From the Guidelines
Coccidioidomycosis, also known as Valley Fever, presents with symptoms ranging from mild flu-like illness to severe pneumonia, and treatment depends on disease severity, with antifungal medications such as fluconazole being the primary treatment option, as recommended by the 2016 IDSA clinical practice guideline 1.
Symptoms of Coccidioidomycosis
- Fever
- Cough
- Chest pain
- Fatigue
- Headache
- Night sweats
- Joint aches
- Sometimes a rash Many infected individuals (60%) remain asymptomatic.
Treatment Options
- For mild cases in healthy individuals, no treatment may be necessary beyond rest and symptom management.
- For more significant infections, antifungal medications are prescribed, typically fluconazole (400-800 mg daily) for 3-6 months, as recommended by the 2016 IDSA clinical practice guideline 1.
- Severe cases may require amphotericin B (0.5-1.0 mg/kg/day IV), as recommended by the 2000 IDSA practice guideline 1.
- Disseminated disease, where the infection spreads beyond the lungs, requires prolonged treatment, sometimes for years or lifelong, with fluconazole or itraconazole being commonly used, as recommended by the 2009 CDC guidelines 1.
- Itraconazole (200 mg twice daily) is often used for bone or joint involvement, as recommended by the 2005 Clinical Infectious Diseases study 1.
- Patients should be monitored with regular blood tests to check liver function while on antifungals.
High-Risk Groups
- People with weakened immune systems
- Pregnant women
- Certain ethnic groups (African Americans, Filipinos) are at higher risk for severe disease, as noted in the 2000 IDSA practice guideline 1.
From the FDA Drug Label
Amphotericin B for Injection USP is specifically intended to treat potentially life-threatening fungal infections: ... coccidioido-mycosis... The symptoms of coccidioidomycosis are not directly mentioned in the drug label. However, treatment options for coccidioidomycosis include amphotericin B as it is specifically intended to treat this fungal infection 2. Key points about treatment:
- Amphotericin B is used for potentially life-threatening fungal infections
- It is specifically intended to treat coccidioidomycosis The FDA drug label does not provide information on the symptoms of coccidioidomycosis.
From the Research
Symptoms of Coccidioidomycosis
- The disease can be self-limited or may require antifungal therapy 3
- Pulmonary disease is the most common presentation and is seen in almost 95% of all cases 4
- One-half to two-thirds of all Coccidioides infections are asymptomatic or subclinical 4
- Symptoms can include a influenza-like respiratory illness 5
- Diffuse miliary pneumonia is uncommon and is especially rare in immunocompetent patients 4
Treatment Options for Coccidioidomycosis
- Currently used triazoles (eg, fluconazole and itraconazole) have largely supplanted amphotericin B, which is fraught with adverse effects 3
- Voriconazole and posaconazole are reasonable but not infallible options for salvage treatment of refractory coccidioidomycosis 3
- Itraconazole and fluconazole are frequently used when treatment is warranted 4
- Fluconazole 200 or 400 mg/d is well tolerated and a moderately effective treatment for chronic pulmonary or nonmeningeal disseminated coccidioidomycosis 6
- Antifungal therapy is typically beneficial requiring treatment ranging from months to lifelong 5
- Clinical factors related to treatment decisions include severity of symptoms, radiography, coccidioidomycosis serologic results, and concurrent medical problems including immunosuppression 5