DEAR DR. ROACH: I am a 57-year-old male who is healthy and physically fit. I contracted Valley fever last November while visiting Arizona. The initial symptoms were flulike body aches, a rash and profound night sweats that lasted for about three weeks. After returning to Canada, my family physician ordered a CT scan, which showed nodules in the left lung, the largest being 4 cm. I began to recover (untreated) before an appointment with a pulmonary specialist became available, and my doctor decided to take a wait-and-see approach. I was fully recovered and back cycling long distances in about three months.
Can I assume that this illness is behind me? I've met many other people who have had VF, but not one who didn't receive some kind of antifungal. I have also read that VF can reappear years down the road. Does not having had treatment with antifungals have any influence on a recurrence?
A: The fungus Coccidioides is the cause of Valley fever. Coccidiomycosis, the disease caused by this fungus, is very different when it infects a young and healthy person like yourself from an infection in a person with immune system disease. You had pretty classic symptoms of Valley fever (the name for the infection in otherwise healthy people), and your body was able to overcome the infection with no treatment.
Two studies have looked at whether treatment improves symptoms faster or prevents recurrence. There was no difference between treated and untreated groups in symptoms, and no patients had recurrence of disease in the untreated group. You can be reassured that the illness is behind you.
In people taking medications to suppress the immune system (such as for auto-immune diseases) or have underlying immune system disease (advanced HIV, recent cancer chemotherapy), coccidiomycosis can be much more serious. Pregnant women need treatment as well, even with mild symptoms. Treatment in these cases is with an antifungal medicine, usually for a prolonged time, and I strongly advise treatment by a pulmonary or infectious disease specialist.