Cocci – what? Many of us know this illness by its more common name, Valley Fever. Coccidioidomycosis is a systemic infection caused by coccidioides immitus, a fungal organism found in the Southwestern United States, parts of Mexico, and Central and South America. Genetic analyses have determined that the Coccidioides fungus has been present on the earth for more than five million years.
About 60 to 75 percent of cases are found in southern Arizona. The Valley fever “season” here in Arizona is usually June, July, October and November but can arise at any time of the year. In 2019, there were 10,359 cases in Arizona reported to the Centers for Disease Control (CDC), but it has been estimated that up to 150,000 people in the Southwestern United States are infected yearly. It is very rare in other parts of the United States. Valley Fever is more prevalent now than it was even 20 years ago as more people are moving to the Southwest with a subsequent increase in building and stirring up the soil. We have also experienced more drought and the spores form in hot dry weather. Dust storms and leaf blowing also shoot those spores into the air.
Coccidioidomycosis is primarily a respiratory infection caused by the inhalation of dust or dirt containing the fungus spores found in the soil. These spores are released from the ground through wind, farming and construction projects. About 60% of cases are mild or even without any symptoms. These are diagnosed by a positive skin test similar to the skin testing done to detect an exposure to tuberculosis. The other 40% may have symptoms ranging from mild to life threatening. People especially at risk of serious illness include the elderly, pregnant women and those with any compromise of their immune systems such as people with cancer, chronic illness, HIV and now also Sars CoV2 aka COVID-19.
Misdiagnosis can be a problem since many symptoms mimic other illnesses. Severe fatigue, cough, fever and body aches can point primary health care providers and emergency department staff to diagnoses of flu, pneumonia and COVID-19. Often when these tests return negative laboratory results, coccidioidomycosis diagnosis becomes an “aha moment.”
The disease may have three forms: acute, chronic and disseminated. Acute pulmonary Valley Fever is almost always mild. Symptoms may appear one to three weeks after exposure to the fungal spores. Most people assume they have a cold with nasal congestion and a mild cough or flu with fever, chills, night sweats and generalized aches. There may be weight loss. Roughly 10% may develop chest pain, knees and ankle swelling, and a red spotty rash. The illness usually resolves within a few weeks to a few months without complications, but in some people lung lesions may persist and the disease may recur.
The lifetime economic burden including health care costs and job loss is estimated to be $736 million, according to a study conducted by the University of Arizona Health Sciences this year.
Treatment of Valley Fever is primarily symptom control and comfort care, including rest, extra fluids and over-the-counter pain relievers such as Tylenol or Motrin are helpful. Andrew Weill, MD, local physician and specialist in complementary care, suggests garlic (2 raw cloves) daily for its antifungal properties. Antifungal medications are given intravenously or orally when respiratory symptoms worsen, to reduce the risk of spreading to other organs, or to treat the dissemination once it has occurred. Antibiotics may or may not be given to prevent a secondary bacterial infection in high risk people.
Coccidioidomycosis is not a contagious illness. To reduce risk of illness, people living in endemic areas should try to limit their exposure to dusty air since this is where the spores arise from the soil. There is no vaccine as yet but infection confers lifelong immunity. Environmental control has yet to be established.
The University of Arizona Valley Fever Center for Excellence is a great reference for both health care providers and the public.
Be aware that your common cold or flu symptoms may be something else; if the illness does not resolve in a week or two, or respiratory symptoms worsen, consult your health care provider and ask if Valley Fever is a possible cause of your illness.
Mia Smitt is a nurse practitioner with a specialty in family practice. She recently retired and settled in Marana.