From the Guidelines
Valley fever treatment should be based on symptom severity, with mild cases often resolving on their own and severe or persistent cases requiring antifungal medications such as fluconazole (typically 400-800 mg daily for 3-6 months) or itraconazole, as recommended by the 2016 Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis 1.
Symptoms and Diagnosis
Valley fever, caused by the fungus Coccidioides, can present with a range of symptoms, including:
- Fever
- Cough
- Fatigue
- Headache
- Chest pain
- Shortness of breath
- Joint pain
- Rash, including erythema nodosum—painful red bumps on the shins Diagnosis is typically made through blood tests or imaging, and early diagnosis is crucial for effective treatment and prevention of complications.
Treatment Options
For mild cases, rest and over-the-counter pain relievers like acetaminophen or ibuprofen may suffice, as the infection often resolves on its own within weeks or months. However, severe or persistent cases require antifungal medications, with fluconazole being the most frequently prescribed due to its predictable absorption, fewer drug interactions, and lower cost 1.
- Fluconazole: typically 400-800 mg daily for 3-6 months
- Itraconazole: 200 mg twice daily
- Amphotericin B: reserved for severe cases
Special Considerations
Certain groups, such as those with weakened immune systems, pregnant women, diabetics, and certain ethnic groups, face higher risks of severe disease and may require more aggressive treatment 1.
Follow-up and Monitoring
Regular follow-up visits are essential to monitor the patient's response to treatment and adjust the treatment plan as needed, with the interval between visits varying according to the severity of symptoms and the course of infection 1.
From the FDA Drug Label
Amphotericin B for Injection USP is specifically intended to treat potentially life-threatening fungal infections: ... coccidioido-mycosis, ...
- Valley fever, also known as coccidioidomycosis, is a fungal infection that can be treated with amphotericin B in severe cases.
- The symptoms of Valley fever are not directly mentioned in the drug label, but it can be inferred that amphotericin B is used to treat the infection when it becomes life-threatening.
- Treatment with amphotericin B is intended for patients with progressive, potentially life-threatening fungal infections, including coccidioidomycosis 2.
From the Research
Valley Fever Symptoms
- Fever, erythema nodosum, and arthralgia are a common triad of symptoms, often accompanied by a respiratory problem 3
- Symptoms may also include desert rheumatism 3
- Individuals with suppressed cellular immunity, such as those with HIV infection, those on immunosuppressive medications, and those who have received a solid organ transplant, are at increased risk for symptomatic coccidioidomycosis 4
- Pregnant women and African-American men are also at increased risk for symptomatic and severe infection 4
Valley Fever Treatment
- Antifungal therapy is frequently not required for primary pulmonary disease, but prolonged courses of antifungals are generally needed for those with extrathoracic disseminated disease 4
- Intravenous amphotericin B should be reserved for those with severe disease 4
- Oral triazole antifungals, such as fluconazole and itraconazole, have been effective for various forms of coccidioidomycosis, including meningitis 4
- Voriconazole and posaconazole are reasonable options for salvage treatment of refractory coccidioidomycosis 5
- Fluconazole is the antifungal agent typically used to treat pulmonary coccidioidomycosis 6
- Treatment varies depending on the immunocompetency of the patient, with special considerations needed for pregnant patients and those with a history of HIV or transplantation 3, 6