Valley fever is the initial form of coccidioidomycosis infection. This initial, acute illness can develop into more serious disease, including chronic and disseminated coccidioidomycosis.
Acute coccidioidomycosis (valley fever)
The initial, or acute, form of coccidioidomycosis is often mild, with few, if any, symptoms. When signs and symptoms do occur, they appear one to three weeks after exposure. They tend to resemble those of the flu, and can range from minor to severe:
- Chest pain — varying from a mild feeling of constriction to intense pressure resembling a heart attack
- Night sweats
- Joint aches
- Red, spotty rash
The rash that sometimes accompanies valley fever is made up of painful red bumps that may later turn brown. The rash mainly appears on your lower legs, but sometimes on your chest, arms and back. Others may have a raised red rash with blisters or eruptions that look like pimples.
If you don't become ill from valley fever, you may learn that you've been infected only when you later have a positive skin or blood test or when small areas of residual infection (nodules) in the lungs show up on a routine chest X-ray. Although the nodules typically don't cause problems, they can look like cancer on X-ray.
If you do develop symptoms, especially severe ones, the course of the disease is highly variable. 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.
If the initial coccidioidomycosis infection doesn't completely resolve, it may progress to a chronic form of pneumonia. This complication is most common in people with weakened immune systems. You're likely to have periods of worsening symptoms alternating with periods of recovery. Signs and symptoms include:
- Low-grade fever
- Weight loss
- Chest pain
- Blood-tinged sputum (matter discharged during coughing)
- Nodules in the lungs
The most serious form of the disease, disseminated coccidioidomycosis, occurs when the infection spreads (disseminates) beyond the lungs to other parts of the body. Most often these parts include the skin, bones, liver, brain, heart, and the membranes that protect the brain and spinal cord (meninges).
The signs and symptoms of disseminated disease depend on which parts of your body are affected and may include:
- Nodules, ulcers and skin lesions that are more serious than the rash that sometimes occurs with other forms of the disease
- Painful lesions in the skull, spine or other bones
- Painful, swollen joints, especially in the knees or ankles
- Meningitis — an infection of the membranes and fluid surrounding the brain and spinal cord and the most deadly complication of valley fever
When to see a doctor
Valley fever, even when it's symptomatic, often clears on its own. Yet for older adults and others at high risk, recovery can be slow, and the risk of developing severe disease is high.
Seek medical care if you are in a high-risk group and develop the signs and symptoms of valley fever, especially if you:
- Live in or have recently traveled to an area where this disease is common
- Have symptoms that aren't improving
Be sure to tell your doctor if you've traveled to a place where valley fever is endemic and you have symptoms. More and more, people who spend a few days golfing or hiking in Arizona return home with valley fever but are never tested for the disease.
Jul. 06, 2012
- Longo DL, et al. Harrison's Online. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/content.aspx?aID=9110670. Accessed March 20, 2012.
- Goldman L, et al. Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-1-4377-1604-7..00341-9&isbn=978-1-4377-1604-7&sid=1288743076&uniqId=326705730-3#4-u1.0-B978-1-4377-1604-7..00341-9. Accessed March 21, 2012.
- Hage CA, et al. Endemic mycoses: Overlooked causes of community acquired pneumonia. Respiratory Medicine. In press. Accessed March 21, 2012.
- Coccidioidomycosis. Centers for Disease Control and Prevention. http://www.cdc.gov/nczved/divisions/dfbmd/diseases/coccidioidomycosis/. Accessed March 20, 2012.
- Coccidioidomycosis (San Joaquin fever; valley fever). The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/infectious_diseases/fungi/coccidioidomycosis.html. Accessed March 21, 2012.
- McPhee SJ, et al. Current Medical Diagnosis & Treatment 2012. 51st ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/content.aspx?aID=19953. Accessed March 20, 2012.
- Ferri FF. Ferri's Clinical Advisor 2012:5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-05611-3..00012-4--sc0190&isbn=978-0-323-05611-3&uniqId=326705730-3#4-u1.0-B978-0-323-05611-3..00012-4--sc0190. Accessed March 20, 2012.
- Steckelberg JM (expert opinion). Mayo Clinic, Rochester, Minn. April 10, 2012.