Coccidioidomycosis is a lung infection caused by a fungus called Coccidioides. This fungus lives in dry, dusty soil. When the soil is disturbed, tiny fungal spores go into the air. People breathe in these spores and the infection starts in the lungs. Many people have no symptoms or only a mild flu-like illness, but some people get very sick, and the infection can spread to the skin, bones, joints, or brain.
Coccidioidomycosis, also called Valley fever, is a lung infection caused by breathing in tiny fungal spores from the soil, mainly in the southwestern United States, parts of Mexico, Central and South America. The fungus lives in dry, dusty ground and becomes airborne when soil is disturbed by wind, farming, or construction.
After inhalation, the spores reach the lungs and change into large round structures called spherules. These spherules release many smaller units (endospores) that spread inside the lungs and sometimes to other organs such as skin, bones, joints, and the brain. Disease can range from mild flu-like illness to severe, life-threatening disseminated infection.
The fungus changes its form once it enters the lungs. In the soil it grows as long filaments. In the body it turns into round “spherules” filled with smaller units that can spread in the tissues. This is why doctors call it a “dimorphic” fungus, meaning it has two main forms, one in the environment and one in the body.
This disease is most common in hot, dry areas with sandy or dusty soil in parts of the Americas. Anyone who breathes the spores can get the infection, but people with weak immune systems, diabetes, pregnancy, or certain ethnic backgrounds have a higher chance of severe disease.
Other names
Coccidioidomycosis is known by several other names. These names often come from where it was first found or how it looks.
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Valley Fever – This is the most common name. It comes from areas with valleys and deserts where many cases occur. People may say “I have Valley Fever” instead of using the medical name.
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Desert Fever or Desert Rheumatism – “Desert fever” refers to the flu-like illness you can get after breathing spores in desert areas. “Desert rheumatism” is used when people have the classic triad of fever, joint pains, and a tender red skin rash, often on the legs.
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San Joaquin Valley Fever – This older name comes from an area where the disease was first recognized in large numbers. It is less used in medical writing now but still heard in local speech.
Types of coccidioidomycosis
Doctors group coccidioidomycosis into types based on how far the infection has spread and how long it has lasted.
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Primary pulmonary coccidioidomycosis
This is the first and most common form. The fungus is limited to the lungs. Many people have no symptoms or only mild flu-like illness that gets better without treatment. -
Chronic pulmonary coccidioidomycosis
In some people the lung infection does not fully clear. It can cause long-term (chronic) cough, weight loss, and lung cavities (holes or thick-walled spaces) seen on imaging. -
Disseminated coccidioidomycosis
Here the fungus spreads outside the lungs through the blood or lymph system. It may reach the skin, bones, joints, lymph nodes, or other organs. This form can be severe and is more common in people with weak immune systems. -
Coccidioidal meningitis
In some patients the fungus reaches the membranes covering the brain and spinal cord. This is called meningitis. It can cause headache, neck stiffness, confusion, or seizures, and is life-threatening if not treated quickly. -
Cutaneous and soft-tissue coccidioidomycosis
These forms affect the skin and tissues under the skin. They may start from spread through the blood or, rarely, from direct entry of spores through a cut or wound. Patients may have nodules, ulcers, or draining sinuses on the skin. -
Bone and joint coccidioidomycosis
In this type the fungus settles in bones or joints. It can cause pain, swelling, and damage to the bone structure. Long-term treatment and sometimes surgery are often needed.
Causes (risk factors and situations)
The direct cause of coccidioidomycosis is always the same: breathing in fungal spores from the environment. But many different conditions and activities make this more likely or make disease more severe.
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Living in an endemic desert area
People who live in dry, dusty regions where the fungus is present in the soil are more likely to breathe in spores during normal daily life. Simple outdoor activities like walking or driving on dirt roads can expose them. -
Travel to an endemic region
A person can travel for work or vacation to an area where the fungus lives, get infected there, and then become sick after returning home. Because of this, doctors must ask about travel history when they see a patient with pneumonia that does not improve. -
Construction and excavation work
Heavy machines digging, grading, or building can break up soil and send large amounts of dust into the air. Workers at these sites and people nearby can breathe in a high dose of spores. -
Farming, gardening, and yard work
Plowing, planting, pulling weeds, or even using a leaf blower can disturb soil in smaller ways. These actions still release spores into the air, especially in dry, windy weather. -
Dust storms and strong winds
Natural events like dust storms, high winds, or tornado-like systems can carry spores over long distances. Infection rates often rise after periods of rain followed by dry, windy weather that makes soil easy to lift into the air. -
Earthquakes, landslides, and wildfires
Large ground-disturbing events can uncover and spread fungal spores from deeper soil layers. People involved in rescue, cleanup, or living nearby may breathe in more spores than usual. -
Military training, archeology, and outdoor sports
Activities that involve crawling, digging, or lying on the ground—such as military drills, archeologic digs, off-road biking, or endurance races—can create “personal dust clouds” around the face, increasing inhalation risk. -
Working with animals in dusty areas
Veterinarians, ranch workers, or animal handlers in endemic regions may be exposed when animals run, dig, or are moved, raising dust that contains spores. -
Weak immune system due to HIV or other diseases
People with low CD4 counts from HIV infection or other immune system problems cannot control the fungus well. They have a higher chance of severe or disseminated disease after exposure. -
Immune-suppressing medicines
Drugs such as high-dose steroids, chemotherapy, or biologic agents for autoimmune diseases reduce the body’s defenses. These patients may get more serious infection or reactivation of a past silent infection. -
Organ or stem-cell transplantation
Transplant patients take strong immune-suppressing drugs to prevent organ rejection. They may get coccidioidomycosis from new exposure or, rarely, from the donated organ if the donor had a silent infection. -
Diabetes mellitus
Diabetes changes how white blood cells work and worsens blood flow, making it harder to fight infections. People with diabetes have more severe coccidioidomycosis and more complications. -
Pregnancy, especially late pregnancy
During pregnancy the immune system and hormone levels change. In the third trimester and just after birth, pregnant people have a higher risk of severe and disseminated disease if they become infected. -
Older age
As people age, their immune response becomes weaker and other chronic illnesses become more common. Older adults are more likely to develop serious disease, lung cavities, or spread outside the lungs. -
Chronic lung disease and smoking
Conditions such as chronic obstructive pulmonary disease (COPD) or long-term smoking damage the airways and lung tissue. This damage makes it easier for the fungus to take hold and harder for the lungs to clear spores. -
Certain genetic and ethnic backgrounds
Studies show higher rates of severe or disseminated disease in people of Filipino or African ancestry, suggesting genetic factors in immune response. This is not about behavior, but about how the immune system recognizes the fungus. -
Laboratory exposure
People who work in microbiology labs may be exposed if culture plates or flasks containing Coccidioides are not handled in proper safety cabinets. The spores can become airborne during lab work. -
Direct skin inoculation (primary cutaneous infection)
Rarely, the spores enter through a cut, needle stick, or injury in the skin. This can cause a local skin infection without lung involvement, though this route is much less common than inhalation. -
Donor-derived infection in solid organ recipients
In very rare cases, the fungus is carried in a transplanted organ from a donor with unrecognized infection. The recipient then develops coccidioidomycosis after the transplant. -
Climate and environmental change
Changes in rainfall, temperature, and land use can shift where the fungus lives and how often spores become airborne. This can increase exposure for people living or working in those changing environments.
Symptoms –
Symptoms can be very mild or quite severe. Many people never know they were infected. Others have symptoms that look like common viral or bacterial infections, which can lead to delayed diagnosis.
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Fever
Fever is one of the most common signs. The immune system raises body temperature to fight the fungus. Patients may feel hot, chilled, or have sweats, especially in the evening. -
Cough
The infection starts in the lungs, so cough is frequent. It may be dry or produce mucus. Sometimes the cough is mild; in other cases it is stubborn and lasts for weeks, making people think they have a long “chest cold.” -
Chest pain
Patients often feel sharp pain in the chest that gets worse when they take a deep breath or cough. This can come from inflammation of the lung covering (pleura) or from infected lung areas near the chest wall. -
Shortness of breath
When lung tissue is inflamed or filled with fluid, it is harder to move air in and out. People may feel out of breath with walking, climbing stairs, or even at rest in more severe cases. -
Fatigue and weakness
Many patients feel very tired, even when fever is low. The immune response and inflammation use a lot of energy. This tiredness can last for months after other symptoms improve. -
Night sweats
People often wake up at night with damp clothes or sheets. Night sweats are a sign of ongoing inflammation and immune activity and are common in many infections, including coccidioidomycosis. -
Unintentional weight loss
Poor appetite, fever, and long-lasting inflammation can cause weight loss. Patients may notice looser clothes or see a drop in their weight over weeks or months. -
Headache
Headache can occur with the early flu-like illness. It becomes especially important if it is strong, persistent, or different from past headaches, because that may signal involvement of the brain or meninges. -
Skin rash (often erythema nodosum)
Some patients develop tender red bumps, usually on the shins. This reaction is called erythema nodosum. It is caused by the immune system reacting to fungal antigens and is often seen in women. -
Joint pain and swelling
Aching or swollen joints, especially in knees and ankles, are common. When joint pain occurs together with fever and erythema nodosum, doctors sometimes call the triad “desert rheumatism.” -
Muscle aches (myalgias)
People may feel generalized body aches, like with influenza. These muscle pains are part of the systemic response to infection and often appear early in the illness. -
Coughing up blood (hemoptysis)
In more severe lung disease, inflamed or damaged blood vessels in the airway can break, leading to blood in the sputum. This is a warning sign that needs urgent medical attention. -
Bone pain or swelling
When the fungus spreads to bones, patients can feel deep, localized pain, often in the spine, ribs, or long bones of arms and legs. There may be swelling or tenderness over the affected bone. -
Neurologic symptoms (meningitis or brain involvement)
Severe headache, neck stiffness, light sensitivity, confusion, or seizures may occur if the fungus infects the coverings of the brain or brain tissue. This is a medical emergency and needs rapid testing and treatment. -
Chronic or recurrent respiratory symptoms
Some patients have long-term cough, repeated lung infections, or symptoms that improve and then return. This can happen when the disease becomes chronic or when cavities or nodules remain and sometimes cause problems later.
Diagnostic tests
Doctors use a mix of history, physical exam, lab tests, and imaging to tell coccidioidomycosis apart from other lung and systemic diseases. No single test is perfect, so results are interpreted together.
Physical examination tests
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General physical exam and vital signs
The doctor checks temperature, heart rate, breathing rate, and blood pressure, and looks at the overall appearance. Fever, fast breathing, and looking ill suggest active infection. Weight loss, pale skin, or signs of dehydration may show long-lasting illness. -
Lung auscultation with a stethoscope
By listening to the chest, the doctor may hear crackles, decreased breath sounds, or other abnormal noises over infected lung areas. These clues help decide where to focus imaging and whether pneumonia or cavities may be present. -
Skin examination
The doctor looks for rashes such as erythema nodosum (tender red nodules) or other bumps, ulcers, or nodules that may represent skin involvement from disseminated disease. These findings support the diagnosis in the right setting. -
Neurological examination
If the patient has headache or other nervous system symptoms, the doctor tests reflexes, strength, sensation, eye movements, and neck stiffness. Abnormal findings may suggest meningitis or brain involvement and guide further tests like spinal tap or brain imaging.
Manual clinical tests
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Chest percussion
The doctor taps on the chest wall with the fingers and listens to the sound. Dull sounds may suggest fluid or dense infection in the lung, while more hollow sounds may suggest air-filled cavities. These simple bedside signs help interpret imaging results. -
Palpation of lymph nodes
The doctor feels for enlarged lymph nodes in the neck, armpits, or groin. Swollen, tender nodes can occur when the immune system reacts strongly or when the fungus spreads through the lymph system. -
Joint examination and range-of-motion testing
When patients report joint pain, the doctor gently moves each joint to check for swelling, warmth, and pain with movement. Objective joint inflammation supports syndromes like “desert rheumatism” in the context of other signs.
Laboratory and pathological tests
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Complete blood count (CBC) with differential
A CBC measures red cells, white cells, and platelets. In coccidioidomycosis there may be high white cell count and sometimes increased eosinophils. These findings are not specific but support infection and inflammation. -
Inflammatory markers (ESR and CRP)
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) rise in many infections. High levels in a patient with suspected coccidioidomycosis show strong inflammation and can be used over time to follow response to treatment. -
Enzyme immunoassay (EIA) serology for IgM and IgG antibodies
EIA blood tests look for antibodies that the immune system makes against Coccidioides. IgM usually appears early; IgG appears later and may rise with more severe disease. EIA is often the first test ordered because it is widely available and gives results quickly. -
Immunodiffusion (ID) antibody tests
ID tests are more specific blood tests that detect certain antibody types. They are often used to confirm positive EIA results and to help separate early from later infection patterns. They require more technical skill and may take longer. -
Complement fixation (CF) titers
CF tests measure the amount (titer) of specific antibody against the fungus. Higher titers generally suggest more severe or more widespread disease. Doctors may repeat CF titers over time to see whether the disease is getting better or worse. -
Antigen detection in blood, urine, or cerebrospinal fluid
Antigen tests look for pieces of the fungus itself rather than antibodies. They can be especially helpful in patients with weak immune systems who do not make strong antibodies, or in those with meningitis. -
Culture of respiratory specimens (sputum or bronchoalveolar lavage)
Samples from sputum or from fluid washed from the lungs during bronchoscopy can be sent to the lab. If the fungus grows in culture, it confirms the diagnosis. However, culture takes time and must be handled in special safety conditions because spores can escape into the air. -
Biopsy and histopathology with special stains
When there are skin lesions, bone lesions, or lung masses, a small tissue sample may be taken. Under the microscope, pathologists can see the characteristic spherules of Coccidioides using stains like silver or periodic acid–Schiff. This gives a very strong diagnosis.
Electrodiagnostic tests
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Electroencephalography (EEG)
EEG records electrical activity in the brain. It is not used to diagnose coccidioidomycosis itself, but it can help evaluate seizures or abnormal brain function in patients with suspected coccidioidal meningitis or brain involvement. This guides treatment choices and monitoring. -
Nerve conduction studies and electromyography (EMG)
If a patient with disseminated disease has numbness, tingling, or muscle weakness, nerve tests can be done. These studies check how well nerves carry electrical signals and how muscles respond, helping doctors see if nerves or muscles are being damaged by infection or inflammation.
Imaging tests
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Chest X-ray
A chest X-ray is often the first imaging test. In coccidioidomycosis it may show patchy lung consolidation (areas that look white), nodules, cavities, enlarged lymph nodes, or, in mild cases, may even look normal. The pattern can overlap with other infections, so it must be interpreted with lab results. -
Chest computed tomography (CT) scan
CT gives a more detailed 3-D view of the lungs. It can show small nodules, cavities, thick-walled lesions, or areas of lung destruction that are not obvious on X-ray. CT is especially useful in chronic or complicated cases and when surgery is being considered. -
Magnetic resonance imaging (MRI) of brain or spine
In patients with headaches, neurologic symptoms, or confirmed meningitis, MRI is used to look at the brain and spinal cord. It can show inflammation, fluid collections, or other complications, and helps doctors plan long-term antifungal treatment and, if needed, neurosurgical care.
Non-pharmacological treatments (therapies and other measures)
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Rest and activity pacing
Careful rest helps the body focus energy on fighting the infection, especially when fever, cough, and fatigue are strong. Patients are advised to avoid heavy work, sports, and long days until fever settles and breathing improves, then slowly increase activity according to how they feel each day. -
Adequate hydration
Drinking enough water, oral rehydration solutions, or clear soups helps replace fluid lost from fever, sweating, and rapid breathing. Good hydration improves blood flow, supports kidney function during illness, and can reduce headaches and weakness that often accompany Valley fever, especially in hot, dry climates where this infection occurs. -
Fever and pain control without prescription drugs
Cool compresses, lukewarm baths, loose clothing, and a fan can gently lower body temperature and ease discomfort. These methods support the natural cooling system of the skin and may reduce the need for higher drug doses in mild cases, while still keeping patients comfortable and able to sleep and eat. -
Breathing exercises and lung expansion techniques
Simple deep-breathing and incentive-spirometry exercises used in hospitals help open air sacs, improve oxygen exchange, and clear mucus from the lungs. Practicing slow, deep inhalations and controlled exhalations several times a day may reduce shortness of breath and lessen the risk of lung collapse or secondary bacterial pneumonia. -
Positioning and sleeping with head elevated
Using extra pillows or elevating the head of the bed can make breathing more comfortable, especially at night. Gravity reduces congestion and pressure in the chest and upper airways, which may ease cough and help patients sleep better, an important factor in immune recovery and energy restoration. -
Cough hygiene and airway protection
Covering the mouth when coughing, using tissues, and washing hands lower the spread of respiratory germs and protect close contacts who may already be vulnerable. Humidified air and warm fluids like herbal tea can soothe irritated airways, making coughs more productive and less painful without adding extra medications. -
Pulmonary rehabilitation strategies
In people with chronic lung problems after Valley fever, supervised pulmonary rehab programs use graded exercise, breathing training, and education to raise endurance. These programs aim to improve walking distance, reduce breathlessness, and help patients return to work or normal daily tasks more safely and confidently over time. -
Nutritional counseling and balanced diet
Dietitians can design meals rich in protein, healthy fats, vitamins, and minerals to maintain body weight and support immune responses. Adequate calories prevent muscle wasting, while micronutrients such as vitamin D, zinc, and selenium are important for normal immune cell function, though they do not replace antifungal drugs. -
Smoking cessation
Stopping tobacco use is crucial because smoking irritates lung tissue, slows mucus clearance, and worsens cough and breathlessness. Quitting improves oxygen delivery and lung defense cells, and can reduce the risk of chronic lung damage in patients who had severe pulmonary coccidioidomycosis or pre-existing lung disease like COPD or asthma. -
Limiting alcohol use
Excessive alcohol harms liver function, which is needed to process many antifungal drugs and other medicines. Reducing or avoiding alcohol lowers the chance of drug-induced liver injury and helps the immune system work better, making medical treatment safer and more effective over the long treatment courses sometimes required. -
Stress reduction and mental health support
Chronic infection, long treatment, and fatigue can cause anxiety, low mood, and sleep problems. Counseling, support groups, mindfulness, and relaxation exercises help people cope with uncertainty and physical symptoms, indirectly supporting immune and hormonal balance that can be disturbed by long-term stress. -
Work modification and sick leave
Temporary changes in work duties, especially for outdoor workers in dusty areas, protect both the recovering patient and co-workers from heavy exposure. Employers can move people to indoor tasks, reduce physical burden, or grant sick leave so the patient can rest and avoid further inhalation of dust-borne spores. -
Environmental dust control around home
Keeping soil moist when gardening, using ground cover plants or gravel to reduce bare dirt, and avoiding leaf-blowing or dry sweeping can lower airborne dust. These actions may reduce the chance of breathing in fungal spores, particularly for high-risk patients living in endemic regions with frequent wind. -
Use of high-efficiency air filtration indoors
HEPA filters and well-maintained air-conditioning systems can reduce the level of dust and fungal particles inside homes and workplaces. This may be especially useful for people who are immunocompromised, pregnant, or have chronic lung disease and need extra protection from environmental exposures in endemic areas. -
Personal protective equipment for high-risk workers
Construction, farming, archaeology, and military training often disturb soil heavily. Wearing properly fitted N95 respirators, goggles, and protective clothing during dusty tasks lowers inhalation of spores and surface contamination, which is a key non-drug measure to protect workers who cannot avoid exposure completely. -
Early medical evaluation and regular follow-up
Seeing a healthcare professional soon after persistent cough, fever, or chest pain in endemic areas allows earlier testing and diagnosis. Regular follow-up visits with blood tests and imaging help detect complications such as spread to skin, bones, or meninges early, when interventions work better and are less risky. -
Vaccination against other infections (indirect support)
Keeping up-to-date with vaccines for influenza, pneumococcal disease, and COVID-19 can reduce additional respiratory infections that might worsen lung function. Preventing these illnesses lowers the overall burden on the immune system and lungs, which is especially important in people still recovering from coccidioidomycosis. -
Rehabilitation for bone or joint involvement
When the infection spreads to bones or joints, physical and occupational therapy focus on gentle range-of-motion exercises, bracing, and safe movement strategies. These therapies reduce stiffness, preserve function, and protect weakened bones or joints while systemic antifungal treatment works to control the infection. -
Skin and wound care in cutaneous disease
If skin lesions or draining sinuses develop, careful wound cleaning, sterile dressings, and protection from trauma help prevent secondary bacterial infection. Good skin care supports healing, reduces pain and odor, and keeps the area clean while systemic antifungals and, in some cases, surgery address the deep fungal focus. -
Education for patients and families
Clear explanations about Valley fever, expected course, red-flag symptoms, and the importance of adherence to medication and follow-up appointments empower patients. Education reduces fear, improves cooperation with long courses of antifungal therapy, and encourages preventive behaviors like dust avoidance and mask use in endemic regions.
Drug treatments
Important: Drug names, classes, and doses below are general information only. Exact medicine, dose, and duration must be decided by a qualified doctor based on age, kidney and liver function, pregnancy status, other medicines, and disease severity.
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Fluconazole (Diflucan) – triazole antifungal
Fluconazole is the most commonly used oral drug for many forms of coccidioidomycosis, including chronic lung disease and meningitis. Adults often receive 400–800 mg once daily, with higher doses up to 1200 mg in meningitis; it blocks fungal ergosterol synthesis, damaging the cell membrane. Main side effects include nausea, abdominal pain, liver enzyme elevation, and drug interactions. -
Itraconazole – triazole antifungal
Itraconazole is another oral azole used for bone, joint, or soft-tissue disease and sometimes for pulmonary infection when fluconazole is not suitable. Doses like 200 mg two or three times daily are used, best absorbed with food and acid. It inhibits ergosterol synthesis but can cause heart failure worsening, liver toxicity, and many drug interactions, so monitoring is essential. -
Amphotericin B deoxycholate – polyene antifungal
This older intravenous drug is reserved for severe or rapidly progressive disease, pregnancy with complicated infection, and life-threatening disseminated disease. It binds fungal cell membrane sterols, forming pores that lead to cell death. Doses are adjusted by weight and kidney function. Side effects include kidney injury, electrolyte loss, infusion-related fever and chills, and anemia, requiring close hospital monitoring. -
Liposomal amphotericin B (AmBisome) – lipid formulation
Liposomal amphotericin B delivers the same active compound in lipid vesicles, allowing higher doses with less kidney toxicity. It is used intravenously for severe pulmonary or disseminated infection and in some immunocompromised patients. Side effects include infusion reactions and liver and kidney test changes but are generally less intense than with standard amphotericin B. -
Amphotericin B lipid complex – lipid formulation
Amphotericin B lipid complex is another lipid form used for patients who cannot tolerate conventional amphotericin B due to kidney problems. It has similar mechanism but different pharmacokinetics, often given as once-daily infusions. Side effects include infusion-related pain, fever, and liver test abnormalities, but kidney toxicity is usually reduced. -
Posaconazole – triazole salvage therapy
Posaconazole is an extended-spectrum triazole used as rescue therapy in coccidioidomycosis that does not respond to or cannot tolerate fluconazole, itraconazole, or amphotericin B. It is given as delayed-release tablets or oral suspension, with dosing guided by blood levels. Side effects include liver enzyme elevations, GI upset, and many drug interactions via CYP3A4. -
Voriconazole – triazole salvage therapy
Voriconazole is sometimes used off-label for refractory coccidioidomycosis, especially in immunocompromised patients. It is available orally and intravenously, with doses adjusted by weight and drug levels. It inhibits fungal ergosterol synthesis but may cause visual disturbances, hallucinations, liver toxicity, and photosensitivity, so regular monitoring and sun protection are important. -
Isavuconazonium sulfate – triazole option
Isavuconazonium, a prodrug of isavuconazole, has activity against several systemic fungi and has been used for difficult coccidioidomycosis cases. It is given IV or orally, with loading doses followed by once-daily maintenance. Major side effects include liver test changes, infusion reactions, and QT-interval shortening, so heart monitoring and drug–drug interaction checks are needed. -
Ketoconazole – older azole (limited use)
Ketoconazole was historically used for coccidioidomycosis but is now rarely chosen because of strong liver toxicity risk and endocrine side effects. When used, it inhibits ergosterol synthesis like other azoles, but its risk–benefit profile is usually poorer than fluconazole or itraconazole, so guidelines favor newer agents instead. -
Nonsteroidal anti-inflammatory drugs (NSAIDs) – symptom relief
NSAIDs such as ibuprofen or naproxen do not kill the fungus but are widely used to relieve fever, chest pain, and joint pain in mild or recovering cases. They block cyclo-oxygenase enzymes, lowering prostaglandin production and inflammation. Side effects include stomach irritation, kidney strain, and bleeding risk, so medical supervision is important during prolonged use. -
Acetaminophen (paracetamol) – antipyretic and analgesic
Acetaminophen is often used to control fever and headache in Valley fever without the stomach irritation associated with many NSAIDs. It acts in the central nervous system to reduce pain and regulate body temperature. Overdose can cause serious liver damage, so total daily dose must stay within doctor-recommended limits and combination products must be checked carefully. -
Bronchodilators (e.g., inhaled albuterol)
In patients whose Valley fever worsens underlying asthma or causes airway spasm, inhaled short-acting beta-agonists like albuterol may ease wheeze and shortness of breath. These drugs relax smooth muscle in the airways, opening bronchial tubes within minutes. Common side effects include tremor and fast heartbeat, so dosing should follow a clinician’s plan. -
Cough suppressants and expectorants
For exhausting dry cough, doctors may prescribe short courses of cough suppressants, sometimes combined with expectorants to thin mucus. These agents act on cough reflex pathways or decrease mucus thickness, improving sleep and comfort. Misuse, especially of opioid cough medicines, can cause drowsiness, constipation, and dependence, so they should be used cautiously and briefly. -
Antiemetics for severe nausea
Some patients experience nausea from infection, fever, or antifungal drugs. Antiemetics such as ondansetron or promethazine help control vomiting by blocking serotonin or histamine pathways in the brain. Side effects can include constipation, headache, or sedation, and some agents affect heart rhythm, so ECG and drug-interaction checks may be required. -
Proton pump inhibitors or H2 blockers (with caution)
Acid-suppressing drugs may be prescribed to protect the stomach when using NSAIDs, but they can also affect absorption of itraconazole, which needs stomach acid. Decisions must balance stomach protection against antifungal effectiveness. Possible side effects include diarrhea, nutrient malabsorption, and, with long-term use, higher risk of certain infections. -
Electrolyte replacement (e.g., potassium, magnesium)
Intravenous amphotericin B often causes low potassium and magnesium, so supplements are routinely given. These electrolytes are vital for heart rhythm, muscle contraction, and nerve function. Replacement is carefully monitored with blood tests to avoid both low and high levels, which can cause dangerous heart problems. -
Intravenous fluids
In hospitalized patients with high fever, low blood pressure, or vomiting, IV fluids maintain blood pressure, kidney perfusion, and urine output. Solutions are chosen based on electrolytes and acid–base status. Too much fluid can cause swelling or lung congestion, so infusion rates are adjusted frequently according to vital signs and labs. -
Blood transfusion products (supportive)
Severe, prolonged infection or amphotericin B therapy can cause anemia, requiring red blood cell transfusion to improve oxygen delivery. Platelet or plasma transfusions may be needed if clotting problems develop. Transfusions carry risks such as allergic reactions and infection transmission, so they are used only when benefits clearly outweigh risks. -
Prophylactic antifungals in high-risk patients
In some very high-risk groups, such as organ-transplant recipients living in endemic regions, doctors may use antifungal medicines preventively to stop reactivation or new infection. Choice of drug, dose, and duration is individualized, balancing protection with side effects and interactions with immunosuppressive medications. -
Long-term suppressive azole therapy
Patients with meningitis or repeated relapses may need life-long azole therapy, often with daily fluconazole, to prevent recurrence. Continuous low-level drug exposure keeps fungal growth under control without fully eradicating every organism. Regular monitoring of liver tests, drug levels, and symptoms is required to adjust therapy safely over many years.
Dietary molecular supplements (adjuncts, not cures)
Supplements should never replace prescribed antifungal drugs. Always ask a doctor before starting them, especially if you take other medicines or have liver or kidney disease.
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Vitamin D
Vitamin D helps regulate innate and adaptive immunity and may support better responses to fungal infections, although direct evidence in coccidioidomycosis is limited. Many people in endemic areas have low levels. Supplement doses are usually tailored to blood tests; excess vitamin D can cause high calcium, kidney stones, and confusion, so medical guidance is needed. -
Vitamin C
Vitamin C acts as an antioxidant and supports normal function of white blood cells. In Valley fever, maintaining adequate vitamin C intake from food or modest supplements may help reduce oxidative stress, but it does not directly kill the fungus. Very high doses can cause stomach upset and, in some people, kidney stones. -
Zinc
Zinc is crucial for many enzymes in immune cells, including those that recognize and respond to pathogens. Deficiency can impair immunity, so correcting low zinc levels through diet or low-dose supplements may support host defense. Too much zinc, however, can cause nausea and interfere with copper balance, so doses must remain moderate. -
Selenium
Selenium participates in antioxidant systems and influences T-cell and antibody responses. Adequate selenium intake through diet or carefully dosed supplements may optimize immunity, but it does not replace antifungal therapy. Chronic overdosing can cause hair loss, nail changes, and nerve problems, so dosing must stay within recommended limits. -
Omega-3 fatty acids (EPA/DHA)
Omega-3 fats from fish oil have anti-inflammatory properties and may help modulate excessive inflammation during infection while preserving immune defense. They can improve triglyceride levels but may slightly increase bleeding tendency at high doses, especially with blood thinners, so coordinated care with a clinician is important. -
Probiotics
Probiotic bacteria may help maintain gut barrier function and immune cross-talk, which can be disturbed by antibiotics or prolonged illness. While not proven to treat Valley fever, they might reduce antibiotic-associated diarrhea and support general immunity. Certain strains can cause infection in severely immunocompromised people, so product choice and oversight matter. -
N-acetylcysteine (NAC)
NAC is a precursor of glutathione, a key antioxidant within cells, and is sometimes used to support liver function under medication stress. In theory, it may help counter oxidative stress from infection and drugs like amphotericin B, but high-quality data in coccidioidomycosis are lacking, so it should be used only under medical supervision. -
Curcumin (from turmeric)
Curcumin has anti-inflammatory and antioxidant effects in laboratory studies and may modulate immune signaling pathways. It can be considered as a food-based adjunct, such as using turmeric in cooking. Concentrated supplements can interact with blood thinners and may affect drug metabolism, so they are not recommended without clinician review. -
Quercetin
Quercetin is a plant flavonoid with antioxidant and anti-inflammatory actions in experimental models. It may support general immune balance, but there is no direct evidence for benefit in Valley fever. Large supplemental doses may cause headache or interact with certain medicines, so emphasis should remain on whole-food sources like fruits and vegetables. -
Multivitamin/mineral complex
For patients with poor appetite or long illness, a standard multivitamin/mineral supplement can help cover basic micronutrient needs. It is not a specific treatment for coccidioidomycosis but can prevent deficiencies that weaken immune responses. High-dose “mega” products are unnecessary and can be harmful, so simple, age-appropriate formulas are preferred.
Immunity-booster / regenerative / stem-cell–related therapies
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Granulocyte colony-stimulating factor (G-CSF, e.g., filgrastim)
G-CSF stimulates bone marrow to produce more neutrophils, which are critical for early defense against fungal infections. In selected immunocompromised patients with very low neutrophil counts and severe coccidioidomycosis, G-CSF may be used as an adjunct to antifungals. Side effects include bone pain, high white counts, and rare spleen problems. -
Granulocyte–macrophage colony-stimulating factor (GM-CSF)
GM-CSF promotes maturation of monocytes and macrophages that ingest and kill fungi. Experimental and case-based data suggest it could support host defenses in difficult fungal infections when standard therapy is failing. It is given by injection under close monitoring because it can provoke fever, bone pain, and inflammatory flares. -
Interferon-gamma therapy
Interferon-gamma is a cytokine that boosts Th1-type immune responses, important for intracellular pathogen control. It has been used as adjunctive therapy in some refractory systemic fungal infections, aiming to strengthen cellular immunity. Side effects include flu-like symptoms, mood changes, and liver enzyme changes, so use is restricted to specialist centers. -
Intravenous immunoglobulin (IVIG)
IVIG provides pooled antibodies from healthy donors and can modulate immune responses. In selected patients with antibody deficiencies or autoimmune complications, IVIG may help stabilize immunity while antifungals control the fungus. Risks include headache, thrombosis, kidney injury, and infusion reactions, so benefits must clearly justify its high cost and complexity. -
Hematopoietic stem cell transplantation (HSCT) in underlying diseases
Some people with severe inherited or acquired immune defects that predispose them to severe fungal infections may undergo HSCT to rebuild a healthier immune system. This is not a direct treatment for Valley fever but addresses the root immune problem. Transplant carries major risks, including graft-versus-host disease and severe infections. -
Experimental coccidioidomycosis vaccines and immunotherapies
Research is underway to develop vaccines and targeted immunotherapies that train T-cell responses against Coccidioides antigens, aiming to prevent or reduce severe disease. These approaches are still experimental and available only in clinical trials, but they represent “regenerative” ideas that harness the body’s own adaptive immunity for long-term protection.
Surgeries (procedures and why they are done)
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Surgical drainage of lung cavities or abscesses
Some patients develop persistent lung cavities that bleed, get infected, or rupture. Surgeons may open and drain these spaces or perform procedures like video-assisted thoracoscopic surgery to remove diseased tissue. The goal is to control bleeding, reduce bacterial superinfection, and improve breathing when cavities do not respond to medicine alone. -
Lobectomy or segmentectomy for localized destroyed lung
If one part of the lung is severely damaged, scarred, or repeatedly infected, doctors may remove that lobe or segment. This operation aims to eliminate a chronic source of symptoms and reduce risk of life-threatening bleeding or repeated pneumonia, while preserving as much healthy lung as possible. -
Debridement and stabilization of infected bone or joint
When coccidioidomycosis spreads to bones or joints, orthopedic surgeons may clean out infected material, remove dead bone, and sometimes insert hardware to stabilize fractures. Combining surgery with long-term antifungal therapy helps relieve pain, protect function, and lower the risk of deformity or fracture from weakened bone. -
Neurosurgical procedures for meningitis complications
Coccidioidal meningitis can cause increased brain pressure or hydrocephalus. Surgeons may place a shunt to drain cerebrospinal fluid from the brain to the abdomen, or perform other decompressive procedures. These operations relieve pressure, prevent brain damage, and allow antifungal drugs to work more effectively over time. -
Excision of severe skin or soft-tissue lesions
Large, painful, or draining skin lesions may be surgically removed to reduce fungal burden, close chronic fistulas, and improve function and appearance. Surgery is always combined with systemic antifungal therapy to prevent recurrence and is carefully planned to minimize scarring and maintain mobility in affected areas.
Prevention tips
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Avoid dust storms and high-wind outdoor activity in endemic areas
Staying indoors with windows closed during dust storms reduces exposure to airborne spores. People should also avoid driving with windows open through obvious dust clouds or near construction sites in Valley fever regions. -
Limit soil-disturbing activities when possible
Gardening, digging, and using leaf blowers or dry sweeping raise dust that may carry spores. Wetting soil before working and choosing low-dust landscaping can help reduce airborne particles and infection risk. -
Use appropriate masks for dusty work
Workers who must disturb soil should use well-fitted N95 respirators rather than simple cloth or surgical masks. This helps filter out tiny spores and is an important occupational health measure in agriculture, construction, and military training. -
Control dust in workplaces
Employers can use water sprays, soil stabilizers, tarps, and enclosed vehicle cabs with filtered air to reduce dust. These engineering controls lower exposure to Coccidioides and other harmful particles for everyone on the site. -
Improve indoor air quality
Using HEPA filters, keeping windows closed during dust events, and maintaining ventilation systems reduce indoor dust levels. These measures are especially useful for high-risk people such as transplant recipients and those on strong immune-suppressing drugs. -
Protect skin injuries
Although infection is usually inhaled, keeping cuts clean and covered while working with soil helps prevent unusual skin entry. Washing with soap and water and using bandages are simple but effective skin-protection habits. -
Educate high-risk groups
People with HIV, organ transplants, pregnancy, diabetes, or on immune-suppressing drugs should be informed about Valley fever symptoms and prevention. Early recognition and medical evaluation can prevent more serious disease. -
Consider relocation or seasonal changes for extreme risk
In rare cases of very high personal risk, doctors may discuss spending less time in highly endemic areas during dustiest seasons. Any decision should balance family, work, and health needs, and is made individually with specialist advice. -
Plan immunosuppression carefully
Before starting strong immune-suppressing medicines in endemic regions, doctors may screen for prior infection and adjust prevention strategies. This may include closer monitoring or preventive antifungal therapy in selected cases. -
Support research and surveillance
Public health programs that track cases, study environmental risk, and support vaccine research help communities respond better to Valley fever. Awareness campaigns inform clinicians and the public, improving early diagnosis and treatment outcomes.
When to see a doctor
Anyone living in or visiting a Valley fever area who develops a flu-like illness that lasts more than 1–2 weeks, especially with persistent cough, chest pain, or extreme fatigue, should see a clinician and mention possible coccidioidomycosis exposure. Early testing with blood tests and imaging can confirm the diagnosis and rule out other conditions.
Urgent medical care is needed if you experience trouble breathing, very high fever, coughing up blood, severe chest pain, confusion, intense headaches, stiff neck, or new neurological symptoms like weakness or seizures. These may signal disseminated disease or meningitis, which require rapid hospital care and intravenous antifungals.
People with weak immune systems, pregnancy, diabetes, organ transplants, or HIV should seek prompt care even for milder symptoms, because they are more likely to develop severe disease. Long-term follow-up is important after diagnosis to monitor for relapse, persistent lung changes, or spread to other organs.
What to eat and what to avoid
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Choose a balanced diet rich in vegetables, fruits, whole grains, lean proteins, and healthy fats to support immune function and tissue repair during and after infection.
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Include protein sources such as beans, lentils, eggs, dairy, poultry, or fish to help maintain muscle mass, especially if illness has caused weight loss and fatigue.
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Drink plenty of water and oral rehydration fluids; avoid sugary sodas and energy drinks, which can worsen blood sugar control and provide little nutritional value.
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Limit alcohol, which strains the liver and may worsen side effects of antifungal drugs and other medicines; completely avoid it if your doctor advises.
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Avoid crash diets and fasting, which can weaken immunity; instead, eat small frequent meals if appetite is low, focusing on nutrient-dense foods.
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Reduce highly processed foods high in trans fats, salt, and added sugar, as they promote inflammation and provide few vitamins or minerals.
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If you have diabetes or metabolic syndrome, follow medical nutrition advice carefully, as good glucose control improves infection outcomes and wound healing.
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Take supplements only after discussing them with your healthcare provider to avoid harmful interactions with antifungal or other medications.
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If nausea is a problem, try bland, low-fat foods like toast, bananas, rice, and clear soups in small portions, gradually increasing variety as symptoms improve.
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In severe illness or weight loss, a dietitian can create a personalized meal plan or recommend medical nutrition drinks to ensure adequate energy and protein intake.
Frequently asked questions (FAQs)
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Is coccidioidomycosis contagious from person to person?
No. Valley fever is almost always acquired by breathing in fungal spores from the environment, not from other people. Standard contact with infected individuals is safe, though good cough hygiene is still important to prevent other respiratory viruses. -
Can a healthy person recover without antifungal drugs?
Many healthy people with mild disease recover with rest, fluids, and symptom control alone. However, only a doctor can decide whether drugs are needed, based on severity, risk factors, and test results, so medical assessment is always recommended. -
How long do symptoms usually last?
Symptoms such as cough and fatigue may last weeks to several months, even with treatment. Some people develop prolonged tiredness similar to post-viral syndromes, but most gradually improve over time with appropriate care and follow-up. -
Can Valley fever come back after treatment?
Yes. Relapse can occur, especially in people with meningitis or weak immune systems, which is why long-term or lifelong azole therapy and regular monitoring may be needed. Missing doses or stopping medicines early increases relapse risk. -
Does infection give lifelong immunity?
Many people who recover develop strong protective immunity and are unlikely to get sick again, although complete protection is not guaranteed. This natural immunity is one reason vaccine research focuses on mimicking the body’s successful T-cell responses. -
Is there a vaccine for coccidioidomycosis?
There is currently no licensed human vaccine, but experimental vaccines are being studied in animals and early-phase research. Until a safe, effective vaccine exists, environmental precautions and early diagnosis remain key prevention strategies. -
Who is at highest risk for severe disease?
People with HIV, organ transplants, hematologic cancers, pregnancy (especially third trimester), long-term steroids, some genetic immune defects, and certain ethnic backgrounds have a higher risk of disseminated and life-threatening disease. -
Can children get Valley fever?
Yes, children can be infected, though severe disease is less common in otherwise healthy kids. However, infants and children with immune problems need prompt evaluation and careful follow-up, just like high-risk adults. -
What tests confirm the diagnosis?
Blood tests for specific antibodies, antigen detection, culture, and molecular tests, along with chest X-ray or CT scans, are commonly used to diagnose and stage disease. Doctors may also test spinal fluid, bone, or skin samples in complicated cases. -
How long must antifungal treatment continue?
Treatment duration varies widely—from a few months for uncomplicated pulmonary disease to lifelong therapy for meningitis. Decisions depend on symptoms, imaging, antibody titers, and immune status, all interpreted by specialists. -
Can I work while being treated?
Many people can continue work with adjustments, especially if tasks are not physically demanding or dusty. Those in high-dust jobs may need temporary reassignment or sick leave until they recover and risk of exposure is lower. -
Is pregnancy especially risky with Valley fever?
Pregnancy, particularly in later trimesters, is associated with increased risk of severe and disseminated disease, and treatment decisions are more complex. Pregnant patients with suspected Valley fever should be managed by specialists familiar with both maternal–fetal health and fungal infections. -
Can pets get coccidioidomycosis?
Yes, dogs and some other animals can develop Valley fever, with symptoms like cough, weight loss, and lameness. Veterinary care is required; treatment principles are similar, with antifungal medicines and long-term monitoring. -
Does climate change affect Valley fever risk?
Warming temperatures and changing rainfall patterns may expand areas where Coccidioides can live and increase dust events, potentially raising case numbers. Public health authorities are watching these trends to prepare healthcare systems. -
Can lifestyle changes alone cure coccidioidomycosis?
No. While rest, nutrition, and environmental precautions are very important, they cannot replace antifungal medicines when treatment is indicated. Only a qualified healthcare professional can decide on the right combination of drugs and supportive measures for each patient.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: February 01, 2025.
