The fungi that cause the infection – Coccidioides immitis
and Coccidioides posadasii
– live in desert
soil. The fungal spores become airborne when wind blows the dust around, are
easily inhaled and settle deep in the lungs, causing pneumonia.
The updated guidelines are now much
more geared towards primary care clinicians who typically are the first to see
and treat patients with pneumonia, but who may overlook valley fever as a
potential cause of the illness and prescribe unnecessary tests and therapy.
While 60 percent of people with valley
fever have a mild infection with few or no symptoms, others may have fever,
fatigue, cough, headache, chest pain, skin rash and joint aches. In extreme
cases it can cause severe pneumonia, holes in the lungs (cavities), lung
nodules, skin sores and meningitis. Pregnant women and people who are
immunosuppressed (those with HIV, who had an organ transplant or are taking
medication for rheumatologic disease) or have diabetes have a very high risk of
Fifty to 80 percent of people infected
don’t require medication. Their immune systems eventually will rid their bodies
of the infection and they will become immune. However, patients may benefit
from physical therapy and should be seen by a health care provider regularly
for two years to ensure their symptoms aren’t worsening, the guidelines say.
Those who do need therapy should be
treated with an anti-fungal medication such as fluconazole. The medication does
not cure the infection, but suppresses symptoms. The guidelines note that some
patients with more serious illness, including coccidioidal meningitis, will
need to remain on antifungal therapy for life.
The updated guidelines recommend
treatment with fluconazole for women with complications from valley fever who
are in their second or third trimester of pregnancy. That is a change from the
previous guidelines (published in 2005), which recommended pregnant women be
treated with amphotericin B, which does not harm the fetus but is highly toxic
for the mother and requires intravenous treatment three times a week.
Fluconazole is not toxic to the mother, can be taken orally and, while not
recommended during the first trimester, appears safe during the second and
third trimester, the guidelines note.
The guidelines note valley fever can
be diagnosed with simple blood tests called enzyme-linked immunosorbent assays
(EIA), which test for antibodies to the fungus. Because it may take weeks or
months for an EIA to show a positive result, taking a culture of the fungus
from the sputum is another option.
The guidelines panel includes
infectious disease, pulmonary, critical care and rheumatology specialists, as
well as thoracic surgeons and neurosurgeons.
In addition to lead author, John
N. Galgiani, MD, FIDSA; the guidelines panel includes Neil M. Ampel, MD; FIDSA;
Janis E. Blair, MD, FIDSA; Antonino Catanzaro, MD; Francesca Geertsma, MD; Susan
E. Hoover, MD, PhD; Royce H. Johnson, MD, FIDSA; Shimon Kusne, MD;Jeffrey
Lisse, MD;Joel D. MacDonald, MD; Shari L. Meyerson, MD; Patricia B. Raksin, MD;
John Siever, MD; David A. Stevens, MD, FIDSA; Rebecca Sunenshine, MD and
Nicholas Theodore, MD.