Steroid Treatment for Valley Fever (Coccidioidomycosis)
Corticosteroids are not recommended as primary treatment for Valley Fever (coccidioidomycosis) and may be harmful by masking symptoms of infection or worsening the disease.
Understanding Valley Fever
- Valley Fever is a fungal infection caused by Coccidioides immitis and C. posadasii, found in arid soils of the southwestern United States, parts of Mexico, and Central and South America 1
- Infection typically occurs through inhalation of fungal spores (arthroconidia) that become airborne after natural events (earthquakes, dust storms) or human activities (construction, agriculture) 1
- Approximately 60% of infections are asymptomatic, while about one-third develop pulmonary illness, and 0.5-2% of cases disseminate to extrapulmonary sites 1
Risks of Corticosteroid Use in Valley Fever
- Corticosteroids can mask symptoms of infection, potentially allowing the fungal infection to progress undetected 2
- A case report documented a patient with cutaneous coccidioidomycosis who was initially misdiagnosed and treated with systemic steroids, resulting in worsening infection with forehead and periorbital cellulitis 3
- Steroid use in fungal infections can suppress the immune response needed to control the infection, potentially leading to dissemination 3
Appropriate Treatment Approach
- Treatment is warranted for patients with pneumonia who have risk factors for complicated disease and for those with extrapulmonary disease 1
- Antifungal medications, not corticosteroids, are the mainstay of treatment for Valley Fever 1
- For cutaneous manifestations of Valley Fever, antifungal therapy such as itraconazole (200mg twice daily) should be continued for at least 4 months beyond clinical resolution 3
High-Risk Populations
- Persons with cellular immunodeficiencies (transplant recipients, HIV) and non-Caucasian races (especially African Americans and Filipinos) are at higher risk for disseminated disease 1
- Pregnant women also have increased risk for severe or disseminated disease 1
- Despite higher awareness of Valley Fever in endemic regions, only 3.5% of people with risk factors for severe disease knew they were at increased risk 4
Regional Considerations
- Incidence in California increased nearly 800% from 2000 to 2018 5
- Highest rates are in the Southern San Joaquin Valley (90.6 per 100,000 population), with the largest increase (15-fold) occurring in the Northern San Joaquin Valley 5
- Only 25% of persons living in high-incidence regions and 3% in moderate-incidence regions were aware they lived in areas where Coccidioides exists 4
Common Pitfalls to Avoid
- Misdiagnosing Valley Fever as another condition and inappropriately treating with corticosteroids, which can worsen outcomes 3
- Failing to consider Valley Fever in patients with community-acquired pneumonia in endemic areas 1
- Not recognizing that corticosteroids can mask symptoms of infection while allowing the fungal disease to progress 2