Coccidioidomycosis, San Joaquin fever or valley fever is a fungal infection of the genus ‘Coccidioides’, generally ‘Coccidioides immitis’ and ‘Coccidioides posadasii’ that affects the lungs but can also spread through the blood to other organs and tissues. In its mild form it presents flu-like symptoms and can disappear without treatment. ‘Coccidioides’ is endemic in the soil of the southwestern United States, in the central valley of California, northern Mexico, in parts of Central America and in Argentina.
Causes of coccidioidomycosis
Inhalation of spore-laden dust
The appearance of coccidioidomycosis is caused by the inhalation of dust loaded with spores of the fungus, which is generally found in the soil between 20 and 25 centimeters from the surface. It is not transmitted from person to person or through mosquitoes. Mammals are sensitive.
There are two types of coccidioidomycosis:
– Primary. It is usually asymptomatic but, between one and three weeks after contracting the fungus, respiratory symptoms similar to those of the flu may appear. But some patients may develop hypersensitivity to respiratory infections with manifestations of arthritis, conjunctivitis and redness of the skin (erythema). There may be coin-shaped (numular) lung lesions.
– Progressive. It can be fatal if not treated. Several months and even years after the primary infection, the infection spreads throughout the body.
The risk factors for developing the disease are:
– Have a weakened immune system.
– Consume corticosteroids.
– Travel to areas where the fungus is endemic.
– Be over 60 years old.
Symptoms of coccidioidomycosis
Respiratory and others
Mild symptoms of coccidioidomycosis are:
– Productive cough that may be tinged with blood.
– Fever.
– Chest pain.
– Difficulty breathing.
– Reddish and painful tumors on the legs.
In the progressive form the symptoms are usually:
– Mild intermittent fever.
– Loss of appetite.
– Weight loss.
– Weakness.
– Changes in mental state.
– Joint inflammation.
– Sensitivity to light.
– Lung abscesses.
If the disease spreads it can affect bones, lungs, liver, meninges, brain, skin, heart and pericardium, the fibrous membrane that surrounds the heart.
Diagnosis of coccidioidomycosis
Blood tests, x-rays and cultures
For diagnosis, in addition to the physical examination and medical history, which must mention whether trips or stays have been made in areas where the fungus is endemic, the specialist will request a urine and blood analysis to check if there are antibodies against the fungus, chest x-rays, sputum culture, and skin culture if erythema is present.
Coccidioidomycosis treatment and medication
Antifungals
Most cases do not need treatment and the first infection may generate lifelong immunity, but in chronic cases or spread of the disease the guideline is to prescribe antifungals such as fluconazole. Serious infections are treated intravenously.
Prevention of coccidioidomycosis
Avoid places where there may be fungi of the genus ‘Coccidioides’
The main prevention measure is to avoid places where there may be fungi of the ‘Coccidioides’ genus, but if you visit them, especially in summer, you should wear a mask or not go out or open the windows during dust storms. If you are going to remove soil, it is key to moisten the soil beforehand and have the doors and windows of the house completely closed.
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