Valley fever is also known as Sao Joaquin Valley fever, California fever, Desert Rheumatism or Coccidiodomycosis. It is caused due to a fungal infection, with the spores of a fungus called Coccidiodes immitis. This infection is most commonly seen in central and south America and in the desert regions of southwestern United States. It is transmitted by inhalation of the fungal spores into the lungs. The infection starts in the lungs. The risk of acquiring this infection is more in cases where the host is immunocompromised or suffering from AIDS, diabetes, those under immunosuppressant drugs.
Incidence: Filipinos, blacks and Hispanics have an increased risk of developing a disseminated disease as compared to whites. Hispanics with a blood group A or B Type have a higher risk of developing a disseminated disease. A lower income group or lower socio economic group is predisposed to severe lung infections and disseminated infection with Coccidiodomycosis. The incidence of Valley Fever is equal in males and in females. All age groups can be affected. The mortality rates in a case of disseminated disease are higher in infants and children.
There are three known forms of Coccidiodomycosis infection. They may be divided into acute, chronic and disseminated infection. In case of an acute pulmonary infection, the duration between inhalation of the fungus and onset of symptoms may be 7 to 21 days. The infection is usually mild and may produce few or no symptoms at all. A chronic infection develops even after 20 years or more after the primary infection. Disseminated Coccidiodomycosis means an infection which has spread from the lungs. It involves the heart, brain, meninges, skin and bones.
Symptoms: In most cases patients may not develop any symptoms. Some may develop cold, cough, flu like symptoms and pneumonia. Other symptoms may be headache, fever, cough, joint pains and stiffness, muscles pains, loss of weight, wheezing, night sweats, neck stiffness, chest pain, erythema nodosum on the lower extremities, joint swelling and effusion, ankle and swelling of the feet and enlarged lymph nodes.
Diagnostic Tests for Valley fever: It can be demonstrated by microscopic detection of the diagnostic cells in the body fluids such as saliva, sweat, blood, sputum and biopsy of the tissues. PCR can be used to detect the DNA of the organism. The fungal antigen or antibody may be detected in the patient’s serum. Chest radiograph, sputum smear and culture, lymph node biopsy and bronchoscopy with lavage are the other tests that might be done.
Treatment: An acute infection is usually a self-limiting process. The patient may benefit from bed rest and conservative treatment of the flu like symptoms. An acute infection does not require treatment with antifungal medications. Disseminated infections must be treated immediately as they are severe and have a high rate of developing complications like meningitis. The fatality rates associated with a disseminated infection are very high. Severe infections of Valley fever may be treated with antifungal medications like ketoconazole, fluconazole, itraconazole and other similar medications.
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