Coccidioidomycosis: Treatment, Procedure, Cost and Side Effects

Synonyms are desert rheumatism, fungal infection, mycosis.

C. immitis is a dimorphic saprophytic fungus that grows as a mycelium in the soil and produces a spherule form in the host organism. It resides in the soil in certain parts of the southwestern United States, most notably in California and Arizona. It is also commonly found in northern Mexico, and parts of Central and South America. C. immitis is dormant during long dry spells, then develops as a mold with long filaments that break off into airborne spores when it rains. The spores, known as arthroconidia, are swept into the air by disruption of the soil, such as during construction, farming, or an earthquake.

Significant disease develops in fewer than 5% of those infected and typically occurs in those with a weakened immune system. Mild asymptomatic cases often do not require any treatment, and the symptoms will go away within a few months. Those with severe symptoms may benefit from anti-fungal therapy, which usually requires 3–6 months of treatment. There is a lack of prospective studies that examine optimal anti-fungal therapy for coccidioidomycosis.On the whole, oral fluconazole and intravenous amphotericin B are used in progressive or disseminated disease, or in immunocompromised individuals.[25] Amphotericin B used to be the only available treatment, although now there are alternatives, including itraconazole or ketoconazole may be used for milder disease. Fluconazole is the preferred medication for coccidioidal meningitis, due to its penetration into CSF. Intrathecal or intraventricular amphotericin B therapy is used if infection persists after fluconazole treatment. Itraconazole is used for cases that involve treatment of infected person's bones and joints. The antifungal medications posaconazole and voriconazole have also been used to treat coccidioidomycosis.

For many people, the symptoms of Valley fever will go away within a few months without any treatment. Healthcare providers choose to prescribe antifungal medication for some people to try to reduce the severity of symptoms or prevent the infection from getting worse. Antifungal medication is typically given to people who are at higher risk for developing severe Valley fever. The treatment is usually 3 to 6 months of fluconazole or another type of antifungal medication. There are no over-the-counter medications to treat Valley fever. If you have Valley fever, you should talk to your healthcare provider about whether you need treatment. The healthcare provider who diagnoses you with Valley fever may suggest that you see other healthcare providers who specialize in treating Valley fever.People who have severe lung infections or infections that have spread to other parts of the body always need antifungal treatment and may need to stay in the hospital. For these types of infections, the course of treatment is usually longer than 6 months.

Valley fever that develops into meningitis is fatal if it’s not treated, so lifelong antifungal treatment is necessary for those cases. Most patients infected with Coccidioides are asymptomatic or have self-limited symptoms and require only supportive care. Symptomatic patients usually come to medical attention because of respiratory tract or systemic manifestations. Management in symptomatic patients varies with the clinical syndrome.Because most Coccidioides infections resolve without specific therapy, few clinical trials have assessed outcomes in less-severe disease. Most treatment recommendations represent consensus guidelines based on the Mycosis Study Group trials and the experience of many investigators.Even physicians in endemic regions disagree on who should be treated, the length of treatment, and what agent should be used.

Commonly used indicators to judge the severity of illness include the following:Continuous fever for longer than 1 month,Body-weight loss of more than 10%,Intense night sweats that persist for more than 3 weeks,Infiltrates that involve more than half of one lung or portions of both lungs,Prominent or persistent hilar adenopathy, Anticoccidioidal complement fixation (CF) IgG titers of 1:16 or higher,Absence of dermal hypersensitivity to coccidioidal antigens,Inability to work, symptoms that persist for more than 2 months.

About 30%-35% of people who develop symptoms have flu-like symptoms (fever, cough, malaise, and chills) that resolve over about two to six weeks without treatment. Some may develop additional symptoms such as shortness of breath, night sweats, headaches, sputum production, and joint and muscle pains (symptoms resembling pneumonia). Women, more often than men, may develop erythema nodosum (reddish, painful, tender lumps, usually on the legs) or erythema multiforme (an allergic reaction similar to erythema nodosum in multiple body sites with rash). The combination of fever, erythema nodosum, and migratory joint pains are often referred to as "desert rheumatism." Usually these symptoms resolve in about two to six weeks.People who do not face any of the above are not prone to Coccidioidomycosis.

Some people, especially pregnant women, people with weakened immune systems — such as those living with HIV/AIDS — and those of Filipino, Hispanic, African or Native American descent are at risk of developing a more severe form of coccidioidomycosis.Complications of coccidioidomycosis may include:Severe pneumonia. Most people recover from coccidioidomycosis-related pneumonia without complications. Others, mainly Filipinos, Hispanics, blacks, Native Americans and those with weakened immune systems, may become seriously ill.

Ruptured lung nodules. A small percentage of people develop thin-walled nodules (cavities) in their lungs. Many of these eventually disappear without causing any problems, but some may rupture, causing chest pain and difficulty breathing. A ruptured lung nodule might require the placement of a tube into the space around the lungs to remove the air or surgery to repair the damage.Disseminated disease. This is the most serious complication of coccidioidomycosis. If the fungus spreads (disseminates) throughout the body, it can cause problems ranging from skin ulcers and abscesses to bone lesions, severe joint pain, heart inflammation, urinary tract problems and meningitis — a potentially fatal infection of the membranes and fluid covering the brain and spinal cord.

Most people get better without treatment. To speed up recovery time, however, doctors often recommend home treatments. These can include bed rest, drinking plenty of fluids, and taking over-the-counter pain relievers such as ibuprofen and acetaminophen.Post treatment certain measures and recommendations have to be followed like wetting soil with water before digging or gardening, wearing a filtration mask that can filter 0.4 micrometer size particles, covering open dirt areas around your home with grass or plants, keeping your doors and windows closed during dust storms or on windy days.

Most people who have Valley fever will make a full recovery. A small percent of people develop long-term lung infections that can take several years to get better. In very severe cases of Valley fever, the nervous system can be affected and there may be long-term damage, but this is very rare.

No specific information is available.

Most people who have Valley fever will make a full recovery. A small percent of people develop long-term lung infections that can take several years to get better. In very severe cases of Valley fever, the nervous system can be affected and there may be long-term damage, but this is very rare.