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Symptoms
By Mayo Clinic staffValley fever is the acute form of coccidioidomycosis infection. This initial illness can develop into more serious disease, including chronic and disseminated coccidioidomycosis.
Acute coccidioidomycosis (valley fever)
The initial, acute form of coccidioidomycosis is often mild, with few, if any, symptoms. When signs and symptoms do occur, they appear one to three weeks after exposure. They tend to resemble those of the flu, and can range from minor to severe:
- Fever
- Cough
- Chest pain — varying from a mild feeling of constriction to intense pressure resembling a heart attack
- Chills
- Night sweats
- Headache
- Fatigue
- Shortness of breath
- Joint aches
- Red, spotty rash
The rash that sometimes accompanies valley fever is made up of painful red bumps that may later turn brown. The rash mainly appears on your lower legs, but sometimes on your chest, arms and back. Some people with valley fever have a raised red rash with blisters or eruptions that look like pimples.
If you don't become ill from valley fever, you may learn that you've been infected only when you later have a positive skin or blood test. Small areas of residual infection (nodules) in the lungs that show up on a routine chest X-ray may also be found. Although the nodules typically don't cause problems, they can look like tumors on X-ray.
If you do develop symptoms, especially severe ones, the course of the disease is highly variable. It can take from six months to a year to fully recover, and fatigue and joint aches can last even longer. The severity of the disease depends on several factors, including your overall health and the number of fungus spores you inhale.
Chronic coccidioidomycosis
If the initial coccidioidomycosis infection doesn't completely resolve, it may progress to a chronic form of pneumonia. This complication is most common in people with diabetes or weakened immune systems. You're likely to have periods of worsening symptoms alternating with periods of recovery. Signs and symptoms are similar to those of tuberculosis:
- Low-grade fever
- Weight loss
- Cough
- Chest pain
- Blood-tinged sputum
- Nodules in the lungs
Disseminated coccidioidomycosis
The most serious form of the disease, disseminated coccidioidomycosis occurs when the infection spreads (disseminates) beyond the lungs to other parts of the body. Most often these parts include the skin, bones, liver, brain, heart, and the membranes that protect the brain and spinal cord (meninges).
The signs and symptoms of disseminated disease depend on which parts of your body are affected and may include:
- Nodules, ulcers and skin lesions that are more serious than the rash that sometimes occurs with other forms of the disease
- Painful lesions in the skull, spine or other bones
- Painful, swollen joints, especially in the knees or ankles
- Meningitis — an infection of the membranes and fluid surrounding the brain and spinal cord and the most deadly complication of valley fever
When to see a doctor
Valley fever, even when it's symptomatic, often clears on its own. Yet for older adults and others at high risk, recovery can be slow, and the risk of developing severe disease is high.
Seek medical care if you are in a high-risk group and develop the signs and symptoms of valley fever, especially if you:
- Live in or have recently traveled to an area where this disease is common
- Have symptoms that aren't improving
Be sure to tell your doctor if you've traveled to a place where valley fever is endemic and you have symptoms. More and more, people who spend a few days golfing or hiking in Arizona return home with valley fever, but are never tested for the disease.
- Coccidiodomycosis. Centers for Disease Control and Prevention. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/coccidioidomycosis_t.htm. Accessed Jan. 20, 2010.
- Galgiani JN. Primary coccidioidal infection. http://www.uptodate.com/home/index.html. Accessed Jan. 20, 2010.
- Galgiani JN, et al. Management of pulmonary sequelae and complications of coccidioidomycosis. http://www.uptodate.com/home/index.html. Accessed Jan. 20, 2010.
- Coccidioidomycosis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec14/ch180/ch180f.html. Accessed Jan. 20, 2010.
- Coccidioidomycosis. In: Ferri FF. Ferri's Clinical Advisor 2010. St. Louis, Mo.: Mosby; 2009. http://www.mdconsult.com/das/book/body/178982054-6/0/2088/150.html#4-u1.0-B978-0-323-05609-0..00012-5--sc0190. Accessed Jan. 20, 2010.
- Ampel NM. Coccidioidomycosis: A review of recent advances. Clinics in Chest Medicine. 2009;30:241.
- Steckelberg JM (expert opinion). Mayo Clinic, Rochester, Minn. January 26, 2010.
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