California Disease

California disease is another name for coccidioidomycosis, also called Valley fever. It is an infection caused by a fungus called Coccidioides that lives in dry soil in parts of California, Arizona, and other desert areas of the Americas. When the soil is disturbed by wind, farming, or construction, tiny fungal spores go into the air. People can breathe these spores into their lungs and get sick. California disease mainly starts as a lung infection. Many people have no symptoms or only mild flu-like illness. In some people, the disease can become more serious, last a long time, or spread from the lungs to other parts of the body such as skin, bones, joints, or the brain coverings (meninges).

California disease is another common name for coccidioidomycosis (Valley fever), a lung infection caused by breathing in tiny fungal spores called Coccidioides immitis or C. posadasii. These fungi live in dry, dusty soil in parts of California, Arizona, and other areas of the southwestern United States and the Americas.[1] People inhale the spores when soil is disturbed by wind, farming, construction, or dust storms, and the spores settle in the lungs. Many people never get sick, but others develop flu-like illness, pneumonia, or severe disease that can spread to the skin, bones, joints, and brain.[2]

Typical symptoms include tiredness, cough, fever, chest pain when breathing, shortness of breath, night sweats, joint or muscle pain, and sometimes a reddish bumpy rash on the legs or upper body.[3] The disease is not contagious; you cannot catch it from another person or from animals. Most mild infections get better without medicine, but some people—especially those with weak immune systems, pregnancy, older age, or certain ethnic backgrounds—need strong antifungal drugs for months or even years.[4]

Most infections get better on their own, but a small number of people can develop chronic lung problems or “disseminated” disease (disease spread outside the lungs). People with weak immune systems, pregnant women, and some ethnic groups have a higher chance of severe disease.

Other names for California disease

Doctors and health agencies use several names for this disease. All of the names below refer to infection with the Coccidioides fungus:

• Coccidioidomycosis – the main medical name.

• Valley fever – common name, often used in California and Arizona.

• San Joaquin Valley fever – older name, used because many cases happen in California’s San Joaquin Valley.

• Desert fever – name used in dry desert areas where the fungus lives.

• Desert rheumatism – used when the disease causes fever, joint pain, and painful skin bumps.

• Cocci – short nickname used by many doctors and patients.

These names all describe the same infection caused by breathing in Coccidioides spores from dust.

Types of California disease (coccidioidomycosis)

Doctors usually describe California disease in several forms or types, based on how far it has spread and how long it lasts.

1. Silent or asymptomatic infection
   Many people breathe in the spores and never feel sick. The immune system kills the fungus quietly. These people may only show a positive blood or skin test in the future, but there are no symptoms.

2. Acute (early) pulmonary California disease
   This is the most common type. It starts in the lungs and looks like a flu or mild pneumonia, with cough, fever, chest pain, and tiredness. Most people get better within weeks to a few months, even without special treatment.

3. Chronic pulmonary California disease
   In some people, especially those with lung problems or weak immunity, the lung infection does not fully clear. Symptoms can last for months or years, such as chronic cough, weight loss, and night sweats. Lung scars, nodules, or cavities may form.

4. Disseminated California disease
   In this serious form, the fungus spreads outside the lungs through the blood. It can affect skin, bones, joints, lymph nodes, and other organs. People may develop skin sores, bone pain, joint swelling, or abscesses. This form needs urgent medical care and usually long-term antifungal treatment.

5. Coccidioidal meningitis
   Sometimes the fungus reaches the brain coverings and causes meningitis. Symptoms may include severe headache, stiff neck, confusion, and vision changes. This is a life-threatening condition and requires long-term or lifelong antifungal therapy.

Causes and risk factors of California disease

The direct cause of California disease is breathing in tiny fungal spores from Coccidioides in dusty air. However, many conditions and activities increase the chance of infection or of severe disease.

1. Living in dry, dusty areas where the fungus lives
   The fungus grows in dry, sandy soil in parts of California, Arizona, New Mexico, Texas, and some countries in Central and South America. People who live there breathe dusty air more often, so they have a higher risk.

2. Working in farming or ranching
   Plowing, harvesting, and moving soil on farms can send spores into the air. Farmers, ranch workers, and field laborers often breathe in more dust and therefore more spores.

3. Construction and excavation work
   Jobs that dig or move earth, like building roads, pipelines, or houses, disturb deep soil layers that may contain the fungus. This raises exposure for construction workers and people living nearby.

4. Military training in dusty outdoor areas
   Marching, crawling, and training in dusty fields can expose soldiers to spores, especially during dry seasons in endemic regions.

5. Outdoor sports and recreation in deserts
   Activities like off-road driving, dirt biking, horseback riding, or hiking in windy deserts stir up dust. People can then inhale spores without knowing.

6. Dust storms and strong winds
   Wind can carry dust and spores far from where they started. Dust storms after long dry periods are linked with spikes in Valley fever cases.

7. Recent heavy rain followed by dry weather
   Rain helps the fungus grow in the soil. When the weather turns hot and dry again, the soil cracks and dust full of spores can easily go into the air.

8. Gardening and yard work in endemic areas
   Digging in the garden, pulling weeds, or planting trees can disturb soil that contains spores, especially around homes in endemic regions.

9. Prison or institutional settings in endemic valleys
   Some prisons and large institutions are built in high-risk valleys. People living or working there may face higher exposure to outdoor dust.

10. Having a weak immune system
    People with HIV, cancer, organ transplant, or those taking high-dose steroids or other immune-suppressing medicines have more trouble fighting off the fungus and are more likely to get severe disease.

11. Pregnancy, especially in later months
    Hormonal and immune changes in pregnancy can make it harder to control the infection. Pregnant women in endemic areas have higher risk of severe or disseminated coccidioidomycosis.

12. Older age
    Older adults have weaker immune responses and more chronic illnesses. This makes it harder for the body to clear the fungus and easier for complications to develop.

13. Chronic lung disease
    Conditions like COPD, asthma, and previous TB scars damage the lungs and reduce their defense. This can increase the risk of chronic pulmonary Valley fever.

14. Diabetes and other chronic illnesses
    Diabetes and some other long-term diseases weaken immune function and healing, making it harder to fight fungal infections effectively.

15. Certain ethnic backgrounds
    People of African, Filipino, or some Asian heritage have higher rates of severe and disseminated forms. The exact reason is not fully understood, but genes and immune responses may play a role.

16. Smoking
    Smoking damages lung tissue and cilia (tiny hairs) that help clear particles. This may increase the chance of lung infection lasting longer.

17. Living or working with animals in dusty areas
    Pets and farm animals can bring dust indoors on their fur. Handling them in dusty barns or pens can add to exposure, though people do not “catch” the disease directly from animals.

18. Laboratory exposure
    People who work with Coccidioides cultures in labs can be exposed if safety procedures fail. For this reason, strict biosafety rules are used.

19. Travel to endemic regions
    Even short trips to high-risk areas can lead to infection if someone is outdoors during dusty conditions. Symptoms may appear after the person returns home.

20. Not using protection in dusty conditions
    Not wearing masks or not staying indoors during wind and dust events in endemic regions increases the chance of breathing spores.

Symptoms of California disease

Symptoms usually start 1–3 weeks after breathing in the spores. Many people have no symptoms. Others feel like they have the flu or pneumonia. Symptoms can be mild or severe.

1. Fever
   Many patients develop a moderate fever. It may go up and down over days or weeks. Fever is the body’s way of trying to kill the fungus.

2. Cough
   A dry or slightly phlegmy cough is common. This happens because the lungs are irritated by the fungus and inflammation.

3. Shortness of breath
   Some people feel they cannot take a deep breath, especially when walking or climbing stairs. This is due to inflammation or infection in the lung tissue.

4. Chest pain
   There may be sharp pain in the chest, especially when taking a deep breath or coughing. This can come from irritation of the lining around the lungs.

5. Tiredness and weakness (fatigue)
   People often feel very tired, even after resting. The immune system uses a lot of energy to fight the fungus, which can cause deep fatigue.

6. Headache
   A dull or throbbing headache is common in the early phase. In rare severe cases, strong headaches can signal meningitis if the infection spreads to the brain coverings.

7. Night sweats
   People may wake up with soaked clothes or bedding. This happens when the body is fighting infection and the temperature is changing.

8. Muscle aches and body pains
   General body pain, like flu aches, is common. It reflects widespread inflammation and immune response.

9. Joint pain and stiffness
   Painful, swollen joints, especially in ankles, knees, or wrists, can occur. When this happens along with fever and rash, it is sometimes called “desert rheumatism.”

10. Skin rash or painful red bumps
    Some people develop a red, raised rash or tender red lumps (often on the legs). These lumps are called “erythema nodosum” and show that the immune system is very active.

11. Weight loss and poor appetite
    In longer-lasting cases, people may lose weight because they feel too ill to eat or because chronic inflammation changes metabolism.

12. Persistent or chronic cough
    If the infection does not fully clear, the cough may last for months. This can signal chronic pulmonary disease or lung cavities.

13. Bone and joint swelling in disseminated disease
    When the fungus spreads to bones or joints, there can be deep bone pain, swelling, and difficulty walking or using the limb.

14. Skin ulcers or draining sores in severe cases
    Disseminated disease can cause long-lasting skin sores or lumps that may drain fluid. These need specialist care.

15. Severe headache, stiff neck, or confusion (meningitis signs)
    In rare but very serious cases, the infection reaches the brain coverings. Symptoms include strong headache, stiff neck, vomiting, confusion, or behavior changes. This is a medical emergency.

Diagnostic tests for California disease

Doctors cannot reliably tell California disease apart from other lung infections just by symptoms. They use a mix of questions, examination, blood tests, and imaging studies to confirm the diagnosis.

Physical examination tests

1. General vital signs check
   The doctor measures temperature, heart rate, breathing rate, and blood pressure. Fever, fast breathing, or fast heart rate can suggest serious infection and help decide if hospital care is needed.

2. Lung listening with a stethoscope
   The doctor listens to the chest for crackles, wheezes, or areas where breath sounds are reduced. These sounds can suggest pneumonia, fluid, or lung cavities linked with Valley fever.

3. Chest inspection and tapping (percussion)
   The doctor looks at how the chest moves when you breathe and lightly taps over the ribs. Dull sounds or uneven movement can point to lung consolidation or fluid related to the fungal infection.

4. Full body exam for rash, joint swelling, and lymph nodes
   The doctor looks for skin rashes or red tender bumps, checks joints for swelling, and feels for enlarged lymph nodes. These findings may suggest disseminated or strong immune forms of California disease.

Manual or bedside tests

5. Simple walking or exertion test
   The patient may be asked to walk in the hallway or climb a few steps while the doctor watches breathing and checks oxygen levels. Worsening shortness of breath during light activity can point to significant lung involvement.

6. Pain and cough assessment (history-based test)
   The doctor asks detailed questions about when the cough and chest pain started, what makes them better or worse, and how long symptoms last. Long-lasting symptoms after travel or work in dusty endemic areas raise suspicion of Valley fever.

7. Joint range-of-motion check
   For patients with joint pain, the doctor moves joints through different positions. Painful or limited motion, especially in ankles and knees, can match “desert rheumatism” related to coccidioidomycosis.

8. Neurologic bedside exam
   In people with strong headaches or behavior changes, the doctor checks reflexes, eye movements, strength, and balance. Abnormal findings can suggest possible meningitis or brain involvement that requires urgent imaging and spinal fluid tests.

Laboratory and pathological tests

9. Complete blood count (CBC)
   This blood test measures white blood cells, red blood cells, and platelets. In California disease, there may be higher white cells, anemia, or raised eosinophils, which can support the idea of a fungal infection but is not specific.

10. Inflammation markers (ESR and CRP)
    Blood tests such as ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) can be raised in active infection. Very high levels may suggest more severe or disseminated disease.

11. Coccidioides antibody blood tests (IgM and IgG serology)
    This is the main lab test. The lab looks for special proteins (IgM and IgG antibodies) that the body makes against Coccidioides. IgM often appears first, then IgG. A positive test strongly supports the diagnosis of California disease.

12. Complement fixation (CF) and other titer tests
    Some blood tests measure how strong the antibody response is by giving a “titer” number. Higher titers often mean more active or widespread disease and help doctors follow progress over time.

13. Antigen detection tests
    In some labs, tests look for pieces of the fungus (antigens) directly in blood, urine, or other body fluids. These tests can be useful in severe cases or in patients with weak immune systems.

14. Sputum smear and culture
    The lab examines mucus that is coughed up from the lungs. Under the microscope and in culture, they may see or grow Coccidioides organisms. This provides direct proof of the fungus but can take time and must be handled carefully.

15. Bronchoscopy with lavage
    If sputum is not helpful, doctors may pass a thin tube into the lungs to wash an area and collect fluid (bronchoalveolar lavage). The lab then looks for the fungus in that fluid. This is more invasive but useful in unclear or severe cases.

16. Tissue biopsy and histopathology
    In cases with lung nodules, skin lesions, or bone problems, doctors may remove a small piece of tissue. Under the microscope, the pathologist looks for the classic round fungal structures of Coccidioides, which confirms the diagnosis.

17. Coccidioides skin test (delayed-type test)
    A small amount of fungal protein is injected into the skin to see if the immune system reacts. A positive skin test can show past or present infection but is not used everywhere and cannot replace blood tests for active disease.

Electrodiagnostic test

18. Electroencephalogram (EEG) in suspected meningitis
    EEG records brain electrical activity using small scalp electrodes. It is not used to diagnose the fungus itself, but in patients with seizures or confusion from possible coccidioidal meningitis, EEG can show abnormal brain activity and help guide treatment.

Imaging tests

19. Chest X-ray (CXR)
    This is usually the first imaging test. It can show areas of pneumonia, lung nodules, cavities, or scarring linked to California disease. Doctors use it to support diagnosis and to follow changes over time.

20. Chest CT (computed tomography) scan
    CT gives more detailed pictures than X-ray and can better show nodules, cavities, or lymph node enlargement. It is helpful when the X-ray is unclear or when doctors are worried about chronic or complicated lung disease.

21. MRI or CT of brain and spine (for meningitis or spread)
    When doctors suspect that the fungus has reached the brain or spine, they may order MRI or CT scans. These images can show swelling, fluid, or other changes that support a diagnosis of coccidioidal meningitis or bone disease around the spine.

Non-pharmacological treatments (therapies and other measures)

Each point explains what it is, its purpose, and simple mechanism in easy English.

1. Rest and energy management
   Rest gives your body strength to fight the infection. The purpose is to reduce strain on the heart and lungs so your immune system can focus on killing the fungus. Mechanically, less activity lowers oxygen demand and inflammation, which can ease cough, fever, and chest pain.[2]

2. Adequate fluids and warm drinks
   Drinking water, oral rehydration, and warm herbal teas helps replace fluid lost from fever and sweating. The purpose is to prevent dehydration and keep mucus thin. Thin mucus is easier to cough up, helping clear fungal material and reduce lung irritation.[3]

3. Breathing exercises (diaphragmatic and pursed-lip breathing)
   Simple breathing drills strengthen the breathing muscles and open small airways. The purpose is to improve oxygen levels and reduce shortness of breath. These techniques slow breathing, keep airways open longer, and help move trapped air and mucus out of the lungs.[3]

4. Positioning and pacing activities
   Sitting upright, using pillows, and avoiding lying flat can reduce breathlessness. The purpose is to let gravity help the lungs expand. Better lung expansion improves airflow, gas exchange, and comfort while walking or doing daily tasks.[2]

5. Pulmonary rehabilitation (under therapist supervision)
   A structured program of gentle exercise, breathing training, and education can help people with chronic or severe lung involvement. The purpose is to build stamina safely. Over time, it improves muscle efficiency, reduces fatigue, and teaches coping strategies for breathlessness.[3]

6. Chest physiotherapy and airway clearance techniques
   Techniques such as gentle chest percussion, huff coughing, and positive-pressure devices help clear sticky sputum. The purpose is to reduce blockages and lower the risk of secondary bacterial infections. Mechanically, they loosen mucus and push it toward larger airways to be coughed out.[6]

7. Humidified air and warm steam (used safely)
   Using a clean humidifier at home can moisten dry air. The purpose is to soothe irritated airways and ease coughing. Moist air keeps mucus from drying out and reduces throat discomfort, but devices must be cleaned regularly to prevent mold growth.[3]

8. Avoiding dust and soil exposure
   People in endemic areas are advised to avoid construction sites, farming dust, and dust storms as much as possible. The purpose is to reduce inhalation of Coccidioides spores that can trigger new or recurrent infections. Mechanically, fewer spores in the air mean fewer fungal particles reaching the lungs.[1]

9. N95 or similar respirator use in high-risk dusty jobs
   Workers who cannot avoid dust (construction, agriculture, military training) can use a well-fitted N95 respirator. The purpose is to filter out airborne spores. The mask’s fine filter traps fungal particles before they reach the mouth and nose.[2]

10. Indoor air filtration and closed windows during dust storms
    Using HEPA filters, closing windows, and running air conditioning on recirculation mode limit the entry of outdoor dust. The purpose is to lower indoor spore levels. Filters physically capture particles so that indoor air is cleaner and safer to breathe.[2]

11. Smoking cessation and avoiding second-hand smoke
    Stopping cigarettes and vaping protects already stressed lungs. The purpose is to reduce airway damage and improve healing. Cigarette smoke destroys cilia (tiny hairs that move mucus), so quitting allows cilia to recover and clear fungal debris more effectively.[3]

12. Blood sugar and chronic disease control
    Managing diabetes, kidney disease, HIV, and other chronic problems makes the immune system stronger. The purpose is to reduce the risk of severe or disseminated coccidioidomycosis. Good control improves white blood cell function and reduces long-term complications from the infection.[4]

13. Weight management and gentle physical activity
    Maintaining a healthy weight with gradual, supervised exercise supports breathing and heart function. The purpose is to improve endurance without over-exertion. Over time, better cardiovascular fitness helps the body tolerate mild lung scarring or chronic symptoms.[3]

14. Stress reduction and mental health support
    Long illness can cause anxiety and depression. Counseling, relaxation techniques, meditation, and support groups help people cope. Stress hormones can weaken immune responses; lowering stress may indirectly help the body clear infection and improve sleep quality.[5]

15. Good sleep hygiene
    Regular sleep times, a quiet dark room, and avoiding screens and caffeine late at night help improve sleep. The purpose is to support immune repair and hormone balance. During deep sleep, the body releases substances that coordinate immune cells and tissue healing.[5]

16. Infection-control habits (handwashing and mask use when sick)
    While Valley fever itself is not contagious, handwashing, masking, and staying home when ill prevent additional viral or bacterial infections. Avoiding “extra” infections keeps the immune system focused on the fungal disease and reduces the chance of pneumonia from other germs.[4]

17. Physiotherapy for bone and joint involvement
    When coccidioidomycosis affects bones or joints, supervised physical therapy maintains motion and strength. The purpose is to prevent stiffness and disability. Gentle exercises protect joint cartilage, strengthen surrounding muscles, and improve daily function.[3]

18. Skin care for cutaneous lesions
    For skin involvement, careful cleaning, non-irritating dressings, and protection from trauma are important. The purpose is to prevent secondary bacterial infection and scarring. Clean dressings create a moist but protected environment that allows the skin to repair.[2]

19. Vaccination against other respiratory infections (as advised)
    Vaccines against flu, COVID-19, and pneumococcal bacteria do not prevent Valley fever, but they reduce other lung infections that can worsen breathing. This lowers hospitalizations and gives the body more reserve to handle coccidioidomycosis.[4]

20. Education and early-care plans
    Learning the warning signs of relapse or dissemination and having a written plan with your doctor improves outcomes. People who know when to seek care can start antifungals earlier, which reduces the risk of severe lung damage and meningitis.[1]

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Drug treatments

Only doctors can choose the right drug, dose, and duration. Below are widely discussed options for coccidioidomycosis; many antifungals are standard of care even when used “off-label” in the U.S.[4][6]

1. Amphotericin B deoxycholate
   Amphotericin B is a classic “gold standard” polyene antifungal for severe or rapidly progressive coccidioidomycosis. It is usually given by IV in hospital at around 0.7–1.0 mg/kg/day under close monitoring.[6][7] It binds to fungal cell membrane sterols, forming pores that leak cell contents and kill the fungus. Major side effects include fever, chills, kidney injury, anemia, and electrolyte disturbances, so kidney function and blood salts must be checked often.[6][8][16]

2. Liposomal amphotericin B (and other lipid formulations)
   Liposomal and lipid-complex forms of amphotericin B deliver the same active drug in a fat-based carrier to reduce kidney toxicity. Usual IV doses for severe disease are higher (for example, 3–5 mg/kg/day) than deoxycholate but with better tolerability.[3][6][12] The mechanism is the same—binding ergosterol in fungal membranes—while the lipid shell changes distribution and lowers damage to human cells.

3. Fluconazole (oral or IV)
   Fluconazole is a triazole antifungal often used as first-line therapy for mild to moderate pulmonary or disseminated coccidioidomycosis, especially for long-term treatment.[6][14][23] Typical adult doses are 400–800 mg once daily, adjusted for kidney function, sometimes higher in meningitis; it blocks fungal ergosterol synthesis. Side effects include nausea, abdominal upset, liver enzyme elevations, and interactions with other drugs that use liver enzymes.[6][9][10]

4. Itraconazole
   Itraconazole is another triazole used as an alternative to fluconazole, particularly for bone or joint disease. Usual doses are about 200 mg twice daily (sometimes higher), taken with food or an acidic drink to improve absorption.[6][14][10] It also blocks ergosterol synthesis. Side effects include liver toxicity, gastrointestinal upset, and many drug interactions, so blood levels and liver tests may be monitored.

5. Ketoconazole (Nizoral) – highly restricted use
   Ketoconazole tablets are officially indicated in labeling for serious systemic fungal infections including coccidioidomycosis, but today they are reserved for situations where no safer antifungal is suitable because of serious liver toxicity risks.[3][17][19] Typical historic doses were 200–400 mg once daily. It inhibits ergosterol synthesis and many human liver enzymes, causing major drug interactions and risk of severe liver damage, so regulatory agencies strongly limit its use.[3][13][17]

6. Voriconazole
   Voriconazole is a newer triazole sometimes used off-label for difficult, disseminated, or refractory coccidioidomycosis. Dosing often starts with a loading dose followed by 200 mg twice daily in adults, adjusted for weight and liver function.[4][6] It inhibits ergosterol synthesis with good tissue penetration. Important side effects include visual disturbances, hallucinations, liver injury, skin sensitivity to sunlight, and strong drug interactions.

7. Posaconazole
   Posaconazole (tablets, suspension, or IV) is used for severe or refractory coccidioidomycosis when other azoles or amphotericin B fail or cannot be tolerated.[2][10][21][25] Typical tablet dosing is 300 mg twice on day one, then 300 mg once daily with food. It also targets ergosterol synthesis. Side effects include liver enzyme elevations, nausea, and potential heart rhythm changes (QT prolongation).

8. Isavuconazonium / isavuconazole
   Isavuconazonium (converted to isavuconazole in the body) is an azole approved for invasive aspergillosis and mucormycosis, but it has been used off-label in complex coccidioidomycosis cases.[3][18][22] Dosing usually involves IV or oral loading then 200 mg (isavuconazole) every 8–24 hours depending on the regimen. It shortens the QT interval rather than prolonging it, and side effects can include liver issues and gastrointestinal upset.

9. Adjunctive corticosteroids (highly specialized use)
   In rare situations with life-threatening inflammation, such as severe meningitis or spinal cord compression, specialists may add corticosteroids like dexamethasone for a short time. The purpose is to rapidly reduce swelling around the brain or spinal cord. Steroids suppress immune responses, so they can worsen fungal infection if not carefully balanced and are only used in expert centers.[6]

10. Non-opioid pain relievers (e.g., acetaminophen, NSAIDs)
    Paracetamol (acetaminophen) and non-steroidal anti-inflammatory drugs can help treat fever, headaches, and joint pains sometimes called “desert rheumatism.”[13] They work by reducing inflammatory chemicals and brain temperature set-point. Overuse can damage liver or kidneys, so doses and combinations must follow label and medical advice.

11. Opioid analgesics (short-term, severe pain only)
    For very severe bone or joint pain not controlled by simpler medicines, doctors may prescribe short courses of opioid painkillers. They act on brain receptors to reduce pain perception. Because of dependence, constipation, and breathing-slowing risks, they are used at the lowest effective dose and for the shortest possible time.

12. Antitussives (cough suppressants) when needed
    In patients with exhausting, dry cough that interferes with sleep and recovery, doctors may use cough suppressants such as dextromethorphan-containing syrups. These act on cough centers in the brainstem to reduce the urge to cough. They must be balanced with the need to clear mucus and used carefully in chronic lung disease.

13. Bronchodilators (e.g., inhaled beta-agonists)
    Some patients with co-existing asthma or airway narrowing benefit from inhaled bronchodilators like salbutamol. These drugs relax smooth muscle around bronchi, widening airways and reducing wheezing. They do not treat the fungus itself but make breathing easier while antifungals work.

14. Inhaled or nasal corticosteroids for co-existing airway disease
    People who also have asthma or chronic airway inflammation may be on inhaled steroids. These lower local inflammation and help control wheeze and cough. Inhaled forms have less systemic effect than oral steroids but still require monitoring for infections like oral thrush.

15. Proton pump inhibitors or acid-reducing drugs (for GI protection)
    Long courses of NSAIDs or some antifungals can irritate the stomach. Acid-reducing medicines may be used to protect the upper gut. They lower gastric acid secretion by blocking proton pumps, which may lessen heartburn and ulcer risk but can also slightly change absorption of other drugs and nutrients.

16. Antiemetics (anti-nausea medicines)
    Nausea and vomiting from amphotericin B or azoles sometimes require anti-nausea drugs like ondansetron. These agents block serotonin or dopamine pathways that trigger vomiting. They improve comfort and help patients keep down life-saving antifungal tablets.

17. Electrolyte supplements (e.g., potassium, magnesium)
    Amphotericin B often causes kidney salt wasting and low potassium or magnesium. Oral or IV replacements correct these imbalances, stabilizing heart rhythm and muscle function. Doses are adjusted according to frequent blood tests to avoid dangerous highs or lows.[6][16]

18. Antibiotics (only when bacterial co-infection is proven or strongly suspected)
    Valley fever itself is fungal, not bacterial, but some patients develop bacterial pneumonia on top of it. In that case, targeted antibiotics are used while antifungals continue. Overuse of antibiotics without clear evidence is avoided to prevent resistance and side effects.

19. Anticonvulsants in CNS disease
    If the fungus spreads to the brain or meninges and causes seizures, doctors may prescribe antiseizure medications. These stabilize electrical activity in brain cells, lowering seizure risk. Drug choice must consider interactions with azole antifungals that use liver enzymes.

20. Long-term antifungal maintenance therapy
    Some high-risk patients (for example, with meningitis, severe bone disease, or persistent immune problems) stay on chronic, lower-dose oral azoles for years. The purpose is to prevent relapse rather than cure. Regular blood tests follow liver function, drug levels, and disease activity.[4][6][10]

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Dietary molecular supplements (supportive, not curative)

These supplements do not cure California disease, but may support general immune and lung health when used safely under professional guidance.

1. Vitamin D
   Vitamin D helps regulate innate and adaptive immune responses and may lower risk of severe respiratory infections.[5] Typical adult supplement doses are 600–2,000 IU/day, adjusted for blood levels. Mechanistically, vitamin D influences antimicrobial peptides and T-cell function.

2. Vitamin C
   Vitamin C is a water-soluble antioxidant that protects cells from damage during infection and supports collagen repair in lungs and skin. Common doses range from 200–1,000 mg/day. It donates electrons to neutralize reactive oxygen species and supports immune cell activity.

3. Zinc
   Zinc is essential for white blood cell development and function. Typical supplemental doses are 10–25 mg elemental zinc per day for adults. Zinc ions influence hundreds of enzymes and transcription factors that control inflammation and antiviral and antifungal responses.

4. Selenium
   Selenium participates in antioxidant enzymes like glutathione peroxidase. Usual supplemental doses are 50–200 micrograms per day. By supporting antioxidant defense and thyroid hormone metabolism, selenium may help the body tolerate chronic infection and inflammation.

5. Omega-3 fatty acids (EPA/DHA)
   Fish-oil omega-3s (often 500–1,500 mg combined EPA/DHA daily) can shift the body toward less inflammatory lipid mediators. They compete with omega-6 fats for enzymes, leading to resolvins and protectins that may reduce chronic lung and joint inflammation.

6. N-acetylcysteine (NAC)
   NAC (commonly 600–1,200 mg/day in divided doses) is a precursor to glutathione and also acts as a mucolytic. It breaks disulfide bonds in mucus, making it thinner and easier to cough up, while boosting intracellular antioxidant capacity.

7. Probiotics
   Selected probiotic strains (for example, Lactobacillus and Bifidobacterium) may support gut barrier function and immune modulation. Doses are usually described in billions of colony-forming units per day. Gut–lung immune crosstalk may influence systemic inflammation and response to infections.

8. Curcumin (from turmeric)
   Curcumin supplements (often 500–1,000 mg/day with absorption enhancers like piperine) have antioxidant and anti-inflammatory effects. They modulate NF-κB and other signaling pathways, which may help reduce chronic joint pains and systemic inflammation in long-lasting disease.

9. Quercetin
   Quercetin (commonly 250–500 mg/day) is a plant flavonoid with antioxidant and possible antiviral and anti-inflammatory actions. It stabilizes mast cells, influences cytokine release, and may support endothelial health, though direct evidence in Valley fever is limited.

10. Beta-glucans (from yeast or mushrooms)
    Beta-glucans (typical doses 250–500 mg/day) are complex carbohydrates that bind immune cell receptors like Dectin-1, “training” innate immunity. They may enhance macrophage and neutrophil responses but should be used carefully in people with autoimmune conditions.

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Immunity booster / regenerative / stem-cell–related drugs

There are no stem-cell drugs specifically approved for California disease. In very special cases, doctors may consider general immune-modulating therapies:

1. Granulocyte colony-stimulating factor (G-CSF, e.g., filgrastim)
   G-CSF is used to raise neutrophil counts in people with severe neutropenia from chemotherapy or other causes. Higher neutrophils can help the body clear fungal infections, but this is an indirect effect and not a standard therapy for typical Valley fever.

2. Granulocyte–macrophage colony-stimulating factor (GM-CSF)
   GM-CSF can stimulate both neutrophils and macrophages. It has been explored experimentally in some fungal infections to boost innate immunity. Because it can also worsen inflammation and has side effects, it is reserved for research or rare complex cases.

3. Interferon-gamma (IFN-γ)
   IFN-γ enhances “Th1-type” immune responses and macrophage killing of intracellular pathogens. It has been tried off-label in certain severe fungal infections but is not routine for coccidioidomycosis. It is given by injection and can cause flu-like side effects.

4. Intravenous immunoglobulin (IVIG)
   IVIG is a pooled antibody infusion used in immune deficiencies and some autoimmune conditions. In theory, it can support humoral immunity, but it is not standard for Valley fever and is usually reserved for patients with co-existing antibody deficiency.

5. Hematopoietic stem-cell transplant–related immune rebuilding
   For patients who already underwent stem-cell transplantation for another disease, careful management of immunosuppression, antifungal prophylaxis, and immune reconstitution helps control coccidioidomycosis risk. The transplant is not done to treat Valley fever itself.

6. Experimental mesenchymal stem-cell therapies
   Mesenchymal stem-cell infusions have been studied in some lung conditions to reduce scarring and inflammation, but there is no established evidence or regulatory approval for treating coccidioidomycosis this way. Such approaches should only occur in formal clinical trials.

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Surgeries (procedures and why they are done)

1. Lung lobectomy or segmentectomy
   In rare cases with a destroyed, chronically infected lung segment or large fungal cavity, surgeons may remove that part of the lung. The goal is to remove persistent infection or cavities at high risk of bleeding or rupture when medical therapy alone is not enough.[6]

2. Drainage of empyema or complicated pleural effusion
   If infection spreads to the space around the lung and pus collects (empyema), surgeons may insert chest tubes or perform surgery to drain it. This reduces pressure on the lungs and helps antifungal drugs reach the infected tissues.

3. Surgical management of bone or joint lesions
   When coccidioidomycosis attacks bone, procedures like debridement, bone grafting, or stabilization with hardware may be necessary. The aim is to remove dead tissue, reduce fungal load, and prevent fractures or deformity, combined with long-term antifungal therapy.

4. Neurosurgical procedures for CNS complications
   For meningitis with hydrocephalus (excess fluid around the brain), neurosurgeons may place a shunt to drain fluid and lower pressure. This protects brain tissue while antifungal drugs treat the infection in the surrounding membranes.

5. Debridement and reconstructive surgery for severe skin disease
   When large skin lesions or ulcers develop, surgical removal of damaged tissue and later reconstruction may improve function and appearance. Removing heavily infected tissue helps antifungal medications work better on remaining fungal cells.

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 Preventions

Because the fungus lives in soil and air, prevention is not perfect, but these steps can lower risk, especially in endemic regions.[1][2][4][6][17][18]

1. Avoid outdoor dust in areas known for Valley fever whenever possible.

2. Stay inside and close windows and doors during dust storms or very windy days.

3. If you must work in dust (construction, farming, military training), wear a well-fitted N95 respirator and take dust-control measures such as wetting soil.

4. Use HEPA filtration or well-maintained air conditioning with recirculation in homes and vehicles.

5. Cover bare soil around homes with plants, gravel, or mulch to reduce dust.

6. People at high risk (weak immune system, pregnancy, certain ethnic backgrounds) should discuss travel and work plans in endemic areas with their doctors.

7. Wash skin injuries with soap and water after outdoor work; though rare, spores can occasionally enter through wounds.[6]

8. Employers in endemic regions should provide education and protective equipment for at-risk workers.

9. Seek early medical care for pneumonia-like illness after travel or work in dusty endemic regions.

10. Follow long-term antifungal plans exactly if you have had severe or disseminated disease, to prevent relapse.

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When to see doctors

You should see a doctor as soon as possible if you live in or have visited areas where California disease is common and you develop symptoms such as persistent fever, cough, chest pain, or shortness of breath lasting more than a week.[2][3][5] Seek urgent or emergency care if you notice high fever, trouble breathing, confusion, severe headache, stiff neck, or new neurological symptoms like weakness, seizures, or trouble speaking, because these can signal severe or disseminated disease. People with weak immune systems, pregnancy, organ transplant, HIV, cancer therapy, or chronic lung disease should have a low threshold for testing and treatment, as they are more likely to get complicated infections and may need prolonged antifungal therapy.[4][6][11]

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What to eat and what to avoid

1. Eat: Plenty of fruits and vegetables (especially colorful ones) to supply vitamins, antioxidants, and fiber that support immune and gut health.

2. Eat: Adequate lean protein (fish, eggs, beans, poultry) to repair lung, muscle, and skin tissue damaged by infection and inflammation.

3. Eat: Whole grains (brown rice, oats, whole-wheat bread) for steady energy and added fiber, which supports gut microbiome balance.

4. Eat: Healthy fats (olive oil, nuts, seeds, avocado, oily fish) to provide essential fatty acids that may help control chronic inflammation.

5. Eat: Small, frequent meals if you have poor appetite, nausea, or weight loss, to maintain calories without overloading your stomach.

6. Avoid or limit: Alcohol, which stresses the liver that is already processing antifungal drugs and other medicines.

7. Avoid: Smoking and vaping, which directly damage lung tissue and worsen cough and breathlessness.

8. Limit: Very salty, ultra-processed, and deep-fried foods that contribute to fluid retention, high blood pressure, and systemic inflammation.

9. Limit: Sugary drinks and sweets that can raise blood sugar and weaken immune function, especially in people with diabetes.

10. Be cautious: With herbal products that claim to “boost immunity” or “cure fungus”—many are untested, may interact with azole antifungals, and can injure the liver or kidneys. Always discuss supplements with your doctor or pharmacist.

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Frequently Asked Questions (FAQs)

1. Is California disease the same as Valley fever and coccidioidomycosis?
   Yes. “California disease,” “Valley fever,” “San Joaquin Valley fever,” and “coccidioidomycosis” are different names for the same fungal infection caused by Coccidioides species.[1][4][13]

2. Is it contagious from person to person?
   No. You get California disease by inhaling spores from dust, not from being around an infected person or pet. Pets can also get infected from the environment but do not pass it to humans.[4][6][9]

3. How long after exposure do symptoms appear?
   Symptoms usually start 1–3 weeks after breathing in spores, but some people never feel sick. Others may develop chronic or disseminated disease months later, especially if the immune system is weak.[2][3][11][16]

4. Can a healthy person recover without medicines?
   Many otherwise healthy people with mild lung disease recover without antifungal drugs, just with rest and monitoring. However, it is impossible to predict in advance who will progress, so decisions about treatment must be made with a knowledgeable clinician.[4][6][21]

5. Who is at higher risk of severe disease?
   Higher-risk groups include people with HIV or other immune-suppressing conditions, organ-transplant recipients, those on high-dose steroids or biologics, pregnant people (especially in later pregnancy), older adults, and certain ethnic backgrounds such as Filipino or African ancestry.[4][6][11][13]

6. Can California disease spread to the brain?
   Yes. In a small percentage of cases, the fungus spreads to the brain and meninges, causing meningitis, severe headaches, neurological symptoms, and life-threatening complications. These patients require urgent, long-term antifungal therapy and sometimes neurosurgery.[6][11]

7. How is the diagnosis confirmed?
   Doctors use a combination of blood antibody tests, cultures, microscopic examination, and sometimes imaging like chest X-ray or CT scan. Serologic tests detecting specific IgM and IgG antibodies are the most common first step.[11][16]

8. How long do antifungal treatments last?
   Treatment can range from a few months in simple lung disease to years or lifelong therapy in meningitis or severe disseminated cases. Duration depends on symptoms, imaging, antibody levels, and the patient’s immune status.[4][6][10]

9. Can the infection come back after treatment?
   Yes. Relapse can occur, especially if therapy stops too soon or if the immune system becomes weaker later. People with previous severe disease often continue on maintenance azole therapy or long-term monitoring.[4][6]

10. Is there a vaccine for California disease?
    At present, no licensed vaccine is available, though research is ongoing. Prevention focuses on reducing dust exposure and early diagnosis rather than immunization.[2][4][18]

11. Does getting California disease once give lifelong immunity?
    Infection usually gives some degree of partial immunity, and repeat infections are less common, but they can still happen, especially in immunocompromised people. Regular follow-up is important in high-risk individuals.[4][21]

12. Can children get California disease?
    Yes, children can become infected if they live or travel in endemic areas. Many have mild disease, but some develop severe pneumonia or disseminated infection, so pediatric evaluation is essential if they develop prolonged fever and cough after dust exposure.[11]

13. Can pregnant people be treated safely?
    Treatment choices in pregnancy are complex. Amphotericin B is usually preferred in early pregnancy for severe disease, while azoles may be considered later because some have potential birth-defect risks. Management requires close coordination between infectious-disease and obstetric specialists.[3][6]

14. Should I stop my immune-suppressing medicines if I get Valley fever?
    You must not change or stop immune-suppressing drugs on your own. Your specialists will weigh the risk of uncontrolled underlying disease against infection risk and may adjust doses or choose different medicines while antifungals are given.[4][6]

15. What is the long-term outlook?
    Many people with mild California disease recover fully and return to normal life. A small percentage develop chronic lung problems, bone disease, or meningitis needing long-term treatment. Early diagnosis, appropriate antifungals, and good management of other health conditions greatly improve outcomes.[4][6][11]

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.