DEAR READER: Valley fever is caused by a fungus (coccidioides) that is commonly found in the soil of certain areas. When the fungus becomes disturbed — by construction, farming, etc. — it can become airborne. Individuals (or animals) who then breathe in the fungus can then develop valley fever, also known as acute coccidioidomycosis.

The fact that three people you know and two pets were all diagnosed recently leads me to believe that you all live within close proximity to one another and that whatever disturbed the fungus is fairly close by as well.

The fungus that causes valley fever thrives in the alkaline desert soil of southern Arizona, Nevada, northern Mexico and the San Joaquin Valley of California. It is also common in areas with mild winters and arid summers, such as Texas, New Mexico and parts of Central and South America.

For some patients, acute valley fever can worsen and develop into more serious forms, such as chronic or disseminated coccidioidomycosis. This is especially true of moderate to severe cases that go untreated. (Mild cases may not need treatment.)

Acute infection is often mild with few or no symptoms. If symptoms do present (typically one to three weeks after exposure), they can include joint pain, fatigue, fever, chills, night sweats, cough, chest pain, headache and shortness of breath. Some may develop a red, spotty rash that may turn brown. It usually appears on the lower legs but can also occur on the chest, back and arms. Occasionally, the rash may have blisters or pimple-like lesions.

People who are infected without symptoms may only discover this when a blood or skin test is positive. Some may also have small nodules of residual infection within the lungs that can appear as tumors during a chest X-ray.

In those with symptoms, the disease is highly variable and can take from six months to one year to recover fully. Joint pain and fatigue can last even longer. Severity depends on general health status before infection and the number of spores inhaled. More spores mean more severe infection.

Chronic infection is most common in those with weakened immune systems who don’t fully recover. This complication is a form of chronic pneumonia that often alternates between periods of recovery and worsening symptoms. These can include cough, weight loss, low-grade fever, lung nodules, chest pain and blood in the sputum (mucous that is coughed up and out of the lungs).

Disseminated infection is the most serious form. It occurs when the fungus spreads outside the lungs to other areas of the body, such as the bones, brain, liver, heart, skin and meninges (coverings of the brain and spinal cord). Symptoms include painful, swollen joints; painful skull, spine or bone lesions; meningitis; and nodules, skin lesions and ulcers.

Most cases of valley fever are treated with bed rest and fluids. Careful monitoring by a physician is required so that prescription medication can be given to those who fail to improve after a reasonable amount of time or whose symptoms worsen.

For those who do require treatment, prescription antifungal medication (fluconazole, itraconazole) is the most commonly used. For the most severe cases, the IV antifungal amphotericin may be used.

These medications all carry some serious side effects that typically disappear after the medication is stopped. These can include allergic reaction, seizures, high cholesterol or triglycerides, insomnia, vertigo, low potassium, tremor, drowsiness and much more.
Now, you specifically asked whether valley fever or fluconazole are linked to hearing loss. Based on the above information, I don’t believe they are; however, because I live in New England, valley fever is not an issue for us, so I am fairly unfamiliar with it. If you are concerned, speak to your physician about it.

Because valley fever can become a chronic lung disorder, I am sending you copy of my Health Report “Pulmonary Disease.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Dear Dr. Gott: I read your column today about the woman who had a decade long illness after her and her husband visited the Tucson, AZ area to see their daughter. You wrote that you thought the mother may have a staph infection.

I do not work in the medical profession but am sending this information along to you, since Valley Fever is misdiagnosed so much as I also thought it had been stamped out along with so many other communicable diseases.

My first wife and I both had Valley Fever as young children. We were both raised in Bakersfield, CA which is in the San Joaquin Valley. This area is also known as “America’s Bread Basket” with many farmers constantly plowing and turning the soil over immediately after harvesting a crop of some kind. I was only five years old at the time I was infected. My grandparents came down from Modesto, CA, picked me up and took me to the coast in Hollister, CA for six weeks per my doctor’s orders. I was then taken to their home in Modesto for another six weeks. After that I was allowed to return home to Bakersfield because I appeared to be healed.

This disease left a spot on my left lung the size of a nickel but so far there have been no ill effects. I am 72 years old now and also served five years in the US Navy.

My first wife’s doctor treated her with medicine and bed rest for about six months and she got well never to be bothered with it again. She never said anything about any spots on her lungs after a physical which always included a chest X-ray.

DEAR READER:
My, my your desk must have been a bit cluttered! However, I am not one to speak since my office has been known, on occasion, to be rather untidy, with all the letters and whatnot I receive every day.

Being raised on the East coast and attending medical school in the South, Valley Fever is not something I would have thought of. However, it is certainly a possibility.

Valley Fever is a fungus which grows as mold in the soil of desert areas in the Southwest United States. It usually grows at a depth of four to twelve inches. The mold spores are spread through the air when the soil is overturned, such as during plowing and other farming activities or during fires. Infection occurs after inhalation of the these spores.

Symptoms generally resemble the flu. Cough, fever, fatigue and headache are common symptoms. Given these rather benign symptoms, most doctors, especially those unfamiliar with the infection, could easily mistake the symptoms for a cold, the flu or another harmless bacterial or viral infection. Unlike these infections, however, Valley Fever will not respond to antibiotics or antiviral medication because it is caused by a fungus. Treatment consists of antifungal medication.

Individuals who are susceptible to infection include farmers and construction workers (who have regular contact with upturned soil), pregnant women and those with weak immune systems, such as children who still have developing immune systems, and those with chronic diseases.

The good news in this situation is that there is a test available. If individuals in southern California, Nevada and New Mexico, eastern and southern Texas, and nearly all of Arizona, have flu-like symptoms that have persisted despite treatment with antibiotics, antivirals, and/or various breathing treatments, need a Valley Fever test. This can also apply to individuals who have visited these areas and developed resistant symptoms.

For individuals who live in these areas, have family there or are simply interested in learning more, I recommend you go online to www.MayoClinic.com/health/valley-fever/DS00695 or www.CDC.gov/nczved/dfbmd/disease_listing/coccidioidomycosis_gi.html for more information.

Because you mentioned having a spot on your lung, I am giving you related information, I am sending you a copy of my Health Report “Pulmonary Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.