Exposure Risks and Clinical Presentation:
The risk of being infected by VF can occur to anyone who lives or travels to the southwest states, particularly to endemic regions of Arizona and California, Mexico, and Central or South America. The risk of infection is greater during high winds or dust storms during residential activities, occupational exposure during ground excavation, sports/athletic training, military field training, construction and farm workers, agricultural field workers, or during recreation (eg, walking/hiking, trail running, mountain biking, etc). Historically, it is more common in adults aged 60 year or greater, but other age groups are at higher risk for disseminated “cocci” in those with weakened or physiologically changed (pregnant) immune function:
- Organ transplant patients
- Pregnant women
Valley Fever is not contagious between individuals. As with humans, pets may too be exposed to “cocci” fungus, and dogs make up the majority of VF animal cases. Pets do not always develop VF symptoms when infected, but when they do, they present with coughing, lack of energy and weight loss. It is essential to seek out a veterinarian ensuring early management to prevent long-term complications and death. When people are exposed to VF fungus 60% are mild with little or no symptoms, and are protected from getting VF again. While 30% have moderate and 10% have severe symptoms. If symptoms last more than a week, seek a healthcare provider and get serologic test for VF. See Figure 5 for common signs and symptoms of VF.
The clinical challenge is to make a fast and accurate VF diagnosis since many patients are sent home based on overlapping symptoms with influenza—headache, fever, cough, myalgia and malaise, causing a delay in diagnosis and treatment. Many VF patients often get diagnosed with community acquired bacterial pneumonia and prescribed an antibiotic, but return with worsening symptoms. According to the CDC, these are not isolated incidences of misdiagnosis. Many clinicians outside of the endemic regions do not treat VF and therefore do not routinely consider a differential diagnosis of VF, and all too often patients get misdiagnosed. When a diagnosis is delayed this illness can become disseminated coccidioidomycosis causing destruction in skin, bones, brain tissue and other organs.
Due to heightened concern of COVID-19 infection, many seek medical care for symptoms of fever, chills, cough, shortness of breath, fatigue muscle and body aches. COVID-19 also has overlapping symptoms with VF. These patients will routinely get tested incorrectly, and go undiagnosed for VF for days and weeks due to COVID-19 bias. Early recognition of VF is imperative during COVID-19 pandemic since approximately 75% of VF patients miss work or school for two weeks until more diagnostic tests, e.g., diagnostic lumbar puncture or biopsy, for worsening of symptoms.