What are the symptoms of Valley Fever meningitis. How is coccidioidal meningitis diagnosed. What are the treatment options for Valley Fever meningitis. Why is lifelong treatment recommended for coccidioidal meningitis. How do doctors assess a patient’s response to Valley Fever meningitis treatment.

Understanding Coccidioidal Meningitis: A Severe Complication of Valley Fever

Coccidioidal meningitis (CM) is a serious and potentially life-threatening complication of Valley Fever, caused by the spread of Coccidioides fungi to the central nervous system (CNS). This condition requires prompt diagnosis and aggressive treatment to prevent fatal outcomes and manage long-term complications.

Recognizing the Symptoms of Valley Fever Meningitis

CM can present with a range of neurological symptoms that may initially be difficult to distinguish from other conditions. Common symptoms include:

• Persistent headaches
• Blurry vision
• Photophobia (sensitivity to light)
• Meningismus (neck stiffness)
• Cognitive decline
• Changes in hearing
• Focal neurologic deficits

Is a lumbar puncture necessary for all patients with Valley Fever? While routine cerebrospinal fluid (CSF) analysis is not recommended for all patients with Valley Fever, it is crucial for those exhibiting CNS symptoms. A recent retrospective study found no evidence to support routine CSF analysis in at-risk groups (based on age, ethnicity, or CF titer) without CNS symptoms.

Diagnostic Approach to Coccidioidal Meningitis

Accurate diagnosis of CM is essential for initiating appropriate treatment. The diagnostic process typically involves:

1. Lumbar puncture and CSF analysis
2. Serologic testing (ID/CF)
3. CSF culture
4. Imaging studies

What does CSF analysis typically reveal in cases of CM? CSF analysis in CM patients often shows:

• Elevated white blood cell count with mixed or lymphocytic pleocytosis
• High protein levels (sometimes measurable in g/dL)
• Low glucose levels

Imaging studies play a crucial role in evaluating complications associated with meningitis, such as hydrocephalus or vascular issues.

The Critical Importance of Timely Treatment for Valley Fever Meningitis

Why is prompt treatment essential for CM? Untreated CM is uniformly fatal. Historical data from before the availability of antifungal medications showed a grim prognosis, with all patients succumbing to the disease within two years, and 91% dying within one year.

While modern antifungal treatments have improved survival rates, CM still carries significant morbidity due to disease complications, treatment devices, and medication side effects.

Common Complications of Coccidioidal Meningitis

CM can lead to several life-threatening complications, including:

• Hydrocephalus
• CNS vasculitis
• Cerebral ischemia and infarction
• Vasospasm
• Hemorrhage
• Basilar meningitis
• Spinal cord involvement

How is hydrocephalus managed in CM patients? Patients with hydrocephalus often require ventricular shunts for decompression. However, these shunts can lead to secondary complications such as infections, obstruction due to persistent coccidioidomycosis, and abdominal pseudocysts. Multiple shunt revisions may be necessary in some cases.

Current Treatment Strategies for Valley Fever Meningitis

What is the primary treatment approach for CM? Most clinicians prefer oral fluconazole therapy for treating CM. The recommended starting dose typically ranges from 800 to 1200 mg per day, although initial studies used 400 mg daily.

Historical Treatment Approaches

Before the advent of azole antifungals, amphotericin B deoxycholate (AmB) was the only available treatment option. However, it was ineffective when administered intravenously and required frequent intrathecal (IT) administrations, which posed significant challenges and toxicity risks.

How do fluconazole and IT AmB compare in treating CM? While there are no direct comparison trials, historical studies show response rates of 51-100% for IT AmB (in studies published before 1986) and approximately 79% for fluconazole. Fluconazole treatment typically results in symptom resolution within 4-8 months, although CSF abnormalities may persist, especially in patients with shunts.

The Necessity of Lifelong Treatment for Coccidioidal Meningitis

Why is lifelong treatment recommended for CM patients? Clinical experience and a small study showing an extremely high relapse rate of 78% when therapy is discontinued have led to the recommendation for lifelong azole treatment in CM patients.

This long-term treatment approach aims to prevent disease recurrence and manage potential complications effectively. However, it also presents challenges in terms of medication adherence and potential side effects over an extended period.

Assessing Treatment Response in Valley Fever Meningitis

How do doctors evaluate a patient’s response to CM treatment? Assessing treatment response primarily relies on serial clinical evaluations and medical judgment. Favorable signs include:

• Return to premorbid functioning
• Decreasing complement fixation (CF) titers
• Excellent adherence to medical care and therapy

Some patients with chronic meningitis may experience refractory illness with poor recovery or exceptionally slow improvement. In these cases, a combination of serology and repeated CSF evaluations may be necessary to assess microbiologic and serologic improvement.

Challenges in Long-term Management of Coccidioidal Meningitis

What are the main challenges in managing CM over the long term? Long-term management of CM presents several challenges:

1. Medication adherence: Ensuring patients consistently take their antifungal medications as prescribed
2. Monitoring for drug side effects: Regular check-ups to assess potential long-term effects of antifungal therapy
3. Managing complications: Addressing issues related to shunts, CNS vasculitis, or other sequelae of the disease
4. Psychosocial support: Helping patients cope with the chronic nature of the condition and its impact on quality of life

How can healthcare providers support CM patients in long-term management? Healthcare providers can support CM patients by:

• Providing comprehensive patient education about the disease and its treatment
• Offering adherence counseling to reinforce the importance of consistent medication use
• Implementing regular follow-up schedules for monitoring treatment response and potential complications
• Collaborating with mental health professionals to address psychological aspects of living with a chronic condition
• Exploring potential clinical trials or new treatment options that may improve outcomes

Emerging Research and Future Directions in Valley Fever Meningitis Treatment

What areas of research are being explored to improve CM treatment? Current research efforts in CM treatment focus on several key areas:

1. Development of new antifungal agents with improved efficacy and safety profiles
2. Investigation of combination therapies to enhance treatment outcomes
3. Exploration of immunomodulatory approaches to complement antifungal therapy
4. Refinement of diagnostic techniques for earlier detection and treatment initiation
5. Studies on the long-term outcomes of different treatment strategies

How might these research directions impact future CM management? Advances in these areas could potentially lead to:

• More effective and less toxic treatment options
• Personalized treatment approaches based on individual patient factors
• Improved quality of life for patients undergoing long-term therapy
• Reduced reliance on invasive procedures like intrathecal drug administration
• Better understanding of disease mechanisms and potential preventive strategies

The Role of Patient Registries and Collaborative Research

How do patient registries contribute to CM research? Patient registries play a crucial role in advancing CM research by:

• Collecting long-term data on disease progression and treatment outcomes
• Identifying patterns and risk factors associated with CM development
• Facilitating the design of targeted clinical trials
• Enabling comparison of treatment strategies across different healthcare settings

Collaborative research efforts, such as those coordinated by the UC Davis Center for Valley Fever, are essential for pooling resources, expertise, and patient data to accelerate progress in understanding and treating this challenging condition.

Public Health Implications of Valley Fever Meningitis

What are the broader public health considerations related to CM? Valley Fever meningitis, while relatively rare, has significant public health implications:

1. Disease surveillance: Monitoring CM cases helps track the spread of Coccidioides fungi and identify potential environmental risk factors
2. Healthcare resource allocation: Understanding the prevalence and impact of CM informs decisions about healthcare resource distribution in endemic areas
3. Prevention strategies: Insights from CM research can guide the development of public health interventions to reduce Valley Fever exposure
4. Economic impact: The long-term nature of CM treatment and potential complications have substantial economic implications for healthcare systems and affected individuals

How can public health initiatives address the challenges posed by CM? Public health approaches to addressing CM may include:

• Enhancing awareness among healthcare providers in endemic areas to promote early diagnosis
• Implementing environmental control measures to reduce exposure to Coccidioides spores
• Developing educational programs for at-risk populations about Valley Fever prevention and early symptom recognition
• Advocating for increased research funding to advance treatment options and potential vaccine development
• Establishing support networks for patients dealing with the chronic effects of CM

By addressing Valley Fever meningitis from both clinical and public health perspectives, healthcare systems can work towards reducing the incidence and impact of this severe complication of coccidioidomycosis.

The Importance of Multidisciplinary Care in Managing Valley Fever Meningitis

Why is a multidisciplinary approach crucial in CM management? The complex nature of CM requires input from various medical specialties to provide comprehensive care:

• Infectious disease specialists: To guide antifungal therapy and monitor treatment response
• Neurologists: To assess and manage neurological complications
• Neurosurgeons: For shunt placement and management in cases of hydrocephalus
• Radiologists: To interpret imaging studies and track disease progression
• Clinical pharmacists: To optimize medication regimens and manage potential drug interactions
• Rehabilitation specialists: To address functional impairments resulting from neurological complications
• Mental health professionals: To support patients coping with chronic illness

How does a multidisciplinary approach benefit CM patients? Collaborative care can lead to:

1. More comprehensive treatment plans addressing all aspects of the disease
2. Improved coordination of care, reducing the risk of treatment gaps or conflicting interventions
3. Enhanced patient outcomes through the combined expertise of multiple specialists
4. Better management of complex cases with multiple complications
5. Increased opportunities for patient education and support

The Role of Specialized Centers in CM Care

What advantages do specialized centers offer in managing CM? Centers like the UC Davis Center for Valley Fever provide several benefits:

• Concentrated expertise in diagnosing and treating coccidioidomycosis and its complications
• Access to the latest research and treatment protocols
• Opportunities for patients to participate in clinical trials
• Comprehensive support services tailored to the needs of Valley Fever patients
• Collaboration with other research institutions to advance understanding of the disease

These specialized centers play a crucial role in advancing CM care and serve as valuable resources for both patients and healthcare providers dealing with this challenging condition.

Coccidioidal Meningitis | UC Davis Center for Valley Fever

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The most deleterious extrapulmonary dissemination is the spread of Coccidioides spp. to the central nervous system (CNS) causing meningitis. A lumbar puncture with analysis of cerebrospinal fluid (CSF) should be done in any patient with suspected or previously diagnosed coccidioidomycosis presenting with a headache, blurry vision, photophobia, meningismus, decline in cognition, hearing changes, and focal neurologic deficit. As illustrated in a recent retrospective study there is no evidence to support routine CSF analysis in patients in at-risk groups (age, ethnicity, CF titer, etc. ) if they do not have CNS symptoms (1). The diagnosis of CM is based on a positive serologic testing (ID/CF) or culture of CSF. CSF analysis typically shows an elevated white blood cell count with a mixed or lymphocytic pleocytosis, a high level of protein (sometimes measurable in g/dL rather than mg/dL), and a low level of glucose. Imaging studies are helpful in evaluating complications associated with meningitis. Initial features of illness may be difficult to distinguish from other etiologies without detailed testing, notably tuberculosis and even autoimmune illnesses.

When left untreated, CM is uniformly fatal (2). In a historical series reported by Vincent et al, before the availability of antifungals, seventeen patients with CM were followed all of whom died within 31 months (2). This review also commented on the combined survival statistics described in five reports of 117 patients where 91% of patients with CM died within one year and all died within 2 years. Though the fatality has improved with the use of AmB and azoles, morbidity is still substantial due to complications from the disease, devices used for treatment management, and side effects of the medications as much higher recommended doses are necessary for prolonged period of time (3).

The most common life-threatening complications of meningitis include hydrocephalus, CNS vasculitis, cerebral ischemia, infarction, vasospasm and hemorrhage. Basilar meningitis and spinal cord involvement may also be encountered. In patients with hydrocephalus, a ventricular shunt is necessary for decompression. Such shunts, often placed distally into the abdominal cavity may develop secondary infections, obstruction due to persistent coccidioidomycosis, and/or abdominal pseudocysts (4). It is not uncommon for patients to require multiple shunt revisions. As illustrated in several case reports, repeated obstruction of the shunt and isolation of fungus should alert one to seek alternate antifungal therapy. Some clinicians have used steroids for vasculitis though this is considered anecdotal.

For treatment of CM, most clinicians prefer therapy with oral fluconazole (5). Although the dose studied in an uncontrolled clinical trial was 400 mg, it is common to begin therapy with 800 to 1200 mg per day of fluconazole (3, 6). Prior to the advent of azoles, amphotericin B deoxycholate (AmB) was the only drug of choice but was ineffective when given intravenously and required frequent administrations via the intrathecal (IT) route. Due to challenges of administration, toxicity associated with this route and lack of experience in utilizing this method, current practitioners seldom resort to recommending AmB as initial therapy although lipid formulations have been used in the salvage setting successfully (7). Though there are no trials comparing IT AmB and fluconazole, the response rate of IT AmB has ranged from 51%-100% in studies published before 1986 and with fluconazole the rate is near 79% (6, 8). With fluconazole symptoms resolve within 4-8 months though there is a delay in normalization of CSF abnormalities which may persist in the presence of a shunt. Based on clinical experience and due to an extremely high relapse of 78% noted in a small series when therapy is discontinued, lifelong treatment with azoles is recommended (9).

Assessing a patient’s response to therapy is primarily a matter of serial evaluation and clinical judgment. Favorable signs include return to premorbid functioning, decreasing CF titers, and excellent adherence to medical care and therapy. Some patients with chronic meningitis have refractory illness with poor recovery or exceptionally slow improvement. A combination of serology and repeated CSF evaluation may be necessary to assess microbiologic and serologic improvement. Adherence counseling, assessment of drug-drug interactions, therapeutic drug monitoring, and consideration of alternative antifungal therapy may be necessary. For CM patients who are failing treatment and/or have refractory coccidioidal disease, salvage regimens may be necessary. Both voriconazole and posaconazole have been used in this situation, with a growing body of case series and clinical experience to support their use.

REFERENCES

1. Thompson G, 3rd, Wang S, Bercovitch R, et al. Routine CSF Analysis in Coccidioidomycosis Is Not Required. PloS one 2013; 8(5): e64249.
2. Vincent T, Galgiani JN, Huppert M, Salkin D. The natural history of coccidioidal meningitis: VA-Armed Forces cooperative studies, 1955-1958. Clin Infect Dis 1993; 16(2): 247-54.
3. Johnson RH, Einstein HE. Coccidioidal meningitis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2006; 42(1): 103-7.
4. Hibbett DS, Binder M, Bischoff JF, et al. A higher-level phylogenetic classification of the Fungi. Mycol Res 2007; 111(Pt 5): 509-47.
5. Galgiani JN, Ampel NM, Blair JE, et al. Coccidioidomycosis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2005; 41(9): 1217-23.
6. Galgiani JN, Catanzaro A, Cloud GA, et al. Fluconazole therapy for coccidioidal meningitis. The NIAID-Mycoses Study Group. Annals of internal medicine 1993; 119(1): 28-35.
7. Mathisen G, Shelub A, Truong J, Wigen C. Coccidioidal meningitis: clinical presentation and management in the fluconazole era. Medicine 2010; 89(5): 251-84.
8. Bouza E, Dreyer JS, Hewitt WL, Meyer RD. Coccidioidal meningitis. An analysis of thirty-one cases and review of the literature. Medicine 1981; 60(3): 139-72.
9. Dewsnup DH, Galgiani JN, Graybill JR, et al. Is it ever safe to stop azole therapy for Coccidioides immitis meningitis? Annals of internal medicine 1996; 124(3): 305-10.

Valley fever – Symptoms & causes

Overview

Valley fever is a fungal infection caused by coccidioides (kok-sid-e-OY-deze) organisms. It can cause signs and symptoms such as a fever, cough and tiredness.

Two coccidioides fungi species cause valley fever. These fungi are commonly found in soil in specific regions. The fungi’s spores can be stirred into the air by anything that disrupts the soil, such as farming, construction and wind.

People can then breathe the fungi into their lungs. The fungi can cause valley fever, also known as acute coccidioidomycosis (kok-sid-e-oy-doh-my-KOH-sis). Mild cases of valley fever usually resolve on their own. In more-severe cases, doctors treat the infection with antifungal medications.

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Symptoms

Valley fever is the initial form of coccidioidomycosis infection. This initial, acute illness can develop into a more serious disease, including chronic and disseminated coccidioidomycosis.

Acute coccidioidomycosis (valley fever)

The initial, or acute, form of coccidioidomycosis is often mild, with few or no symptoms. Signs and symptoms occur one to three weeks after exposure. They tend to be similar to flu symptoms. Symptoms can range from minor to severe, including:

• Fever
• Cough
• Tiredness
• Shortness of breath
• Headache
• Chills
• Night sweats
• Joint aches and muscle soreness
• Red, spotty rash, mainly on lower legs but sometimes on the chest, arms and back

If you don’t become ill or have symptoms from valley fever, you may only find out you’ve been infected later. You may find out when you have a positive skin or blood test or when small areas of residual infection in the lungs (nodules) show up on a routine chest X-ray. The nodules typically don’t cause problems, but they can look like cancer on X-rays.

If you develop symptoms, especially severe ones, the course of the disease is highly variable. It can take months to fully recover. Fatigue and joint aches can last even longer. The disease’s severity depends on several factors, including your overall health and the number of fungus spores you inhale.

Chronic coccidioidomycosis

If the initial coccidioidomycosis infection doesn’t completely resolve, it may progress to a chronic form of pneumonia. This complication is most common in people with weakened immune systems.

Signs and symptoms include:

• Low-grade fever
• Weight loss
• Cough
• Chest pain
• Blood-tinged sputum (matter discharged during coughing)
• Nodules in the lungs

Disseminated coccidioidomycosis

The most serious form of the disease, disseminated coccidioidomycosis, is uncommon. It occurs when the infection spreads (disseminates) beyond the lungs to other parts of the body. Most often these parts include the skin, bones, liver, brain, heart, and the membranes that protect the brain and spinal cord (meninges).

Signs and symptoms of disseminated disease depend on the body parts affected and may include:

• Nodules, ulcers and skin lesions that are more serious than the rash that sometimes occurs with initial infection
• Painful lesions in the skull, spine or other bones
• Painful, swollen joints, especially in the knees or ankles
• Meningitis — an infection of the membranes and fluid surrounding the brain and spinal cord

When to see a doctor

Seek medical care if you are over 60, have a weakened immune system, are pregnant, or are of Filipino or African heritage, and you develop the signs and symptoms of valley fever, especially if you:

• Live in or have recently traveled to an area where this disease is common
• Have symptoms that aren’t improving

Be sure to tell your doctor if you’ve traveled to a place where valley fever is common and you have symptoms.

Causes

Valley fever is caused by a person inhaling spores of certain fungi. The fungi that cause valley fever — Coccidioides immitis or Coccidioides posadasii — live in the soil in parts of Arizona, Nevada, Utah, New Mexico, California, Texas and Washington. It’s named after the San Joaquin Valley in California. The fungi can also often be found in northern Mexico and Central and South America.

Like many other fungi, coccidioides species have a complex life cycle. In the soil, they grow as a mold with long filaments that break off into airborne spores when the soil is disturbed. A person can then inhale the spores.

The spores are extremely small and can be carried far by the wind. Once inside the lungs, the spores reproduce, continuing the disease cycle.

Risk factors

Risk factors for valley fever include:

• Environmental exposure. Anyone who inhales the spores that cause valley fever is at risk of infection. People who live in areas where the fungi are common — especially those who spend a lot of time outdoors — have a greater risk.

  Also, people who have jobs that expose them to dust are most at risk — construction, road and agricultural workers, ranchers, archaeologists, and military personnel on field exercises.

• Race. For reasons that aren’t well understood, people of Filipino and African heritage are more susceptible to developing serious fungal infections.
• Pregnancy. Pregnant women are vulnerable to more-serious infections when they get the infection during the third trimester. New mothers are vulnerable right after their babies are born.
• Weakened immune system. Anyone with a weakened immune system is at increased risk of serious complications. This includes people living with acquired immunodeficiency syndrome (AIDS) or those being treated with steroids, chemotherapy and anti-rejection drugs after transplant surgery. People with certain autoimmune diseases, such as rheumatoid arthritis or Crohn’s disease, who are being treated with anti-tumor necrosis factor (TNF) drugs also have an increased risk of infection.
• Diabetes. People with diabetes may have a higher risk of severe lung infections.
• Age. Older adults are more likely to develop valley fever. This may be because their immune systems are less robust or because they have other medical conditions that affect their overall health.

Complications

Some people, especially pregnant women, people with weakened immune systems — such as those living with human immunodeficiency virus (HIV)/AIDS — and those of Filipino or African heritage are at risk of developing a more severe form of coccidioidomycosis.

Complications of coccidioidomycosis may include:

• Severe pneumonia. Most people recover from coccidioidomycosis-related pneumonia without complications. Others, such as people of Filipino and African heritage, and those with weakened immune systems, may become seriously ill.
• Ruptured lung nodules. A small percentage of people develop thin-walled nodules (cavities) in their lungs. Many of these eventually disappear without causing any problems, but some may rupture, causing chest pain and difficulty breathing. A ruptured lung nodule might require the placement of a tube into the space around the lungs to remove the air or surgery to repair the damage.
• Disseminated disease. This is the most serious complication of coccidioidomycosis but it’s uncommon. If the fungus spreads (disseminates) throughout the body, it can cause problems including skin ulcers, abscesses, bone lesions, severe joint pain, heart inflammation, urinary tract problems and meningitis — a potentially fatal infection of the membranes and fluid covering the brain and spinal cord.

Prevention

There is no vaccine to prevent valley fever.

If you live in or visit areas where valley fever is common, take common-sense precautions, especially during the dry season following a rainy season when the chance of infection is highest.

Consider these tips:

• Wear a mask.
• Avoid very dusty areas, such as construction sites.
• Stay inside during dust storms.
• Wet the soil before digging in it, or avoiding soil if you’re at higher risk of infection.
• Keep doors and windows tightly closed.
• Clean skin injuries with soap and water.

US drought resurrects fungus that causes fever and meningitis

09/02/2022 at 19:15

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Photo: Global Look Press

Fires, floods and the record sting of 2022 certainly pose a great danger to human health. But dry weather in the United States in California has brought to life a disease-causing fungus that spreads by airborne droplets.

It’s called Coccidioides, and it causes Valley Fever. Its symptoms are crushing headaches and sinus infections. Worst of all, it can turn into meningitis.

Former financial planner and father of two, Rob Purry, first contracted a fever and then contracted meningitis. He complained that the illness had taken away all his health and all the money the family had.

Coccidioides requires a dry and hot climate to survive. Therefore, the disease, originally characteristic of the hot plains of California, is becoming more common. This was announced by infectious disease expert Dr. Royce Johnson.

Most of the western US is already in drought, added Morgan Gorris, an Earth system researcher at Los Alamos National Laboratory.

“The western half of the US is still expected to be fairly dry and Valley Fever is expected to spread,” he predicted.

It is important to note that soil, if left undisturbed, will not necessarily lead to inhalation of the disease. But any disturbance to the layer, whether it be a full-scale archaeological site or a burrowing animal, will release the fungus from the soil. Pathogenic spores can travel up to 75 miles (120 km).

Scientists recently warned that the next global pandemic could be fungal. Therefore, the growing spread of Coccidioides is of particular concern.

See also: “The number of cases of monkeypox infection in the world has exceeded 50 thousand”

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  Anastasia Kukova

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“I lost everything”: a debilitating disease that can be caught out of thin air in California

The disease that changed Rob Purdy’s life began with a severe headache – the pain first appeared on New Year’s Eve in 2012 and lasted for several months, says The Guardian.

It wasn’t until several emergency room visits, several doctors, and misdiagnosis that he realized what was wrong with him. A Bakersfield, California resident had meningitis caused by valley fever. This disease, also called coccidioidosis, is caused by the fungus Coccidioides, endemic to the soil of the southwestern United States. The diagnosis was followed by years of debilitating illness, struggles to find effective treatments, and other difficulties.

“It took everything: my health,” Purdy said. “It had a huge impact on my family. We lost everything, our financial security, our entire pension.”

A father-of-two is among the small percentage of people who develop severe forms of valley fever—most do not become ill after infection, and very few have severe symptoms. But for those who develop the chronic form of the disease, it can be devastating.

Valley fever is afflicting California’s Central Valley, and experts say the number of cases could increase in the American west in the future as the climate crisis makes the landscape drier and hotter. Kern County, north of Los Angeles at the end of the Central Valley, has reported a significant increase over the past decade. The county where Purdy lives had about 1,000 cases in 2014 and more than 3,000 in 2021.

Testing and awareness of fever have improved in recent years, but there has also been a significant rise in incidence, said Dr. Royce Johnson, medical director of the Valley Fever Institute in Bakersfield. He attributes this to climate and weather: the fungus needs dry and hot conditions.

The fungus grows in the mud as a thread that segments, breaks off and flies up to 75 miles – even sea otters have been infected with it. People can contract valley fever by digging into undisturbed soil or by simply breathing in the air. Those who work outdoors are at greater risk. Approximately 40% develop the disease, which can be mild, and 1% develop severe consequences.

According to the latest available data, there were about 20,000 cases of valley fever reported to the CDC in 2019 in the US, Arizona, and California, and an average of about 200 related deaths each year from 1999 to 2019.