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In most cases of acute coccidioidomycosis, the body's own immune system is adequate to bring about recovery without medical intervention. Fever and pain can be treated with non-prescription drugs.

Chronic and disseminated coccidioidomycosis, however, are serious diseases that require treatment with prescription drugs. Patients with intact immune systems who develop chronic coccidiodomycosis are treated with the drug ketoconazole (Nizoral) or amphotericin B (Fungizone). Patients with suppressed immune systems are treated with amphotericin B (Fungizone). Amphotericin B is a powerful fungistatic drug with potentially toxic side effects. As a result, hospitalization is required in order to monitor patients. The patient may also receive other drugs to minimize the side effects of the amphotericin B.

Patients with AIDS must continue to take itraconazole (Sporonox) or fluconazole (Diflucan) orally or receive weekly intravenous doses of amphotericin B for the rest of their lives in order to prevent a relapse. Because of the high cost of fluconazole, Pfizer, the manufacturer of the drug, has established a financial assistance plan to make the drug available at lower cost to those who meet certain criteria. Patients needing this drug should ask their doctors about this program.

Because the fungus that causes coccidioidomycosis is airborne and microscopic, the only method of prevention is to avoid visiting areas where it is found in the soil. Unfortunately, for many people this is impractical. Maintaining general good health and avoiding HIV infection will limit coccidioidomycosis to the acute and relatively mild form in most people.

Review of Coccidioidomycosis for Primary Care Professionals

Program Overview Released Sponsored by Valley Fever Center for Excellence, University of Arizona and Southern Arizona VA Health Care System And Southwest Health Professions Education Center, Inc. /VA Employee Education System/Northern Arizona VA Health Care System

In the southern deserts of Arizona as well as other areas of the southwest, Valley Fever is a familiar phrase to most residents. Specialists in Respiratory and Infectious Diseases are particularly familiar with the less frequent but more serious forms of the disease. In January, 1996, the Valley Fever Center for Excellence established a hotline which physicians and others with questions about Valley Fever may call for information. From questions received through the hotline, it became apparent that even though Valley Fever is a more commonly known disease, the infections that it causes are not fully understood. The nature of the calls illustrated a significant lack of awareness of the importance of early diagnosis and proper management of the primary infection. Early diagnosis of Valley Fever by primary care providers can improve patient care by reducing patient anxiety, unneeded diagnostic tests, and unwarranted use of antibacterial agents. Moreover, serious complications requiring treatment might be identified sooner. Hence the need for this course.

This activity is intended to provide a guide to the recognition and management of the most common manifestations of Valley Fever. It is not intended to be an exhaustive review of the disease. The information was selected for its relevance and usefulness to busy family practitioners, internists, and others dealing with patients in primary care settings, especially within regions endemic for Coccidioides immitis.

Upon completion of this program participants will be able to:

1. Describe specific tests needed for diagnosing Valley Fever;
2. Develop an early diagnosis of coccidioidal infections which will help to reduce or eliminate the use of empiric therapy for bacterial infections;
3. Obtain early and accurate diagnosis of coccidioidal infections, thereby reducing the need and related expenses of testing for other diseases;
4. Describe commonly reported symptoms associated with primary infection versus those associated with secondary infection (dissemination).

Intended Audience
Family practitioners, internists, nurse practitioners and other primary care providers

VFCE - General Information For Treatment

In severe cases, especially in those patients with rapid and extensive primary illness, those who are at risk for dissemination of disease, and those who have disseminated disease, antifungal drug therapy is used. The type of medication used and the duration of drug therapy is determined by the severity of disease and response to the therapy. The medications used include ketoconazole, itraconazole and fluconazole in chronic, mild-to-moderate disease, and amphotericin B, given intravenously or inserted into the spinal fluid, for rapidly progressive disease. Although these treatments are often helpful, evidence of disease may persist and years of treatment may be required. Surgical removal of cavities in the lung from Valley Fever is sometimes necessary. Surgical drainage of Valley Fever abscesses in bones or joints is also commonly performed.










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