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Being Alive
Valley Fever On The Rise
Henry L. Poscher, M.D.
March 5, 1993
Being Alive 1993 Mar 5: 10

The dust borne disease known as Valley Fever has increased to epidemic proportions in Kern County, with over 400 people infected in the last year. Increasing numbers of cases have been reported in Orange and Ventura Counties as well as the desert areas. The disease is caused by the fungus coccidioidiomyces immitis, a soil inhabitant of certain arid regions of the United States, including California, Arizona, west Texas, and New Mexico. Infection occurs in susceptible individuals by inhalation of airborne arthrospores, causing a primary infection which is usually asymptomatic. Forty percent of individuals are symptomatic, with symptoms that range from a mild flu-like illness to severe pneumonia.

Usually, this pulmonary infection heals completely. If this does not occur, the infection may disseminate beyond the lungs, involving the bone, skin, joints, and other sites. Disseminated disease is seen in certain ethnic groups including African Americans, Latinos, Native Americans, and immunosuppressed patients, particularly those with HIV.

Symptomatic primary pulmonary infection is characterized by fever, cough, chest pain, headache, malaise, muscle aches, and fatigue. Chronic progressive primary disease is manifested by cough, sputum, fever and weight loss. Those with HIV commonly present with severe shortness of breath. Individuals with asymptomatic primary infection may develop thin walled cavities in the lung, with the fungus present, in an inactive state, similar to those infected with tuberculosis. In these individuals, reactivation can occur with subsequent dissemination as a result of immunosuppression with HIV or malignancies such as Hodgkins Disease or non-Hodgkins lymphoma.

Diagnosis is made using serologic or blood tests which measure the presence of antibodies to the fungus. Positive tests are least common in primary pulmonary infection, as opposed to multiorgan disseminated disease in which tests are nearly always positive. Diagnosis is established by identification of the large spherules of C. immitis on culture.

Treatment of Valley Fever includes four drugs: Amphotericin B, ketoconazole, Fluconazole, and the recently FDA approved Itraconazole. Amphotericin B, an intravenous drug, is reserved for the more severe forms of the disease. The other three, which are oral agents, are used in more moderate disease states.

The only known method of transmission is inhalation of the spores in the soil dust. The disease is not a communicable one and decreasing the risk of exposure is limited to avoiding the dust whenever possible. With increasing incidence of the disease, it is imperative to consider coccidioidomycosis infection in individuals at risk for possible exposure and with symptoms noted above, particularly those with HIV. This will allow for early treatment and thus the avoidance of progressive disseminated disease and its possibly fatal complications.

(Henry L. Poscher, MD is in private practice with the Bedford Medical Group in Beverly Hills, 310.246.6555.) 

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