IDSA Updates Valley Fever Guidelines

What is Valley Fever

According to the Centers for Disease Control and Prevention (CDC), Valley fever, or coccidioidomycosis, is a fungal infection caused by Coccidioides, which can be found in soil in Southwest United States, certain areas in Mexico, Central America, and South America. Infection usually occurs when an individual breathes in microscopic Coccidioides spores; however, not all those who are exposed to the spores will become infected.

Valley fever usually affects the lungs, but can spread throughout the body in those who have severe infection, often called 'disseminated coccidioidomycosis'. In most cases, the immune system is able to fight off the infection; some patients recover within weeks, while for others it takes months. In those at high risk for developing the fever, treatment will require antifungul medication, according to the CDC. For those with severe lung infection, treatment with medication can take more than 6 months.

Individuals at highest risk for developing Valley fever include those who are immunocompromised, organ transplant patients, pregnant women, individuals receiving corticosteroids or TNF-inhibitors, and those of certain ethnicities. Valley fever does not spread from person to person, or between humans and animals, although animals can become infected with Valley fever. However, if an individual receives an organ transplant from someone who was infected with Valley fever, he or she may acquire infection, according to the CDC. In most cases, infection with Valley fever renders an individual immune to the fungus; relapse is rare. For those of whom Valley fever attacks the nervous system, the CDC warns that there may be long-term damage.

Valley Fever Guidelines

In late July, the Infectious Diseases Society of America (IDSA) updated their guidelines for Valley fever, urging clinicians to suspect Valley fever in pneumonia patients who reside in or who have visited southwest states, especially Arizona and central California. They report that an estimated 150,000 individuals acquire Valley fever on an annual basis, of whom around 160 die.They believe that Valley fever is “often over-looked.” According to IDSA, early diagnosis reduces the need for otherwise unnecessary testing and treatment.

According to John Galgiani, MD, lead author of the guidelines, and professor at the University of Arizona College of Medicine, director of the Valley Fever Center for Excellence, in Tucson, Arizona, “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… 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.”

Valley fever is diagnosed based on medical and travel history, symptoms, physical exams, and blood tests, according to the CDC. Furthermore, Valley fever pneumonia can be identified through chest x-rays or lung CT scans, tissue sample testing, or cultures.