San Joaquin Valley fever is another name for Valley fever, a lung infection caused by a fungus called Coccidioides. A fungus is a tiny living thing, like mold, that can grow in soil. When dry soil that has this fungus is disturbed, very small spores go into the air. If a person breathes in these spores, the fungus can enter the lungs and cause infection. This disease is most common in dry, dusty areas of the southwestern United States, especially parts of Arizona and California, including the San Joaquin Valley. It also occurs in parts of northern Mexico and some areas of Central and South America.
San Joaquin Valley Fever, also called Valley Fever or coccidioidomycosis, is a lung infection caused by breathing in tiny spores of a fungus called Coccidioides, which lives in dry, dusty soil in parts of the southwestern United States and some areas of Central and South America. When the soil is disturbed by wind, farming, building, or digging, the spores become airborne and can be inhaled into the lungs.
Most infected people either have no symptoms or a mild flu-like illness with fever, cough, tiredness, chest pain, and joint aches. A small group of people develop more serious disease, with long-lasting lung infection or spread to skin, bones, or brain (disseminated disease). People with weak immune systems, pregnant women, and some ethnic groups have higher risk of severe illness.
Many people who breathe in the spores never feel sick at all. Others develop flu-like illness with fever, cough, chest pain, and tiredness. In a small number of people, especially those with weak immune systems, the infection can spread from the lungs to the skin, bones, joints, or brain and become very serious.
Other names
San Joaquin Valley fever has several other names that mean the same illness. Doctors often call it coccidioidomycosis, which is the medical name for infection caused by the Coccidioides fungus. It is also called Valley fever, California fever, desert rheumatism, or simply cocci. All these names describe the same fungal infection, just with different words used in different places or time periods.
Types of San Joaquin Valley fever
Here are the main types, shown in a short list and then explained:
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Acute (primary) pulmonary coccidioidomycosis
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Chronic pulmonary coccidioidomycosis
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Disseminated coccidioidomycosis
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Rare primary cutaneous (skin) coccidioidomycosis
Acute (primary) pulmonary coccidioidomycosis is the most common form. It happens when a person first breathes in the spores and gets a new infection in the lungs. Many people have no symptoms, or they only have mild flu-like illness that gets better on its own. Symptoms usually start 1–3 weeks after breathing in the spores.
Chronic pulmonary coccidioidomycosis happens when the lung infection does not fully clear and slowly continues over months or years. People may have a long-lasting cough, weight loss, night sweats, or chest pain. On chest X-ray or CT scan, doctors may see lung nodules, cavities, or scarring that stay for a long time.
Disseminated coccidioidomycosis means the fungus has spread outside the lungs through the blood to other parts of the body. It may affect the skin, bones, joints, or the coverings of the brain and spinal cord (meninges). This type can cause severe illness, such as bone pain, skin sores, or meningitis with bad headache and neck stiffness. It is more likely in people with weak immune systems, during pregnancy, or in some ethnic groups.
Primary cutaneous coccidioidomycosis is rare. It happens when the fungus enters the body directly through a break in the skin, such as a cut. In this type, the first and main problem is at the skin, not in the lungs. People may develop a painful bump or ulcer at the site of entry.
Causes and risk factors
The basic cause of San Joaquin Valley fever is breathing in spores of the Coccidioides fungus from dusty air. There is no person-to-person spread. However, many situations and conditions make it more likely to breathe in spores or to become seriously ill. Below, each item is called a “cause” in a broad sense, but many of them are really risk factors or ways of exposure.
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Living in an endemic area
People who live in areas where the fungus is common in the soil, such as parts of the southwestern U.S. and California’s Central Valley, have a higher chance of breathing in spores during normal daily life. Simply being outdoors in these places over many years increases lifetime risk. -
Travel to an endemic area
Even short trips to dusty regions where the fungus lives can cause infection. A visitor who hikes, drives on dirt roads, or joins outdoor events in these areas can breathe in spores and later become ill after returning home. -
Working in dusty outdoor jobs
Farmers, construction workers, road crews, archeologists, military trainees, and others who disturb dry soil at work are at higher risk. Their jobs create dust clouds that lift spores into the air, so they breathe in more spores than people in indoor jobs. -
Dust storms and strong winds
Natural events such as dust storms, high winds, and haboobs can move large amounts of contaminated soil into the air. During these events, spores can travel long distances and be inhaled by many people at once, even indoors if windows are open. -
Soil disturbance from building or digging
Activities like building houses, digging trenches, or putting in pipelines disturb soil where the fungus may live. The deeper and drier the soil, the more spores can be launched into the air, raising the risk for nearby workers and residents. -
Post-drought weather patterns
After a period of drought followed by rain, the fungus may grow more in the soil. When the soil dries again and is disturbed, more spores can be released. Public health data show higher Valley fever case numbers in years after droughts in parts of California. -
Living near construction or agricultural fields
People who live close to large farms, animal feedlots, or housing developments may be exposed to dust from plowing, harvesting, or construction work. Even if they do not work there, wind can carry spores from these sites into homes and yards. -
Outdoor sports and hobbies in dusty areas
Hiking, biking, off-road driving, horseback riding, or camping in dry, dusty areas can increase exposure. When groups do these activities in endemic regions, more people may report Valley fever weeks later. -
Weakened immune system (immunosuppression)
People with HIV/AIDS, cancer patients on chemotherapy, organ transplant recipients, or those taking strong immune-suppressing medicines are more likely to develop severe or disseminated disease once infected, because their bodies cannot control the fungus well. -
Use of high-dose steroids or biologic drugs
Medicines such as long-term oral corticosteroids or biologic agents for autoimmune diseases can weaken immune defenses. In endemic areas, people on these drugs have a higher risk of severe or complicated Valley fever if they inhale spores. -
Older age
Older adults, especially those over 60 years, are more likely to become seriously ill when infected. Age-related changes in the immune system and other health conditions make it harder for the body to clear the fungus. -
Pregnancy (especially second and third trimester)
Pregnant people, particularly later in pregnancy, have changes in their hormones and immune system that can increase the chance of disseminated disease. This risk is higher in those living in endemic regions. -
Certain ethnic backgrounds
Studies show that people of Filipino or African ancestry have higher rates of severe or disseminated Valley fever compared with some other groups. The exact reasons are not fully understood, but genetic or immune differences may play a role. -
Chronic lung diseases
People who already have lung problems like chronic obstructive pulmonary disease (COPD), asthma, or scarring from past infections may become more short of breath and more ill when they develop Valley fever. Their lungs have less reserve to handle extra inflammation. -
Diabetes and other chronic illnesses
Chronic health conditions such as diabetes, kidney disease, or heart failure can make it harder for the body to fight infections in general. In endemic regions, these conditions are linked to more severe Valley fever. -
Smoking
Smoking damages the airways and weakens local lung defenses. Smokers who inhale Coccidioides spores may have more symptoms, slower recovery, or higher risk of complications compared with non-smokers. -
Living or working in crowded settings with dust entry
In prisons, military camps, or worker housing located in endemic, dusty regions, many people may be exposed at once when wind blows dust into poorly sealed buildings. This can increase the number of infected people in those settings. -
Infection from organ or tissue transplant (rare)
Very rarely, Valley fever can be passed from a donor organ or tissue to a recipient if the donor had unrecognized infection. This is uncommon but serious when it occurs, because the recipient is usually on immune-suppressing medicines. -
Direct skin inoculation (rare)
In rare cases, the fungus can enter through the skin when a person has a cut or puncture wound contaminated with soil that contains spores. This leads to primary skin infection instead of starting in the lungs. -
Climate change and environmental shifts
Rising temperatures and changing rainfall patterns may allow the fungus to spread into new areas or increase its growth in known regions. This may explain the rising case numbers and expansion of Valley fever beyond traditional hot spots.
Symptoms
Not everyone with San Joaquin Valley fever feels sick. When symptoms do happen, they often look like a flu or pneumonia. Here are 15 important symptoms, each explained in simple words.
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Fever
Many people develop a raised body temperature. They may feel hot, sweaty, or chilled. Fever is the body’s way of trying to fight the fungus. -
Cough
A dry or mildly productive cough is very common. The cough comes from irritation and inflammation in the airways and lungs where the spores have settled. -
Chest pain
People often feel sharp or aching pain in the chest, especially when taking deep breaths or coughing. This pain happens because the lining around the lungs and chest wall becomes inflamed. -
Shortness of breath
Some people feel like they cannot get enough air or become easily winded when walking or climbing stairs. The infected parts of the lung do not move oxygen as well, so breathing feels harder. -
Tiredness and weakness (fatigue)
A strong feeling of tiredness is very common. People may feel worn out even after resting. The immune system uses a lot of energy to fight the infection, which makes the person feel weak. -
Headache
Many patients report headache during the acute illness. The headache may be from fever, dehydration, or general body inflammation. In rare cases, a very bad, persistent headache can signal spread to the coverings of the brain. -
Muscle aches (myalgia)
Muscles in the arms, legs, back, or neck can feel sore and achy. This is similar to muscle pain seen in other viral or flu-like infections and reflects whole-body inflammation. -
Joint pain (arthralgia)
Some people get aching or swelling in the joints, such as knees, ankles, or wrists. A classic pattern called “desert rheumatism” includes joint pain, rash, and fever. -
Rash on the skin
A red, raised rash can appear, often on the lower legs. One type is called erythema nodosum, which looks like tender, red bumps. This rash is usually a sign of a strong immune response to the fungus. -
Night sweats
People may wake up at night with their clothes or sheets soaked with sweat. Night sweats often go along with fever and can last for weeks in some cases. -
Chills
Along with fever, many people feel shaking chills. They may feel very cold even when the room is warm. Chills often come and go as the body temperature rises and falls. -
Unintentional weight loss
In more serious or long-lasting cases, poor appetite and increased body energy use can cause weight loss. People may notice their clothes getting looser over weeks or months. -
Coughing up blood (hemoptysis)
Rarely, people may cough up small amounts of blood or blood-streaked mucus. This can happen if inflamed lung tissue or small blood vessels in the airways are damaged. This is a warning sign that needs urgent medical care. -
Bone or joint swelling and pain (in disseminated disease)
If the infection spreads beyond the lungs, it can affect bones and joints. People may have deep, persistent bone pain, swelling around joints, or trouble walking. -
Severe headache with neck stiffness (meningitis)
In rare, serious cases, the fungus spreads to the coverings of the brain and spinal cord. This can cause strong headache, neck stiffness, nausea, vomiting, sensitivity to light, and confusion. This is a medical emergency.
Diagnostic tests for San Joaquin Valley fever
Doctors use a mix of history, physical examination, laboratory tests, and imaging to diagnose San Joaquin Valley fever. No single test is perfect in all cases. Often, several tests are done together over time. Below are 20 important tests, grouped by type but all explained in simple words.
Physical examination tests
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General physical examination and vital signs
The doctor starts by checking temperature, pulse, breathing rate, and blood pressure. They listen to the lungs with a stethoscope, looking for crackles, decreased breath sounds, or other changes. They also watch how the person breathes and how sick they look overall. This helps decide how serious the illness might be. -
Chest auscultation (listening to the lungs)
Using a stethoscope, the doctor listens carefully to different parts of the chest. They may hear crackling sounds, wheezes, or areas where air sounds are reduced. These clues suggest pneumonia or other lung changes that can happen with Valley fever. -
Skin and lymph node examination
The doctor looks for rashes, such as tender red bumps on the legs, and feels for enlarged lymph nodes in the neck, armpits, or groin. Skin findings and swollen nodes can support the suspicion of Valley fever, especially in someone from an endemic area.
Manual tests (hands-on clinical maneuvers)
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Chest percussion
The doctor taps on the chest with their fingers while listening to the sound. Duller sounds compared with normal may suggest fluid, consolidation, or cavities in the lungs, which can appear in coccidioidomycosis. This simple bedside test helps guide the need for imaging. -
Tactile fremitus and vocal resonance
The patient is asked to say certain words while the doctor places hands on the chest to feel vibrations. Changes in how these vibrations are transmitted can suggest areas of lung consolidation from infection, helping localize disease. -
Joint range-of-motion testing
If the patient has joint pain, the doctor gently moves the joints to see how far they can bend and if there is pain or swelling. This helps identify arthritis related to Valley fever or other causes of joint symptoms.
Lab and pathological tests
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Complete blood count (CBC)
A CBC measures different parts of the blood, including white blood cells, red blood cells, and platelets. In Valley fever, the white blood cell count may be normal or slightly raised, and there may be changes that show inflammation or chronic disease. The CBC also helps look for other causes of illness. -
Inflammation markers (ESR and CRP)
Blood tests such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) show how much inflammation is in the body. These markers may be elevated in Valley fever, especially in more severe disease, but they are not specific and must be interpreted with other findings. -
Coccidioides serology (enzyme immunoassays for IgM and IgG)
These blood tests look for antibodies (IgM and IgG) that the body makes against the Coccidioides fungus. Enzyme immunoassays (EIA) are often used first because they are quick and sensitive. A positive result supports the diagnosis, especially in a person with typical symptoms and exposure history. -
Immunodiffusion (ID) antibody tests
Immunodiffusion tests are more specific blood tests that detect IgM and IgG antibodies to Coccidioides. They are often used to confirm positive EIA results. Because they may take longer and require expertise, they are usually done in reference laboratories. -
Complement fixation (CF) antibody tests
The complement fixation test measures IgG antibody levels and often gives a “titer” such as 1:2 or 1:16. Higher titers can be linked to more severe or disseminated disease. Doctors may repeat CF titers over time to track how the infection is responding to treatment. -
Fungal culture of sputum or respiratory samples
Samples of mucus coughed up from the lungs (sputum) or fluid collected during bronchoscopy can be sent to the lab to grow the fungus. If Coccidioides grows in culture, this provides strong proof of infection. However, culture takes time and must be handled carefully because the fungus can pose a risk to lab workers. -
Microscopy and special fungal stains
Lab staff can look at sputum or tissue samples under a microscope after staining them with special dyes, such as silver stains. Large round “spherules” filled with smaller structures (endospores) are classic for coccidioidomycosis. Seeing these in tissue or fluid strongly supports the diagnosis. -
Coccidioides antigen detection in blood or urine
In more severe cases, tests that detect pieces of the fungus (antigen) in blood or urine can be helpful, especially in people with weakened immune systems. These tests can sometimes become positive when antibody tests are still negative. -
Polymerase chain reaction (PCR) for Coccidioides DNA
PCR tests look for small amounts of fungal genetic material (DNA) in respiratory specimens or tissue. When available, PCR can give faster results than culture and help confirm infection, especially in difficult cases.
Electrodiagnostic and monitoring tests
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Pulse oximetry (oxygen saturation monitoring)
A small clip on the finger uses light to measure how much oxygen is in the blood. In Valley fever affecting the lungs, oxygen levels can drop, especially during activity or sleep. Pulse oximetry helps doctors judge how serious the lung involvement is and whether hospital care is needed. -
Electrocardiogram (ECG)
An ECG records the electrical activity of the heart through stickers placed on the chest and limbs. While it does not diagnose Valley fever directly, it helps rule out heart causes of chest pain or shortness of breath and guides safe treatment, especially in very ill patients.
Imaging tests
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Chest X-ray
A chest X-ray is often the first imaging test. It can show pneumonia, lung nodules, cavities, or fluid around the lungs. These patterns are not specific, but in a person from an endemic area, typical findings plus positive blood tests strongly support Valley fever. -
Chest CT (computed tomography) scan
A CT scan uses X-rays and a computer to make more detailed images of the lungs than a plain X-ray. It can better show nodules, cavities, scarring, and enlarged lymph nodes. CT is useful when the X-ray is unclear or when doctors are worried about complications. -
MRI of brain or spine (for suspected meningitis or spread)
If doctors think the infection has spread to the brain or spinal cord, they may order an MRI. MRI uses magnets and radio waves to show very detailed images without radiation. It can reveal inflammation of the meninges, fluid collections, or other changes linked to disseminated coccidioidomycosis.
Non-Pharmacological Treatments (Therapies and Other Supportive Care)
These methods support the body and help symptoms; they do not kill the fungus by themselves. They are usually used along with medical care when needed.
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Adequate Rest and Sleep
Getting enough rest reduces strain on your heart and lungs and lets the immune system focus on fighting infection. Simple steps like going to bed at the same time daily, short daytime naps, and avoiding late-night screens can lower fatigue, feverish discomfort, and cough-related tiredness during Valley Fever recovery. -
Hydration with Water and Oral Fluids
Drinking regular small amounts of water, oral rehydration solution, or clear broths helps thin mucus, makes coughing easier, and prevents dehydration from fever and rapid breathing. Good hydration supports circulation and kidney function, which is important when the body is removing inflammatory by-products and any medicines used later. -
Energy-Conserving Activity Pacing
People with Valley Fever often feel deep tiredness. Planning short activities with rest breaks, avoiding heavy lifting, and using “sit rather than stand” strategies prevents over-exertion that can worsen cough and breathlessness. Pacing daily tasks helps maintain independence while allowing lungs and muscles to heal more comfortably. -
Breathing Exercises and Pulmonary Rehabilitation-Style Techniques
Simple breathing methods, such as slow diaphragmatic breathing and pursed-lip breathing, can reduce the feeling of air hunger, improve oxygen exchange, and help clear secretions. In more persistent lung disease, formal pulmonary rehab programs teach safe exercise and breathing strategies under supervision. -
Humidified Air and Steam Inhalation (Safe Use)
Using a clean room humidifier or warm (not scalding) steam from a basin can moisten irritated airways and loosen thick phlegm. This may ease dry cough and chest tightness. Devices must be cleaned regularly to avoid bacterial or mold growth, and very hot steam should be avoided to prevent burns. -
Chest Positioning and Gentle Postural Drainage
Sitting upright, sleeping with the head raised, or lying briefly on the side with more affected lung on top can sometimes help drainage of mucus from the airways. Combined with coughing techniques, it may reduce congestion and ease breathing, especially in people with lingering lung changes after infection. -
Smoking Cessation and Avoidance of Secondhand Smoke
Tobacco smoke inflames and damages airway lining, reduces cilia function, and impairs immune defenses in the lungs. For Valley Fever, quitting smoking and staying away from other people’s smoke can improve lung healing, reduce chronic cough, and lessen the risk of long-term lung complications. -
Avoiding Dusty Outdoor Exposure in Endemic Regions
Because Coccidioides spores live in dusty soil, limiting outdoor dust exposure—especially during windstorms, farming, or construction—can reduce new inhalation and repeated exposure while recovering. This means staying inside with closed windows during dust storms and avoiding dirt-disturbing activities when possible. -
Use of Respirators or Masks in High-Risk Jobs
When dust exposure cannot be avoided (for example, in construction, farming, or military training), properly fitted N95-type respirators can lower inhaled spores. They are especially helpful for people with weak immune systems who must live or work in high-risk areas. -
Indoor Air Filtration and Dust Control
Using high-efficiency air filters, keeping windows closed during dust storms, and wet-mopping rather than dry sweeping can reduce indoor dust that may carry spores into homes or workplaces. Simple environmental hygiene supports overall prevention and reduces exposure for patients and their families. -
Fever and Pain Relief with Non-Drug Methods
Cool compresses on the forehead, light clothing, lukewarm sponge baths, and relaxation techniques can help reduce fever discomfort and muscle aches. These measures are especially useful when patients are sensitive to medicine side effects or are waiting for medical advice about medications. -
Psychological Support and Stress Management
Long-lasting infections can cause worry and low mood. Simple tools like relaxation breathing, mindfulness, talking with supportive family, or counseling can ease anxiety, help with sleep, and improve coping with chronic fatigue or long courses of antifungal therapy. -
Weight Management and Gentle Exercise as Tolerated
Once acute symptoms improve, gradual low-intensity walking or light stretching can rebuild stamina, prevent deconditioning, and help weight control. Healthy body weight is linked with better lung function and lower strain on the heart and joints, which can be helpful during recovery from fungal lung infections. -
Blood Sugar and Chronic Disease Control
Good control of diabetes, chronic lung disease, and heart conditions through diet, monitoring, and prescribed non-antifungal medicines lowers the risk of severe Valley Fever and complications. Stable underlying diseases allow the immune system to respond more effectively to the fungal infection. -
Vaccination Against Other Respiratory Germs
While there is no Valley Fever vaccine, staying up to date on flu, COVID-19, and pneumococcal vaccines reduces the chance of additional lung infections on top of coccidioidomycosis. Fewer overlapping infections can make the overall illness milder and easier to manage. -
Careful Skin and Wound Hygiene
If the infection spreads to skin or if the patient has minor cuts, gently washing with soap and water and keeping skin clean lowers the risk of secondary bacterial infection. Clean, dry dressings and attention to signs of redness or pus can prevent further complications. -
Allergen and Irritant Avoidance
Avoiding strong perfumes, chemical fumes, and other inhaled irritants helps reduce coughing and bronchial sensitivity. For people with asthma-like symptoms triggered by Valley Fever, this environmental control can be an important part of non-drug symptom management. -
Education About Disease and Self-Monitoring
Learning the signs of worsening disease—such as new shortness of breath, night sweats, or weight loss—helps patients seek timely medical review. Education about the long, sometimes relapsing course of Valley Fever sets realistic expectations and improves treatment adherence. -
Support Groups and Peer Communities
Connecting with others who have Valley Fever, whether locally or online, can provide emotional support, practical tips, and encouragement during long treatments. Patients often feel less isolated and more confident about asking questions and following medical plans. -
Work and School Adjustments
Short-term changes such as reduced working hours, lighter duties, or remote work can help patients manage fatigue and respiratory symptoms safely. These adjustments support recovery and may reduce the risk of relapse or complications due to over-exertion and dust exposure.
Drug Treatments (Antifungal and Supporting Medicines)
Only a specialist or treating doctor can choose the right drug, dose, and duration. Below are key medicines used in Valley Fever, with information drawn from clinical guidelines and regulatory labels.
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Fluconazole – Core First-Line Azole
Fluconazole is an oral triazole antifungal often used as the first medicine for mild to moderate pulmonary or disseminated coccidioidomycosis. Typical adult doses for deep endemic mycoses (including coccidioidomycosis) are around 400 mg daily, adjusted by severity and kidney function, and continued for months until clinical and serologic improvement. Common side effects include nausea, abdominal pain, diarrhea, liver enzyme elevation, dry skin, and possible hair thinning; liver tests and drug interactions need monitoring. -
Itraconazole – Alternative Azole, Especially for Bone/Joint Disease
Itraconazole is another oral triazole antifungal used when fluconazole is not tolerated or when bone and joint disease is present. Doses for systemic mycoses are often 200 mg two or three times daily with food, with careful monitoring of blood levels and heart function. It can cause stomach upset, liver enzyme elevation, swelling, and has an important warning in patients with congestive heart failure due to risk of worsening heart function and strong drug interactions. -
Amphotericin B Deoxycholate – Conventional IV Therapy for Severe Disease
Amphotericin B deoxycholate is an intravenous polyene antifungal reserved for severe or rapidly progressive Valley Fever, pregnancy with serious disease, or failure of azoles. Typical adult dosing for systemic fungal infections ranges around 0.7–1 mg/kg/day, with test doses and careful hospital monitoring. Side effects include fever, chills, kidney toxicity, electrolyte disturbances, and infusion-related reactions, so frequent blood tests and pre-medications are often required. -
Liposomal Amphotericin B (e.g., AmBisome)
Liposomal forms package amphotericin B in lipid carriers, allowing higher doses (around 3–5 mg/kg/day for systemic infections) with reduced kidney toxicity compared with conventional formulations. They are used in very severe, disseminated, or CNS disease, or when standard amphotericin B is poorly tolerated. Adverse effects still include infusion reactions and electrolyte changes, but kidney injury is usually less frequent, making it preferred in high-risk patients. -
Voriconazole – Salvage Triazole Therapy
Voriconazole is a newer triazole used mainly when fluconazole or itraconazole fail or are not tolerated. It has good in-vitro activity against Coccidioides and is used for refractory pulmonary or disseminated disease, often after amphotericin B. Side effects can include visual disturbances, liver toxicity, skin photosensitivity, and many drug interactions, so careful monitoring and dose adjustment are essential. -
Posaconazole – Salvage Therapy for Refractory Disease
Posaconazole is an extended-spectrum triazole approved in some regions for salvage therapy of invasive fungal infections and has been successfully used in chronic refractory coccidioidomycosis when standard treatments failed. Oral doses such as 800 mg/day in divided doses have shown clinical improvement in case series, sometimes over many months. Common side effects include gastrointestinal upset, liver enzyme elevation, and drug interactions; monitoring of drug levels is common in long-term therapy. -
Isavuconazole – Newer Triazole Option
Isavuconazole (isavuconazonium) is a newer broad-spectrum triazole with both IV and oral forms and fewer drug interactions than some older agents. Studies from high-volume centers suggest it can be useful in chronic and CNS coccidioidomycosis when other azoles are not tolerated or have failed. Side effects may include liver test abnormalities, gastrointestinal symptoms, and rare infusion reactions; QT interval effects differ from other azoles and need ECG awareness. -
Caspofungin and Other Echinocandins (Limited Role)
Echinocandins like caspofungin are IV antifungals mainly used for Candida and Aspergillus infections. They have limited evidence for Valley Fever and are not first-line, but may occasionally be considered in combination regimens in complex, refractory cases. Side effects generally include infusion reactions, liver enzyme changes, and mild gastrointestinal upset. -
Adjunctive Corticosteroids in Specific Situations (Very Cautious Use)
Short courses of systemic steroids may sometimes be used in severe inflammatory complications, such as immune-mediated arthritis or certain respiratory reactions, under specialist supervision. However, steroids also weaken immune response and can worsen fungal infections, so they must be weighed carefully, often given only when antifungal therapy is already in place and benefits clearly outweigh risks. -
Analgesics (e.g., Acetaminophen, NSAIDs)
Pain and fever from Valley Fever may be treated with over-the-counter pain relievers such as acetaminophen or non-steroidal anti-inflammatory drugs, when appropriate for the patient’s kidney, liver, and stomach health. These medicines do not treat the fungus but improve comfort, helping patients rest and maintain nutrition while antifungal therapy works. -
Cough Suppressants and Expectorants
Short-term use of cough medicines may be recommended for distressing dry cough or to help bring up mucus. Doctors choose products based on symptom pattern, avoiding over-use in people who need to clear secretions. These drugs are supportive, not curative, and should be used according to medical advice. -
Bronchodilators in Reactive Airways
In patients who develop asthma-like bronchospasm triggered by Valley Fever, inhaled bronchodilators (like short-acting beta-agonists) may open airways, reduce wheeze, and improve exercise tolerance. They are used along with, not instead of, antifungals if underlying fungal disease is present. -
Oxygen Therapy
For people with low blood oxygen levels due to severe lung involvement, supplemental oxygen by nasal cannula or mask can be life-saving. Oxygen improves tissue delivery of oxygen while antifungal treatment and the body’s immune response work to control the infection. -
Intravenous Fluids and Electrolyte Replacement
In hospital, IV fluids may be needed for patients with severe illness, high fever, low blood pressure, or kidney effects from amphotericin B. Carefully balanced fluids and electrolytes support circulation and organ function, especially during intensive antifungal therapy. -
Antiemetic Medicines
Drugs that reduce nausea and vomiting can be important when azoles or amphotericin B cause stomach upset. Better symptom control helps patients keep taking long-term antifungal therapy, which is often essential to prevent relapse. -
Hepatoprotective Monitoring and Dose Adjustment
Though not a separate drug, careful adjustment of antifungal doses and monitoring liver tests is a crucial “treatment” step. When liver enzymes rise, the prescriber may lower the dose or switch to another antifungal to prevent serious liver injury while still controlling the infection. -
Long-Term Maintenance Azole Therapy
Some patients with meningitis or severe disseminated disease need lifelong suppressive therapy with azoles like fluconazole to keep the fungus controlled. This is a planned, long-term drug strategy balancing effectiveness, toxicity, and quality of life, individualized by specialists. -
Drug Level Monitoring (Therapeutic Drug Monitoring)
For itraconazole, voriconazole, and posaconazole, measuring blood drug levels helps ensure enough medicine reaches the body without causing toxicity. This reduces treatment failure due to low absorption and guides dose changes in long-term therapy. -
Combination Therapy (Amphotericin B plus Azole) in Special Cases
Some experts use an initial combination of amphotericin B with an azole in very severe, life-threatening, or CNS disease to rapidly reduce fungal burden and then continue with oral azole alone. Evidence is still evolving, so this approach is typically reserved for expert centers. -
Individualized Regimens for Pregnant Patients and Those with HIV or Transplants
In pregnancy, amphotericin B is often preferred for severe early disease, while azoles may be avoided in the first trimester. In HIV or transplant patients, drug interactions and immune status strongly influence choice and duration of antifungals. These complex regimens must be designed by specialists.
Dietary Molecular Supplements (Support, Not Cure)
Evidence for supplements in Valley Fever is limited. They do not replace antifungal drugs but may support general immune and tissue health when used safely under medical guidance.
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Vitamin D – Supports innate and adaptive immune responses and may help the body handle infections; low levels are common in many populations. Typical supplemental doses vary by baseline level, and excess can harm kidneys or raise calcium, so testing and medical advice are important.
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Vitamin C – Acts as an antioxidant and supports white blood cell function and collagen repair in lungs and skin. Moderate daily supplement doses can fill dietary gaps, but very high doses may cause stomach upset or kidney stones in susceptible people.
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Zinc – Plays a central role in immune cell signaling and barrier integrity of skin and mucosa. Short-term zinc supplementation can correct deficiency and may support overall immunity, but high doses over time can cause copper deficiency and gastrointestinal side effects.
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Selenium – A trace element involved in antioxidant enzymes and immune responses. Adequate selenium intake may support resistance to infections, but excessive intake leads to hair changes, nail problems, and nerve symptoms, so supplementation should stay within recommended limits.
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Omega-3 Fatty Acids (Fish Oil or Algal Oil)
Omega-3 fats help modulate inflammation and may support cardiovascular and joint health in chronic infection. Usual doses are moderate daily capsules with meals; high doses can increase bleeding risk in people on blood-thinning medicines and should be reviewed with a doctor. -
Probiotics
Probiotic supplements aim to support gut microbiota, which interacts with immune function. They may be considered in patients on long-term antibiotics or multiple medicines, but evidence in Valley Fever is indirect, and people with severe immune suppression should discuss risks and benefits carefully with specialists. -
High-Quality Protein Supplements (e.g., Whey, Plant Protein)
When illness reduces appetite, protein powders or high-protein drinks can help maintain muscle mass, antibody production, and wound healing. Doses are usually tailored to weight and kidney function; excessive protein may be harmful in advanced kidney disease. -
B-Complex Vitamins
B-group vitamins support energy metabolism and nerve function, often depleted in poor intake or chronic illness. Balanced B-complex supplements at standard daily doses may reduce fatigue and support red blood cell production but should not exceed upper safe limits without supervision. -
Copper (When Indicated)
In patients on long-term high-dose zinc or with proven deficiency, small copper supplements may be used under supervision to keep blood counts and immune function normal. Unsupervised copper use can be toxic to the liver, so it must only be taken if clearly indicated by tests. -
Multivitamin with Minerals
A simple, once-daily multivitamin can cover routine micronutrient needs in people with poor diet during illness. It is not a treatment for the fungus but reduces the chance that multiple small deficiencies slow down recovery and tissue repair.
Immunity Booster / Regenerative / Stem Cell Drug Concepts
There are no approved stem-cell or regenerative drugs specifically for Valley Fever. Some medicines and approaches may support immune recovery or blood counts in complicated patients, but they are not standard antifungal therapy.
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Granulocyte Colony-Stimulating Factor (G-CSF) – Can be used in severely neutropenic patients to raise white cell counts, helping the body respond to infections, but is not a Valley Fever-specific drug.
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Interferon-Gamma (Experimental Adjunct) – Has been tried in some severe fungal infections to boost macrophage activity; use is rare, experimental, and reserved for specialist centers.
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Optimized Antiretroviral Therapy in HIV – In people with HIV, restoring immune function with appropriate antiretroviral regimens can indirectly improve control of coccidioidomycosis.
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Immunosuppressant Reduction in Transplant Patients – Carefully lowering certain immunosuppressive drugs (when safe for the transplant) may help the immune system better handle Valley Fever, always balanced against rejection risks.
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Nutritional Rehabilitation Programs – Structured nutritional support, while not a drug, can be as powerful as medicine for regenerating muscle, immune proteins, and tissue healing capacity in chronically ill patients.
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Clinical Trials of Novel Antifungals and Immunotherapies – Some centers enroll patients into trials testing new antifungal agents or immune-modulating strategies for refractory coccidioidomycosis. These approaches are experimental and closely monitored.
Surgeries (Procedures and Why They Are Done)
Surgery is not common in Valley Fever but may be needed for complications.
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Resection of Persistent Lung Cavities or Nodules – Removal of a chronic lung cavity or nodule may be done if it bleeds, causes repeated infections, or is suspicious for cancer.
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Drainage or Debridement of Bone and Joint Lesions – When infection spreads to bones or joints, surgical cleaning and stabilization may be needed to remove necrotic tissue and reduce pain and fracture risk.
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Skin Lesion Excision – Disfiguring or non-healing skin lesions may be surgically removed for symptom relief, diagnosis, and better control when combined with antifungals.
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Neurosurgical Procedures for CNS Disease – In meningitis with hydrocephalus, shunt placement or other cerebrospinal fluid surgery may relieve pressure and improve symptoms while long-term antifungals continue.
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Abscess Drainage in Soft Tissues – Deep abscesses in muscles or organs may require image-guided or open surgical drainage to reduce fungal burden and allow medicines to work more effectively.
Preventions
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Avoid dusty outdoor activities in endemic areas when possible.
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Stay indoors with windows closed during dust storms.
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Use well-fitting N95-type respirators when working in soil-disturbing jobs.
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Moisten soil before digging or construction to reduce dust.
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Use indoor air filtration and keep homes clean of dust.
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People with weak immunity should discuss relocation or reduced exposure with their doctors.
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Keep chronic diseases well controlled to lower risk of severe illness.
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Educate at-risk workers (construction, farming, archaeology, military) about Valley Fever.
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Seek early testing for persistent cough or fever after dust exposure in endemic regions.
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Follow public health alerts and employer safety rules about dust exposure.
When to See Doctors
You should see a doctor promptly if you live in or have travelled to a Valley Fever area and develop symptoms such as fever, cough, chest pain, rash, or extreme tiredness lasting more than one to two weeks. You should seek urgent care if you have trouble breathing, very high fever, confusion, severe headache, stiff neck, weight loss, night sweats, bone pain, skin ulcers, or if you have a weakened immune system, are pregnant, or are taking medicines that suppress immunity. Early evaluation and testing allow doctors to decide whether antifungal treatment is needed and to prevent serious complications.
What to Eat and What to Avoid (General Guidance)
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Eat: Balanced meals with whole grains, lean protein, fruits, and vegetables to support immune and tissue repair needs.
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Eat: Adequate protein from beans, fish, eggs, or lean meat to maintain muscle and antibody production during chronic infection.
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Eat: Foods rich in vitamins and minerals (leafy greens, citrus, nuts, seeds) rather than relying only on pills.
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Eat: Small, frequent meals if medicines cause nausea, to keep calorie intake steady.
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Avoid: Excessive alcohol, which stresses the liver already handling antifungal drugs and other medicines.
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Avoid: Very high-sugar drinks and ultra-processed foods that provide calories but few nutrients and may worsen diabetes control.
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Avoid: Grapefruit or grapefruit juice with certain azoles (like itraconazole or voriconazole) because it can change drug levels; follow label and doctor advice.
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Avoid: Large doses of unproven herbal products that may harm the liver or kidneys, especially while on antifungal medicines.
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Avoid: Very salty processed foods if amphotericin B-related kidney issues or blood pressure problems are present.
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Avoid: Crash diets and severe calorie restriction; they weaken the body’s ability to fight infection and recover.
Frequently Asked Questions (FAQs)
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Is Valley Fever contagious from person to person?
No. You cannot catch San Joaquin Valley Fever from another person or from animals. It comes from breathing in fungal spores from soil in certain regions. -
Can I get Valley Fever more than once?
Most people develop some lasting immunity after infection, but it may not be complete. Reinfection appears uncommon but is not impossible, especially in people with weakened immune systems or high ongoing exposure. -
Do all patients need antifungal drugs?
No. Many healthy people with mild disease get better without antifungal therapy. Doctors consider severity, symptoms, risk factors, and test results before deciding on medicine. -
How long does treatment usually last?
When antifungals are needed, they are often taken for several months; severe or disseminated disease, especially meningitis, may require treatment for years or even lifelong suppression. -
Can Valley Fever affect organs outside the lungs?
Yes. In some people the fungus spreads to skin, bones, joints, or the central nervous system, leading to more serious disease needing aggressive therapy. -
Is there a vaccine for Valley Fever?
At present there is no approved human vaccine, although research is ongoing. Prevention focuses on reducing dust exposure and early detection of disease. -
Who is at higher risk of severe Valley Fever?
People with weak immune systems (HIV, transplants, cancer therapy), pregnant women (especially in later pregnancy), people with diabetes, and some ethnic groups, such as people of African or Filipino ancestry, have higher risk of serious disease. -
Can children get Valley Fever?
Yes. Children in endemic areas can develop Valley Fever, though patterns of disease can differ by age. Management is individualized by pediatric specialists. -
Does Valley Fever always show up on a chest X-ray?
Not always. Some patients have mild findings or normal X-rays early on, so doctors also use blood tests and sometimes CT scans or other imaging when suspicion is high. -
What tests confirm Valley Fever?
Common tests include blood serology for Coccidioides antibodies, culture or molecular testing of respiratory samples, and imaging such as chest X-ray or CT. In complicated cases, biopsies or spinal fluid tests may be needed. -
Can I keep working if I have Valley Fever?
Many people continue working with adjustments such as lighter duties, rest breaks, or temporary indoor tasks if symptoms are mild. Your doctor can advise based on your lungs, energy level, and job dust exposure. -
Will Valley Fever damage my lungs forever?
Some people are left with small lung nodules or cavities that may be stable and cause no symptoms, while others fully recover. A minority develop chronic lung disease needing long-term follow-up and treatment. -
Can pregnancy make Valley Fever worse?
Pregnancy, especially later in pregnancy, increases risk of severe or disseminated disease, so pregnant women in endemic areas need careful evaluation and specialized treatment choices. -
What if I have HIV or am on transplant medicines?
People with significant immune suppression have higher risk of severe Valley Fever and relapse. They usually need longer antifungal therapy, close monitoring, and sometimes adjustments of their other medicines. -
Can I fully recover and live a normal life after Valley Fever?
Yes. Many people, especially those diagnosed early and treated appropriately when needed, return to normal activities. Some may need ongoing medicines or follow-up, but with good medical care and lifestyle support, long-term outlook can be favorable.
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.
