From the Guidelines
For a patient with a history of valley fever (coccidioidomycosis) that was treated six years ago and is currently asymptomatic, a preoperative workup is not necessary unless there are signs or symptoms suggestive of recurrent or residual disease, as the risk of reactivation is low in immunocompetent individuals 1.
Clinical Evaluation
The preoperative evaluation should start with a detailed history and physical examination focusing on respiratory symptoms. A chest X-ray may be considered to rule out any active pulmonary lesions or residual cavities, but this is not routinely recommended for asymptomatic patients with a remote history of valley fever 1.
Laboratory Tests
Basic laboratory tests such as complete blood count and comprehensive metabolic panel may be part of the routine preoperative workup but are not specifically indicated for valley fever unless there are clinical indications. A Coccidioides antibody test (IgG and IgM) is not necessary for asymptomatic patients with a remote history of infection, as serologic clearance does not necessarily correlate with the risk of reactivation 1.
Special Considerations
If the patient has risk factors for disseminated disease (such as immunosuppression) or if the original infection was severe or disseminated, consulting with an infectious disease specialist may be warranted. Additional imaging such as chest CT may be considered if there are concerning findings on chest X-ray or if the patient had extensive disease previously 1.
Antimicrobial Prophylaxis
For most patients with a remote, treated, and resolved valley fever infection, no special antimicrobial prophylaxis is needed preoperatively, as the risk of reactivation during surgery is low in immunocompetent individuals 1. The decision to use antimicrobial prophylaxis should be based on the individual patient's risk factors and the type of surgery being performed.
From the Research
Preoperative Workup for Valley Fever
The preoperative workup for someone with a history of valley fever six years ago, now asymptomatic and treated, should consider the following:
- Review of medical history to assess for any signs of recurrent or disseminated disease 2
- Physical examination to evaluate for any signs of infection or disease recurrence
- Laboratory tests, such as enzyme immunoassay with immunodiffusion confirmation, to assess for any evidence of active infection 3
- Imaging studies, such as chest radiography, to evaluate for any signs of pulmonary disease or complications 4
- Assessment of immune status, as individuals with compromised immune systems are at higher risk for complications and recurrence 5, 4
Considerations for Asymptomatic Patients
Asymptomatic patients with a history of valley fever may not require extensive preoperative workup, but should still be evaluated for any signs of recurrent or disseminated disease 2, 3
- Monitoring of complement fixation titers and chest radiography may be recommended until patients stabilize and symptoms resolve 3
- Patients who are treated with antifungals should have complement fixation titers followed for at least two years 3
Special Considerations
Special considerations should be taken for patients with a history of valley fever who are undergoing surgery, as they may be at higher risk for complications and recurrence 5, 4, 6
- Patients with a history of valley fever should be monitored closely for any signs of infection or disease recurrence during the postoperative period 2, 3
- Antifungal prophylaxis may be considered for patients with a history of valley fever who are undergoing surgery, especially if they have a compromised immune system 5, 3