Valley Fever

What is Valley fever?

Valley fever, or coccidioidomycosis (cocci), is a fungal infection you can get if you breathe in spores of the fungus called Coccidioides. It’s also called desert rheumatism and San Joaquin Valley fever.

These fungal spores are found in certain areas where the air is dry and the soil is alkaline. You can find them in certain parts of the southwestern United States, including Arizona, California, Nevada, New Mexico, Texas, Utah and Washington. They’re also found in Mexico and parts of Central and South America.

When the soil is disturbed by wind, earthquakes, construction, outdoor recreation, farming or gardening, the spores can become airborne and people and animals can inhale them. The spores can travel for many miles.

Symptoms of Valley fever

Some people don’t have any symptoms or even know they were infected. Others have mild symptoms like the flu, while some have more serious complications that need medical care.

If symptoms develop, they usually appear one to three weeks after you’ve inhaled spores and include:

• Fever
• Cough
• Chest pain
• Fatigue
• Shortness of breath
• Headache
• Muscle aches or joint pain
• Night sweats
• Chills
• Skin rash 

Valley fever is not contagious from person to person. Most of the time, if you’ve had Valley fever once, you won’t get it again. If you have a compromised immune system, though, you may have your original infection recur or could be reinfected.

When to seek medical attention

If you live in or have recently traveled to an area where Valley fever is common and you have any of the symptoms above, you should seek medical care. When Valley fever is diagnosed and managed early, it can prevent unneeded medical treatment for possible diseases you do not have. For some, early diagnosis can also help identify when treatment is needed to prevent complications and help you recover faster. 

It’s especially important to get care if you have:

• Symptoms that are severe or getting worse
• Difficulty breathing or chest pain
• A high fever and over-the-counter (OTC) medications aren’t helping
• Long-lasting fatigue or weakness
• A cough that lasts more than a week
• New or unusual symptoms, such as skin rash or joint pain

If you’ve visited an area where Valley fever is common and you have symptoms when you’re somewhere else, tell your health care provider you might have been exposed. Providers in other areas may not recognize the infection as Valley fever. If you get treated for something else, your infection might get worse.

Diagnosing Valley fever

To diagnose Valley fever, your health care provider will probably use a combination of medical history, a physical exam and lab tests. For your medical history and physical exam, your provider will ask about your symptoms, travel history and any exposure to areas where Valley fever is usually found.

If your provider suspects Valley fever, blood tests can detect antibodies to the fungus that causes the infection. Without testing, there’s no way to tell if it’s Valley fever or something else, like bacterial pneumonia or COVID-19, causing your symptoms.

Your provider may also recommend imaging tests such as chest X-rays or CT scans to see how widespread the infection is in your lungs and to look for signs of complications. If you have a persistent cough, your provider may collect a sputum sample (the material you cough up) to analyze in a lab for signs of the fungus. If the infection has spread beyond the lungs, you may need a tissue biopsy to confirm the diagnosis.

Treating Valley fever

Most of the time, you don’t need treatment for Valley fever. Your immune system will help you heal, although it may take a few weeks to a few months.

If you need treatment, your health care provider may prescribe antifungal medications that fight the infection. Which medication you take and how long you’ll need treatment will depend on how severe the infection is and your overall health. 

Medications that are usually prescribed include:

• Azoles: Medications such as fluconazole (Diflucan) and itraconazole (Sporanox, Tolsura), can treat mild to moderate cases of Valley fever. Voriconazole (Vfend), posaconazole (Noxafil) and isavuconazonium sulfate (Cresemba) may be used for more serious infections. They may stop the fungus from growing and spreading.
• Amphotericin B (Abelcet, Ambisome): This medication treats more severe cases of Valley fever or cases that have spread to other parts of the body. It needs to be given intravenously (by IV) in a hospital.

Managing Valley fever symptoms

Along with medication, your health care provider may recommend treatments to help reduce your symptoms:

• OTC pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) may help with muscle aches, joint pain and fever.
• Cough suppressants or expectorants can help reduce coughing and irritation.
• Rest and fluids can help support your body’s immune system so you can recover. Pace yourself and take breaks so you don’t overexert yourself and make symptoms worse.
• Keeping the area clean and moisturized can reduce discomfort if you have a rash or skin lesions.
• Eating a healthy diet with plenty of fruits, vegetables, whole grains and lean proteins can support your immune system and overall health. 
• Walking, swimming or gentle yoga may be good exercise options if you can tolerate them. Steer clear of strenuous activities that might make your symptoms worse.
• Avoiding smoking since it can make your lungs less healthy and increase your risk of complications.
• Physical therapy and reconditioning may help with fatigue and muscle aches as you recover.
• Reaching out to friends and family members can give you emotional support.

Possible complications of Valley fever

Most of the time, people recover from Valley fever without any issues. You’re at higher risk for a more severe case of Valley fever and complications if you:

• Are older
• Have other health conditions, including diabetes
• Have a weakened immune system from an organ transplant, AIDS, chemotherapy or immunosuppressive treatments
• Are pregnant 
• Are Native American, Black or Filipino

Complications from Valley fever infections are uncommon but include: 

• Chronic lung problems such as pneumonia or lung nodules (cavities).
• Disseminated disease, which means the disease spreads through the blood stream beyond the chest. This complication may need years or even life-long treatment and surgeries.
• Meningitis, which is the most serious form of a disseminated infection of the membranes that surround the brain and spinal cord. This infection needs immediate medical attention and specialized treatment.

If you have Valley fever and your symptoms are getting worse or you have new health concerns, contact your health care provider. You’ll also need regular follow-up appointments with your provider to monitor your treatment progress.

Preventing Valley fever

You can reduce your risk of Valley fever by minimizing your exposure to the fungus that causes it:

• Avoid breathing outdoors in dusty conditions. Stay indoors on windy days or during dust storms if you can.
• If you need to be in dusty environments, wear a mask (ideally an N95 mask) to filter the air. 
• Limit outdoor activities such as gardening, hiking or construction work during times of high dust.
• Keep soil moist by watering outdoor areas like gardens or construction sites. That can help keep dust and spores out of the air.
• If you’re planning outdoor activities, consider holding them in early mornings or late evenings, when dust levels are usually lower.

Support for Valley fever

You may be able to get support and information from:

• Your health care team, who can give you personalized guidance and connect you with reliable sources of information such as websites, books and articles.
• Support groups for people affected by Valley fever.
• Community resources such as local health departments, public health agencies or patient advocacy organizations.

Final thoughts 

Valley fever is an infection you could develop if you breathe in spores from the fungus that causes it. In the U.S., it’s mainly found in Southwestern desert areas. 

Most of the time, Valley fever doesn’t cause symptoms or causes only mild symptoms and you can recover on your own. But sometimes it can cause a more severe infection. In those cases, you may need anti-fungal medications for treatment.