Symptoms of Valley Fever
Valley fever typically presents 1-3 weeks after exposure with fever, fatigue, cough, and headache as the most common symptoms, often mimicking community-acquired pneumonia. 1
Primary Clinical Manifestations
Most Common Symptoms
- Fever is the predominant symptom, occurring in the vast majority of symptomatic patients and lasting a median of 10 days in untreated individuals 1
- Fatigue is frequently reported and often persists as the most enduring symptom even after other manifestations resolve 1
- Cough is a hallmark respiratory symptom, often accompanied by chest pain, as valley fever presents primarily as pneumonia 1, 2
- Severe, debilitating headaches are common and may be retroorbital with photophobia, sometimes misdiagnosed as migraines or even dental problems when pain radiates to the jaw 1
- Chills and myalgia are frequently reported systemic symptoms 1
Classic Triad ("Desert Rheumatism")
- Fever, erythema nodosum, and arthralgia comprise the classic triad of symptoms, often accompanied by respiratory complaints 3
Disease Course and Timeline
Incubation and Onset
- Symptoms appear 1-3 weeks after inhaling fungal spores from contaminated soil or dust 1, 4
- Onset can be gradual or abrupt with variable severity 2
Duration and Resolution
- Fever typically resolves within 72 hours of appropriate antifungal treatment when treatment is indicated 1
- Systemic symptoms improve first, followed by respiratory symptoms, with fatigue being the most persistent 1
- Most infections in immunocompetent individuals are self-limited and resolve spontaneously without specific antifungal therapy 1, 2
Clinical Recognition Challenges
Diagnostic Pitfalls
- Valley fever is commonly misdiagnosed as bacterial pneumonia or other respiratory infections due to similar clinical presentation 1
- The disease accounts for 17-29% of community-acquired pneumonia cases in endemic regions, yet remains underrecognized without specific testing 2, 5
- Clinical features alone cannot distinguish valley fever from other causes of community-acquired pneumonia without serologic testing 2
Key Epidemiologic Clues
- Travel or residence in endemic regions (southern Arizona, central California, southern New Mexico, west Texas) is essential for diagnosis 4, 2
- Dust exposure, particularly during dust storms, is a critical risk factor for infection 4
- No person-to-person transmission occurs, distinguishing it from other respiratory infections 2
Special Populations
Asymptomatic Disease
- Half to two-thirds of infections are subclinical, meaning many infected individuals never develop symptoms 4
High-Risk Patients
- Patients with risk factors for dissemination (immunocompromised, pregnant, certain ethnicities) may develop more severe manifestations requiring antifungal therapy 1, 6
Clinical Management Implications
When to Suspect Valley Fever
- Any patient with community-acquired pneumonia who has lived in or traveled to endemic regions should be evaluated for valley fever 1, 2
- Obtaining a travel history is essential when evaluating patients with respiratory symptoms 2
Treatment Considerations
- Immunocompetent patients with mild to moderate symptoms generally do not require antifungal therapy, as most infections resolve spontaneously 1, 6
- Antifungal treatment is indicated for severe primary pulmonary disease, patients with risk factors for dissemination, and disseminated disease 1, 6
- Fluconazole 400-800 mg daily is the first-line treatment when antifungals are needed 1, 6