling of the chest, sometimes with dullness upon percussion over lung fields Arthralgias. [dermnetnz.org]

• Parotid Swelling

  The patient was treated with 800 mg of fluconazole every day for 3 months with resolution of the parotid swelling. [ncbi.nlm.nih.gov]

• Chest Pain

  Many of these eventually disappear without causing any problems, but some may rupture, causing chest pain and difficulty breathing. [mayoclinic.org]

  We describe the case of a previously healthy man presenting to a Dublin hospital with fever, dry cough and chest pain, following a visit to the western USA. [ncbi.nlm.nih.gov]

  Occasionally, these cavities rupture, causing chest pain and difficulty breathing, and require surgical repair. [vfce.arizona.edu]

  They may include: chest pain - may be mild or quite severe chills cough fatigue fever headache joint aches muscle aches night sweats shortness of breath A skin rash can occur. [medicalnewstoday.com]

• Hepatosplenomegaly

  […] localized destruction of the outer table of the skull, or in the vertebral body, arch, or processes. 6 7 Lumbar spine, lower extremity, and follow-up chest radiographs were obtained to stage progression of her disease revealing increased heart size, massive hepatosplenomegaly [hcplive.com]

  Liver and spleen involvement may be demonstrated on CT as diffuse hepatosplenomegaly or focal low density parenchymal lesions. 8, 38 A radionuclide liver-spleen scan may demonstrate patchy tracer uptake in the liver. [appliedradiology.com]

• Hepatomegaly

  In our cases and in the literature, liver tenderness, hepatomegaly, or elevated hepatic transaminases may not be present10,31,49,126. [journals.lww.com]

• Arthralgia

  Common symptoms (median 3 mo) included pain/arthralgia (21) and swelling (10). Cultures and serology were positive in 15 of 17 (88%) and 19 of 22 patients (86%), respectively. [ncbi.nlm.nih.gov]

  Caused by Coccidioides imitus, a soil fungus endemic to the Southwest (San Joaquin Valley) • Primary coccidioidomycosis • Most are asymptomatic • Clinically, may have arthralgias, skin rash Imaging • Patchy infiltrates mainly in lower lobes (80%) • Hilar [learningradiology.com]

  The clinical presentation includes dry cough, pleuritic chest pain, myalgia, arthralgia, fever, sweats, anorexia, and weakness. An erythematous rash, erythema multiforme, and erythema nodosum may be seen. [visualdx.com]

  The constellation of fever, arthralgias, erythema nodosum or erythema multiforme, and chest pain is commonly referred to as San Joaquin Valley fever (or simply Valley fever) or desert rheumatism. [emedicine.medscape.com]

• Arthritis

  We report a case of Coccidioidomycosis of the cranium that presented as a cystlike structure with adjoining bone destruction in a 40-year-old patient with underlying rheumatoid arthritis that was treated with a combination of lipid amphotericin B and [ncbi.nlm.nih.gov]

  Complications Pneumonia *, arthritis, meningitis, and other serious problems can result if the infection spreads throughout the lungs or to other parts of the body, such as the liver, heart, brain, bones, or joints. [humanillnesses.com]

  BY Rachel Cook and Rebecca Plevin ReportingonHealth Collaborative More people are dying from valley fever than previously thought, and illnesses including diabetes, lung disease, arthritis and certain cancers may increase a person’s chances of dying from [reportingonhealth.org]

  Arthritis and rheumatism 2004; 50(6): 1959-66. [health.ucdavis.edu]

  […] of cases) Rarely, infected tendon sheaths demonstrating a villonodular synovitis Although arthritis is usually monoarticular, it can be migratory in nature. [emedicine.medscape.com]

• Myalgia

  Despite resolution of his cutaneous symptoms, his fevers and myalgias continued. He returned to his primary care physician for outpatient evaluation. [jamanetwork.com]

  Most often they have an influenza-like illness with fever, cough, headaches, rash, and myalgias (muscle pains). [medicinenet.com]

  Illness and treatment: Symptoms can include fever, fatigue, cough, dyspnea, headache, night sweats, myalgias, and rash. Typical presentations are shortness of breath and pneumonia. [doh.wa.gov]

  The clinical presentation includes dry cough, pleuritic chest pain, myalgia, arthralgia, fever, sweats, anorexia, and weakness. An erythematous rash, erythema multiforme, and erythema nodosum may be seen. [visualdx.com]

• Joint Swelling

  Symptoms may also include: Change in mental status Enlarged or draining lymph nodes Joint swelling More severe lung symptoms Neck stiffness Sensitivity to light Weight loss Skin lesions of valley fever are often a sign of widespread (disseminated) disease [medlineplus.gov]

  swelling joint pain arthritis ankle, feet, and leg swelling skin lesions. [diagnose-me.com]

  Other symptoms include chest pain, chills, night sweats, neck or shoulder stiffness, bloodtinged sputum, loss of appetite and weight loss, wheezing, change in behavior, joint swelling (ankles, feet, legs), arthritis, and light sensitivity. [encyclopedia.com]

• Knee Pain

  Attack, Blood Sugar, Eye Disease, Skin disease ,Skin Problem, Skin Allergy, Jaundice, Homeopathy, Ayurvedic, Allopathy, Nails, Skin Brightness, Lipoma, Cancer, Vitamin Deficiency, Hair Growing, Helathy Hair, Mounth, Liver, Kidney Stones, Sexual problems, Knee [play.google.com]

• Night Sweats

  Here, we report a 42-year-old male farmer from the west Texas who presented with an approximately 2-month history of progressive shortness of breath and dyspnea on exertion, weight loss, and night sweats. [ncbi.nlm.nih.gov]

  All symptoms are graded on a 0-3 severity scale, except for night sweats and hypoxia which are graded on a 0-2 severity scale, where 0 indicates the symptom is absent or normal. [clinicaltrials.gov]

  The fungus is Coccidioides immitis, subdivision Deuteromycotina ‘Persons with coccidioidomycosis may present with cough, fever, and night sweats.’ [oxforddictionaries.com]

  Rash (erythema nodosum) due to Valley fever Symptoms of Valley fever include: Fatigue (tiredness) Cough Fever Shortness of breath Headache Night sweats Muscle aches or joint pain Rash on upper body or legs In extremely rare cases, the fungal spores can [cdc.gov]

• Skin Rash

  Caused by Coccidioides imitus, a soil fungus endemic to the Southwest (San Joaquin Valley) • Primary coccidioidomycosis • Most are asymptomatic • Clinically, may have arthralgias, skin rash Imaging • Patchy infiltrates mainly in lower lobes (80%) • Hilar [learningradiology.com]

  rash, persistent pulmonary symptoms, bone pain, headache, or confusion. [ajronline.org]

  Symptoms of Valley fever may include: Fatigue Fever or night sweats Cough or shortness of breath Headache Muscle aches and joint pain Skin rash Often, Valley fever infections don’t cause any symptoms. [my.clevelandclinic.org]

  However, the patient did not experience respiratory symptoms, develop a skin rash, or develop abnormalities on CXR. [bmcinfectdis.biomedcentral.com]

• Skin Ulcer

  Disseminated coccidioidomycosis, or coccidioidal granuloma, is a progressive form of infection that can result in skin ulcers, many nodules or cavities in the lungs, widespread involvement of lymph nodes, lesions of the bones, and osteomyelitis (infection [britannica.com]

  If the fungus spreads (disseminates) throughout the body, it can cause problems ranging from skin ulcers and abscesses to bone lesions, severe joint pain, heart inflammation, urinary tract problems and meningitis — a potentially fatal infection of the [mayoclinic.org]

  Complications can include: Skin ulcers and abscesses Swollen and painful joints Bone lesions Heart inflammation Urinary tract problem Meningitis Meningitis is by far the most serious complication. [infectiousdiseases.about.com]

  Complications can include: Skin ulcers and abscesses Swollen and painful joints Bone lesions Heart inflammation Urinary tract problem Meningitis Meningitis is fatal if it is not treated. [verywellhealth.com]

• Eruptions

  the eruption preceded, accompanied, or followed the onset of systemic symptoms. [jamanetwork.com]

  Reactive, immunologically mediated eruptions include erythema nodosum, a generalized exanthem, Sweet syndrome, and reactive granulomatous dermatitis. [ncbi.nlm.nih.gov]

  Erythema nodosum is the most frequent reactive eruption associated with coccidioidomycosis. [msdmanuals.com]

  Others may have a raised red rash with blisters or eruptions that look like pimples. [mayoclinic.org]

  Once inside the lungs, the fungal spores can multiply and create eruptive nodules in the airways. In people with severe immune supression—particularly those diagnosed with AIDS —this lead to severe lung infections. [infectiousdiseases.about.com]

• Scrotal Mass

  While testicular coccidioidomycosis is not common, the case is presented because consideration as a differential diagnosis for scrotal masses or lesions in patients who live in endemic areas is essential. [ncbi.nlm.nih.gov]

• Headache

  If you have symptoms, they may include a flu-like illness, with fever, cough, headache, rash and muscle aches. Most people get better within several weeks or months. [icd9data.com]

  Symptoms include headache, vomiting, stiff neck, and other central nervous system disturbances. A spinal tap is required for a definite diagnosis of meningitis. Clinical Images of Complications [vfce.arizona.edu]

  136.2.393 ABSTRACT : Disseminated coccidioidomycosis should be considered as a diagnostic possibility whenever a patient has visited or resides in an endemic coccidioidal area and has a history of fever, skin rash, persistent pulmonary symptoms, bone pain, headache [ajronline.org]

  Mexico, and Central America and that may be asymptomatic or present as a mild to serious flu-like illness marked chiefly by fever, cough, sore throat, headache, fatigue, and pneumonia but sometimes becoming disseminated beyond the lungs especially [merriam-webster.com]

• Confusion

  It is sometimes called valley fever but should not be confused with rift valley fever. Infection is caused by inhalation of airborne, fungal particles known as arthroconidia, a form of fungal spores. [icd9data.com]

  Disseminated coccidioidomycosis should be considered as a diagnostic possibility whenever a patient has visited or resides in an endemic coccidioidal area and has a history of fever, skin rash, persistent pulmonary symptoms, bone pain, headache, or confusion [ajronline.org]

  Pleural effusion, hilar lymphadenopathy, or erythema nodosum may be the predominant manifestation and cause diagnostic confusion unless coccidioidomycosis is considered. [annals.org]

  It is sometimes called valley fever but should not be confused with RIFT VALLEY FEVER. Infection is caused by inhalation of airborne, fungal particles known as arthroconidia, a form of FUNGAL SPORES. [mesh.kib.ki.se]

  Squamous cell carcinoma, halogenoderma, mycobacterial infection – The massive epidermal hyperplasia which often accompanies coccidioidomycosis my cause diagnostic confusion with these other diverse pathologic processes. [dermnetnz.org]

The diagnosis of coccidioidomycosis is very difficult to ascertain clinically because this fungal infection may mimic common viral infections. Chest X-ray may not even give a specific diagnosis inferring to Coccidioidomycosis. The definitive diagnosis of coccidioidomycosis falls on the demonstration of the fungus in the tissues, blood, secretions and washings from bronchoalveolar lavage [8].

The following test are done to diagnose coccidioidomycosis:

• Sputum smear and culture: This test makes use of microscopy to demonstrate the presence of coccidioidomycosis fungus from the sputum.
• Blood tests: Blood tests can confirm antibodies against the fungus [9].

• Pulmonary Infiltrate

  Despite treatment with broad-spectrum antimicrobials, the patient developed progressive bilateral pulmonary infiltrates and a large pleural effusion. [ncbi.nlm.nih.gov]

  Radiographic changes include a variable degree of interstitial pulmonary infiltration, hilar lymphadenopathy, and osseous lesions. [doi.org]

  Among patients without immune compromise, therapy should be considered if the patient has intense night sweats for more than 3 weeks, has lost more than 10% body weight, has extensive pulmonary infiltrates, or has an elevated complement fixation titer [infectiousdiseaseadvisor.com]

• Cavitary Lesion

  Both spherules and endospores of Coccidioides immitis were seen histologically after a transbronchial biopsy of a cavitary lesion. The patient was treated with amphotericin B. At the time of this writing (8 months), he remains disease free. [ncbi.nlm.nih.gov]

  Most cavitary lesions resolve spontaneously, within 2 years in up to 50% of cases (24,42). Even when the cavitary lesion persists, extrathoracic dissemination of infection is rare. [pubs.rsna.org]

  Chronic pulmonary coccidioidomycosis, mainly with nodular or cavitary lesions, were often diagnosed by surgical lung biopsies. [ci.nii.ac.jp]

  As mentioned, pleural effusion, cavitary lesions or nodules may also be seen. CT thorax if indicated. CT head scan prior to lumbar puncture (LP) if focal neurologic deficits are present. [cancertherapyadvisor.com]

• Pulmonary Consolidation

  Occasionally, an area of pulmonary consolidation undergoes excavation, resulting in a thin- or thick-walled cavity (21). These cavities have been described in 2%–8% of hospitalized patients with acute primary infection. [pubs.rsna.org]

• Skin Test Positive

  tests positive for coccidioidal antigens. [emedicine.medscape.com]

• Coccidioides Immitis

  The Coccidioides immitis infection is caused by inhaled airborne fungal spores and it may occur as primary pulmonary (acute or chronic) asymptomatic form, meningitis, or disseminated disease. [ncbi.nlm.nih.gov]

  Coccidioides immitis microscopy.jpg 363 466; 38 KB Coccidioides immitis on Sabouraud's medium.jpg 363 444; 44 KB Dog with Coccidioidomycosis.jpg 3.045 2.005; 6,5 MB Dog with Coccidioidomycosis.png 3.045 2.005; 13,15 MB Valley fever.png 2.005 3.045; 13,06 [commons.wikimedia.org]

  immitis (disorder), Infection by Coccidioides immitis, Coccidioidomycosis NOS, Coccidioidomycosis [Disease/Finding], Coccidioides immitis Infection, Coccidioides immitis Infections, Valley Fevers, Valley Fever, Infection, Coccidioides immitis, Infections [fpnotebook.com]

• Granulomatous Tissue

  Even though the mainstay of treatment for Sweet's syndrome are corticosteroids, they are not recommended in the setting of coccidioidal infection, since they could exacerbate the condition.60 INTERSTITIAL GRANULOMATOUS DERMATITIS Granulomatous tissue [ncbi.nlm.nih.gov]

• Pleural Effusion

  Manifestations of chronic disease include residual nodules, chronic cavities, persistent pneumonia with or without adenopathy, pleural effusion, and regressive changes. [ncbi.nlm.nih.gov]

  Pleural Effusion.—Pleural effusion occurs in approximately 15%–20% of patients with acute coccidioidomycosis (3,10,32). [pubs.rsna.org]

  […] imitus, a soil fungus endemic to the Southwest (San Joaquin Valley) • Primary coccidioidomycosis • Most are asymptomatic • Clinically, may have arthralgias, skin rash Imaging • Patchy infiltrates mainly in lower lobes (80%) • Hilar adenopathy (20%) • Pleural [learningradiology.com]

Coccidioidomycosis is often mild and may not require any treatment. In severe cases, symptoms are treated with increased fluid intake and adequate rest. For patients with persistent symptoms with high risk medical profile, antifungal medications like fluconazole and itraconazole in serious cases of coccidioidomycosis are used. The most serious disseminated forms of coccidioidomycosis are treated with intravenous amphotericin B [10].

Majority of cases of coccidioidomycosis is self-limiting and resolves completely within a few months. The use of antifungal therapy is associated with excellent prognosis. Patients who progress to chronic inflammatory phase of coccidioidomycosis with deficient cellular immunity has higher risk for intrapulmonary cavitations and extrapulmonary spread of the coccidioides infection to other organs. Poor prognosis is associated with the disseminated type of spread of coccidioides spherules which only represents 1% of all cases.

Complications

A majority of patients who inhales the coccidioides spores develop mild to moderate symptoms that may resolve spontaneously without medications. However, certain races like Filipinos, Hispanic and Asians may be at risk to develop the severe disseminated form of the infection. The following clinical conditions are common complications of coccidioidomycosis in an immune deficient hosts:

• Severe pneumonia: This occurs when the coccidioides lung inflammation fails to resolves spontaneously and harbors other pathogens to cause the lung infection.
• Ruptured lung nodule: A rupture lung nodule may require chest tubes to drain the trapped air or surgical repair of the lung parenchyma.
• Disseminated disease: This refers to the most serious complication of coccidioidomycosis spreading to distant organs presenting as skin ulcers and abscess, bone lesions, arthropathies, heart inflammation, urinary tract problems, and meningitis.

Coccidioidomycosis is caused by two genetically distinct organisms but morphologically identical soil fungus. These fungus are Coccidioides immitis and Coccidioides posadasii respectively. Both fungus are found to be endemic in the arid regions of the western hemisphere. Coccidiodes soil fungi abound regions with low elevation, scant rainfall, mild winters, hot summers, sandy alkaline soil with increase in salinity [1]. The Coccidioides immitisis is largely limited to the San Joaquin Valley; thus, coined the “valley fever”. There has been reports of zooanthropologic transmission from coccidioidomycosis infected cats to humans [2].

Coccidioides are found to be endemic in the soil of the western hemisphere regions located between latitude 40 degrees north and 40 degrees south [3]. In the United States, the occurrence of C. immitis dominates the San Joaquin Valley of California while C. posadasii abounds in the desert of the southwest which includes regions of Arizona, Utah, Nevada, New Mexico and Texas.

Archeologists, farmers and construction workers are potentially at risk to coccidioidomycosis because of their frequent contact to the infected soil [4]. There is an estimated 150,000 coccidioides infections per year in the United States. The death rate approaches 75 cases per year in the US alone due to coccidioides infection.

The prevalence rate of the disease reaches 30 to 40% of the population in endemic areas like California and Arizona [5]. There are no known racial predilection for coccidioidomycosis. Older males are more prone to the infection due to occupational exposure. Coccidioides infection of the neonate rarely occurs [6].

The pathophysiology of coccidioidomycosis begin with the inhalation of the coccidioides spores from the soil where it is lodged in the terminal bronchioles as a C. immitis or a C. posadasii arthroconidia. Spherules are formed within the bronchioles as the arthroconidia enlarges. Hundreds to thousands of endospore offspring within the spherules rapidly divides within 48-72 hours until it is fully filled. The rupture of the endospore offspring within the bronchioles gives rise to new spherules in the pulmonary mucosa [7].

The transformation of the arthroconidia into a coccidioides spherule results into a local inflammatory process within the bronchioles causing suppuration and tissue necrosis. C. immitis has been found to trigger the complement system and release mediators of chemotaxis for neutrophils. Macrophages engulfs endospores that initiates the acute phase of the inflammation.

Chronic unabated infection with the coccidioides endospores harbors more histiocytes and lymphocytes forming a granuloma or giant cells marking the initiation of the chronic phase of inflammation in coccidioidomycosis.

Those who are living near coccidioidomycosis endemic areas must take extra precaution especially during the summer months. One may use protective mask to prevent spore inhalation. Staying inside the house during dust storms, wetting the soil before digging, and keeping doors and windows tightly closed can prevent the fungal spores from being inhaled to the lungs.

Coccidioidomycosis or valley fever is a fungal infection characterized by coughing, fever, shortness of breath, and chest pain caused by a fungus called Coccidioides. The fungi are commonly found in the soil where it can be agitated to the air by anything that disrupts the soil such as the wind, farming, excavation, and construction.

The spores can easily be inhaled into the lungs and cause coccidioidomycosis. Mild fungal infection may spontaneously resolve without treatment while more serious infections may require antifungal medications for its resolution.

Definition

Coccidioidomycosis is a type of fungal infection characterized by coughing, difficulty in breathing and chest pain.

Cause

The soil fungi Coccidioides immitis and Coccidioides posadasii cause the disease.

Symptoms

Flu-like symptoms and rashes occur in acute phase, persistent symptoms may be joint pains and pneumonia in the chronic phase. Extrapulmonary involvement in disseminated coccidioidomycosis is possible.

Diagnosis

Sputum smear and culture and blood tests (fungal antibodies) are used to diagnose the condition.

Treatment and follow-up

Rest, oral antifungal and intravenous amphotericin B are the treatment options for coccidioidomycosis.

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3. de Aguiar Cordeiro R, Brilhante RS, Rocha MF, et al. Twelve years of coccidioidomycosis in Ceara State, Northeast Brazil: epidemiologic and diagnostic aspects. Diagn Microbiol Infect Dis. 2009.
4. CDC. from the Centers for Disease Control and Prevention. Coccidioidomycosis following the Northridge earthquake--California, 1994. JAMA. Jun 8 1994; 271(22):1735.
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