Coccidioidomycosis (Valley Fever) - Diagnosis and Management Summary



WHAT?

 • Coccidioidomycosis due to Coccidioides immitis or Coccidioides posadasii infection, also known as valley fever, is a fungal infection that can develop after inhalation of arthroconidia from soil.



EPIDEMIOLOGY:

 • Coccidioidomycosis infections are most common in the southwestern United States, including California, Arizona, New Mexico, and Texas



WHO:

Risk factors for disseminated disease include:

 • Older age

 • Diabetes

 • HIV and AIDS

 • Late-term pregnancy

 • Immunosuppressant drug use

 • African or Filipino ancestry

 • Obesity



HOW?

These arthroconidia mature into spherules in the lungs that release endospores, causing the body to develop inflammatory granulomas. In some instances, macrophages laden with arthroconidia may travel to the lymphatic system and disseminate the infection to:

 • Central nervous system (CNS)

 • skin

 • bones

 • joints

 • peritoneal spread



TESTING:

 • Most common initial testing performed is serologic analysis using complement fixation or immunodiffusion to check for IgM and IgG antibodies. A titer greater than 1:16 is highly suspicious for disseminated disease and should prompt additional tests and imaging.



TREATMENT:

Clinically stable patients with mild to moderate disease generally are treated with: oral triazole (commonly fluconazole or itraconazole)

for 6 months or longer, depending on the site of infection and response to therapy.



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