5-60
usually for 6-12 months.
Alternative: Ketoconazole 400-800 mg/ day or fluconazole 400-800 mg/ po day
Patient Education
General: Acute pulmonary infection may resolve untreated in 1-3 weeks. All other forms carry a high risk
of death if not treated.
Activity: As tolerated.
Diet: No limitations.
Medications: See precautions listed for oral azoles (itraconazole, ketoconazole and fluconazole) and IV
amphotericin B in the Candidiasis section.
Prevention and Hygiene: None necessary.
Follow-up Actions
Wound Care: Local care to prevent secondary bacterial infection.
Return evaluation: Observe patients over a 1-2 year period for resolution of infection.
Consultation Criteria: Refer all patients to a specialist for care.
Zoonotic Disease Considerations
Principal Animal Hosts: Dogs, cats, horses
Clinical Disease in Animals: Nonspecific, dependent on organ involvement; weight loss, coughing, anorexia,
diarrhea, ocular disease, lameness, skin lesions, fever
Probable Mode of Transmission: Environmental or animal exposure
Known Distribution: Worldwide
ID: Coccidioidomycosis (Valley Fever, Desert Rheumatism)
LTC Duane Hospenthal, MC, USAIntroduction: Coccidioides immitis is a dimorphic fungus that causes disease ranging from self-limited
pulmonary infection to chronic meningitis. Incubation period is 7-21 days. More than 60% of all infections
are asymptomatic. Most symptomatic infections take the form of acute pulmonary disease. Untreated, acute
infection resolves in 95% of patients. About 1% of those infected develop chronic pulmonary disease or
disseminated infection to the meninges, skin, bone, or soft tissue. Geographic Associations: It occurs in the
southwest deserts of the US and northern Mexico, and a few pockets of in Central and South America. It
has frequently been reported in service members training at Fort Irwin, California. Incidence peaks during
dry periods following rains, usually in summer and fall, and is often associated with wind and dust storms.
Risk Factors: Filipinos, blacks, Hispanics, pregnant women, immunocompromised patients are at higher risk
for dissemination and severe disease.
Subjective: Symptoms
Cough (usually dry), fever, pleuritic chest pain, malaise, headache, anorexia, myalgia and often rash; severe
disease may present with a sepsis-like syndrome. Large joint pain may occur after asymptomatic infection,
especially in white females (desert rheumatism). Meningitis presents with chronic headache, memory loss,
lethargy, or confusion.
Focused History: Have you traveled recently to the deserts of the southwest US or northern Mexico?
(endemic areas of disease)
Objective: Signs
Using Basic Tools: Vital signs: Fever and tachypnea
Inspection: Various rashes: Diffuse, faint erythematous rash lasting less than one week; or erythema
multiforme (painless, diffuse rash consisting of rings and disks); or erythema nodosum (painful red nodules
usually occurring on the shins).
Auscultation: Diffuse ausculatory findings (abnormal breath sounds).
Using Advanced Tools: Ophthalmoscope: Patients with meningitis may have papilledema on funduscopy.