Early diagnosis of coccidioidomycosis is important in order to reduce unnecessary tests and treat the condition, according to updated guidelines released by the Infectious Diseases Society of America (IDSA) and published in the journal Clinical Infectious Disease.1
The updated guidelines note that coccidioidomycosis, originally nicknamed San Joaquin Valley fever, may be overlooked as a cause of illness, which may lead to unnecessary blood imaging tests and antibiotic use. The guidelines emphasize that physicians should suspect this illness in patients with pneumonia or ongoing influenza-like symptoms who live in or have visited the west or southwest United States, especially Arizona and central California.
“Valley fever is underdiagnosed in part because past guidelines were directed to the specialists, whereas most of these patients initially see their primary care physicians, many of whom aren’t aware just how common this infection is,” John N. Galgiani, MD, lead author of the guidelines noted in a prepared statement.2 “About a third of cases of pneumonia in Arizona are caused by valley fever. Doctors need to ask patients with pneumonia about their travel history and if they’ve recently traveled to endemic areas, and need to consider valley fever.”
About 60% of people with valley fever have a mild infection with few or no symptoms, and almost half don’t require medication. Others however, may have fever, fatigue, cough, headache, chest pain, skin rash and joint aches. In extreme cases it can cause severe pneumonia, holes in the lungs, lung nodules, skin sores and meningitis. Pregnant women and people who are immunosuppressed (those with HIV, who had an organ transplant or are taking medication for rheumatologic disease) or have diabetes are at very high risk of complications.
Those patients who do need therapy should be treated with an antifungal medication such as fluconazole, according to the guidelines. The medication does not cure the infection but suppresses the symptoms. The guidelines note that some patients with more serious illness, including coccidioidal meningitis, will need to remain on antifungal therapy for life.
The guidelines recommend treatment with fluconazole for women with complications from valley fever who are in their second or third trimester of pregnancy. That is a change from the previous guidelines, which recommended pregnant women be treated with amphotericin B. Fluconazole is not toxic to the mother, can be taken orally and, while not recommended during the first trimester, appears safe during the second and third trimester, the guidelines note. The infection itself is not harmful to the fetus.
Every year, an estimated 150,000 people get the infection, according to information provided by the Infectious Diseases Society of America.
1. Galgiani JN, Ampel NM, Blair JE, et al. 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis. Clin Infect Dis J. 2016; doi: 10.1093/cid/ciw360.