Facts and Commentary
- Valley Fever is contracted by inhaling spores of Coccidioides
sp. fungus. These fungi are Coccidioides immitis
(C. immitis for short and the specific fungus most
commonly discussed in medical literature for Valley Fever) and also Coccidioides
posadasii (C. posadasii for short). Valley
Fever is also known as cocci and the medical term for the disease is coccidioidomycosis.
- The fungus that causes Valley Fever is regulated by
the federal government in the Antiterrorism and Effective Death Penalty
Act of 1996. In accordance with this law, anyone possessing, using,
transferring, or receiving any of the select agents (including Coccidioides) must notify the Secretary of the Department of Health and Human Services, or is otherwise committing a federal crime.
To culture Coccidioides safely in a laboratory setting, one must adhere to Biosafety Level 3 Regulations. However, you are allowed to live in, work in, and visit areas where it grows. You can even
expose your children to this biohazard without penalty.
- To guard against biological terrorism in the wake of
the 9/11 terrorism and subsequent anthrax deaths, Coccidioides
was regulated even further in the Public Health Security and
Bioterrorism Preparedness and Response Act of 2002.
- Valley Fever case reporting in Arizona has increased 3,931% from 1990 (255 reports) to 2009 (10,279 diagnosed case reports). That was not a typo. There was almost a four thousand percent increase in cases reported from 1990 to 2009. When also considering how many people suffer with infections that are undiagnosed and never reported, the effect of the Valley Fever epidemic is staggering.
- Legionella and anthrax can be contracted through
ventilation systems. The Coccidioides arthroconidial spore is as
small as the anthrax spore, making infection possible in your office,
home, automobile, airport or hotel. It can pass through an open door in
your home or a window screen. When driving in your car it is advisable
to keep your vents closed, especially when it is
dusty or windy outside.
- If a portion of the population in a given area has
developed coccidioidomycosis, it is called an endemic disease.
If a region has Coccidioides growing in its native
soil, the region is an endemic area to the fungus.
- Strong winds and blowing dust should be a signal to
keep your family and pets indoors. Be sure to close your windows when
it’s windy. The spores that cause Valley Fever are frequently
airborne and have been known to be spread by wind as far as 500 miles
beyond their original endemic area.
- For safety’s sake, no exposure is too
- An ordinary dust mask will NOT
prevent Valley Fever. The tiny spore size of Coccidioides
can easily be inhaled through the mask. While miner's masks with an NIOSH-approved N95 respirators or better can prevent inhalation of Coccidioides spores, ordinary paper N95 and N100 masks are unlikely to have a protective seal around the wearer's face.
- America’s endemic areas are located in
Arizona, California, Texas, Nevada, Utah and New Mexico. There are also
endemic areas outside the United States in Mexico, Central America, and
South America. When the soil is disturbed these spores can become
airborne and inhaled, sometimes hundreds of miles away from their
original place of growth.
- In the year 2000, an estimated 29,500,000 people
visited Arizona. No one knows how many new students, business
travelers, new residents, vacationers, retirees, or other visitors to
endemic areas have been infected. This is because Arizona, California,
New York, Nevada, and Rhode Island are the only states we have found
that require reporting of this disease. Many victims are unaware that
this disease even exists and doctors misdiagnose it frequently. One can
only imagine how many infections occur among visitors to all the
- It is possible to contract Valley Fever just by
passing through an endemic area to Coccidoides sp.
It can even be contracted by a visitor passing through an airport.
There is a case of a woman changing planes in the Phoenix Airport who
came down with Valley Fever. Other visitors have contracted Valley
Fever just by passing through endemic areas.
- Two thirds of all Valley Fever infections are
contracted in Arizona. According to the 2000 Census, Arizona’s population increased by 40%. This made it the 2nd fastest growing state in the country and its ongoing population growth shows no signs of slowing. Census estimates show an additional 20% population increase from 2000 to 2006. 2010 Census updates should be enlightening.
- Other fast growing endemic states are California,
Nevada, and Texas. People are moving into these areas rapidly, in
essence increasing the population’s exposure to Coccidioides.
- Kern County (Bakersfield) is the most heavily endemic
area in California.
- The Valley Fever Center for Excellence (VFCE),
located in Tucson, AZ, has called coccidioidomycosis Arizona's "local
secret." Very few people outside states with endemic areas know that
Valley Fever even exists.
- Valley Fever is not a benign disease. Valley Fever
can have devastating medical, emotional, and monetary effects on those
who require treatment and their families. According to California U.S. Representative Kevin McCarthy of California, Valley Fever kills 200-500 Americans every year. However, if active surveillance evaluated all patients with VF symptoms, perhaps thousands of annual deaths would be discovered.
- The VFCE estimates that there are 150,000 new VF
infections annually in the southwestern United States. This was said to
be based on the population data in selected counties of Arizona,
California and Texas with a 3% annual likelihood of infection.
- By applying the 3% annual infection rate to the year 2000 population in the same endemic counties (6.38 million residents), the estimate of VF infection rose to 191,400 new infections per year. These are just the highly endemic selected counties; their population continued to increase dramatically since the 2000 census, the infection can still be picked up elsewhere, winds can spread the infection out of these counties, and visitors are not tracked nationally or internationally for infection. In nearly every year since 2000, Arizona has experienced an explosion in infection rates that was considered the worst Valley Fever epidemic of all time (until the following year eclipsed that).
- Doctors have also estimated that only 2% of the total number of Valley Fever infections are diagnosed. Based on the record-breaking infection rate in 2006, 5,493 patients were diagnosed with Valley Fever in Arizona. This means 274,650 people would have been estimated to be infected in just that one state for 2006 alone. Over 400,000 were estimated to be infected nationally in 2006, and nearly 400,000 nationally in 2007. In 2009, the estimated total of cases and undiagnosed infections jumped to over 600,000 people. This epidemic is escalating.
- It was estimated in 1980 that ten million
Americans were already infected with coccidioidomycosis, as noted in Dr. David Stevens'
- As stated in Medical Mycology,
"Between 1930 and 1960...it was established that histoplasmosis
[another fungal disease] and coccidioidomycosis infected over 100 million
people in the United States alone." Mass testing has not been attempted
for decades to learn more.
- “...too often Valley Fever is still
perceived as simply an annoyance by the general public, health care
professionals and local government officials. Even the majority of
local residents in the endemic area perceive Valley Fever as a
relatively benign disease. Combining this misconception with the lack
of knowledge about the disease among new residents, tourists, new
businesses, athletes and students moving into the endemic area, creates
a vast population base which must endure Valley Fever illnesses (often
without an accurate diagnosis) while being unprepared to deal with any
possible complications arising from a Coccidioides sp.
infection.” -- Robert J. Brauer Jr., Executive Director of
VFCE. (VFCE Annual Report 2001-2002)
- Although Valley Fever can be contracted all year
round, more cases are diagnosed in Arizona from June to July and October
to November. (Comrie AC. Climate factors
influencing coccidioidomycosis seasonality and outbreaks. Environ
Health Perspect. 2005 Jun;113(6):688-92.)
- Valley Fever is most likely to cause illnesses in
California from June through November -- but as with Arizona and other
endemic areas, it can be contracted at any time of year. (Galgiani JN, Brauer RJ. VFCE 2002-2003 annual
- Valley Fever can be contracted at any time of the day
- Valley Fever is frequently misdiagnosed because it
can have so many symptoms (i.e.: pneumonia, malaise, rashes, fever,
headaches, and rheumatism to name just a few).
- In some Valley Fever cases, shunt tubing can grow a
biofilm that resists antifungal treatment. You may wish to read this
article and share it with your doctor if you have shunt
tubing and a Valley Fever infection.
- Valley Fever starts in the lungs but can disseminate
(spread to cause secondary infections) to other parts of the body such
as skin, bones, joints, and the meninges (the lining of the brain).
- Meningitis (the inflammation of lining of the brain)
is the most lethal form of Valley Fever dissemination.
- Once a person is infected, Valley Fever never
completely leaves. To date, it can not be totally eliminated from the
body by any medication. There is no cure.
- Valley Fever can be a chronic illness or it can wax
and wane in varying degrees.
- Whether your Valley Fever case is severe or
asymptomatic, it is with you for life. It can be inactive but can
activate at any time, even 45 or more years later. No long term studies
have been conducted to see how many asymptomatic cases reactivate or to
gauge the strength of reactivated infections.
- The primary infection of coccidioidomycosis is an
equal opportunity biohazard. It doesn’t care if you are an
infant, elderly or a dog, cat, horse, zoo animal or any other mammal.
- The secondary infection (dissemination) is known to
occur more often in the elderly, African-Americans, Filipinos, organ
transplant recipients, those with immune deficiencies, women in the
third trimester of pregnancy, and men more often than non-pregnant
women. However, even if you are not in any of the risk
groups, you can still suffer a severe infection.
- The founder of valleyfeversurvivor.com
was not in any of the risk categories but still suffered a severe
infection. Don’t count on your age or current
health to save you. To read about Sharon’s case, click here.
- If you are African-American, Filipino, Hispanic,
pregnant, diabetic, on medication, elderly, have HIV, received an organ
transplant, or any immune deficiency, you may want to consider not
visiting, living in, or moving to or near any endemic area.
- "30% of Filipino patients with pulmonary disease
progressed to disseminated disease. Nonwhite race was a predictor for
dissemination; African American patients more often developed
disseminated bony disease while Filipinos were more likely to develop
cutaneous or central nervous system disease. Relapse of disseminated
coccidioidomycosis occurred in 24% of patients; the risk was highest
(71%) among those with central nervous system disease...Predictors of
permanent disability included African American or Filipino race,
central nervous system disease, and bony disease." (Crum
NF, Lederman ER, Stafford CM, Parrish JS, Wallace MR.
Coccidioidomycosis: A Descriptive Survey of a Reemerging Disease.
Clinical Characteristics and Current Controversies. Medicine
(Baltimore). 2004 May;83(3):149-175).
- If you are in the 2nd or 3rd trimester of pregnancy,
live in or visit an endemic region, and contract Valley Fever, you have
a significantly higher risk for a severe disseminated infection. Before
antifungal drugs were used to combat cocci almost all cases of pregnant
women with Valley Fever died. Even though doctors presently have drugs
that can help the mother, some antifungals like fluconazole and
ketaconazole can cause birth defects or even kill the baby. If you plan
to visit an endemic region during your pregnancy, you may wish to
consider the health risks as a part of your decision-making. Only you
can decide what risks you are willing to take with your life and your
- "Infections acquired during pregnancy are often
aggressive. The risk of disseminated disease, as well as maternal and
fetal or neonatal [young baby] mortality, increases the later in
pregnancy the infection is acquired. Termination of pregnancy or early
delivery should be considered, depending on the stage of pregnancy, and
amphotericin B therapy given. This treatment appears to be safe for the
fetus if the pregnancy is continued. Infants who acquire C.
immitis infection in the postnatal period also have a higher
mortality rate than older children and adults." (Stevens
DA. Current concepts: coccidioidomycosis. N Engl J Med 1995;332:1077-82)
- Men tend to have disseminated cases of cocci more
often than women. Even though they do not face the risk of Valley Fever
during pregnancy, men should be aware that cocci can infect testicles,
and these cases have previously been treated with surgical removal of
the infected testicles (Cocci Study Group
2002). Cocci can also infect and inflame the prostate and
may require a biopsy to be diagnosed. (Truett
AA, Crum NF. Coccidioidomycosis of the prostate gland: two cases and a
review of the literature. South Med J. 2004 Apr;97(4):419-22)
- Valley Fever is more likely to disseminate if there
is an immune deficiency present -- even if the victim was never aware
of his or her initial infection, it could make its presence felt years
later. If someone with immune deficiencies becomes infected with Valley
Fever, that person is far more likely to suffer a severe disseminated
infection, a chronic infection, and to die from this disease.
- One does not need an immune deficiency to have a
disseminated case of Valley Fever. You can be a perfectly healthy
person with no immune deficiency, contract Valley Fever, and have a
severe or lethal case.
- People over 60 years of age are twice as likely to be
diagnosed with Valley Fever and to have the most severe cases. Retirees
and vacationers coming from other states should have the right to know
about this disease before deciding to relocate to or visit any endemic
- “Some infections even spread out of the
lungs to many other parts of the body. These complications require long
periods of medical and surgical treatment and even then may prove
fatal. In these respects, Valley Fever is not so different
from polio, measles, chicken pox, or lyme disease, infections for which
a vaccine strategy has already been put into widespread use, with the
exception that there is no vaccine for Valley Fever.” -- John
Galgiani, MD., VFCE Director (VFCE
Annual Report 2001-2002)
- An increasing number of dogs in Arizona are suffering
Valley Fever infections. They have greater chances of contracting
Valley Fever than humans do because of behavioral differences. Cats,
horses, and other mammals can be infected as well.
- Dogs infected with Valley Fever frequently suffer
from secondary (disseminated) infections. The fungus can spread from
the lungs to any part of the body. Many of the dogs' symptoms are the
same as in humans, however owners will notice lameness, tiredness, loss
of appetite, fever, cough and possibly a change in temperament.
- Dolphins, Sea Lions, and Sea Otters have been fatally
infected by cocci that had been blown out to sea.
- It is widely believed that most people who get over a
Valley Fever infection are protected from inhaling a second infection.
To date, however, it is not possible to determine whether a person's
illness is a reactivation of their first infection, or if their illness
is from inhaling additional spores. Laboratory accidents have proven
that reinfections can occur in humans.
- Valley Fever does not always show positive in titer
tests, even in an infected individual. Since only the immune response
is presently detected in blood testing, if your body is not producing
VF antibodies, the blood test will be negative (it will not show a VF
infection). Visit our glossary
to read more about titer testing.
- Valley Fever's lung nodules have frequently been
misdiagnosed as lung cancer. The Arizona Respiratory Center recommends
patients keep copies of X-Rays with VF nodules so the nodules are not
misdiagnosed as lung cancer later. If your chest X-rays seem to show
lung cancer and you have ever lived in, visited, or received packages
from an endemic region, we recommend you have yourself checked for
cocci and get a second opinion as to whether the lung cancer diagnosis
- There are claims that sulfur (flowers of sulfur or
sublimed sulfur) can cure Valley Fever. Please be aware we have found
zero medical research on the validity of these claims, this sulfur is
unrelated to "sulfa" drugs (sulfonamides), and there can be serious
side effects if sulfur is ingested. Warning labels on sulfur packages
have stated that it is not for ingestion. No doctor to our knowledge
has ever suggested a person take this toxic, explosive substance.
- Some people dismiss unpleasant reactions to the
sulfur treatment in VF patients because some fungi release toxins when
they die. This is known as the Herxheimer reaction, but does not apply
to Valley Fever because the fungi of Coccidiodies sp.
are not known to release these toxins. Sulfur is therefore the likely
cause of the discomfort. Further, some people are allergic to sulfur.
In our interview with Robert J. Brauer Jr., Executive Director of VFCE,
he stated, "Sulfur treatment [for Valley Fever] is basically taking a
toxic chemical and putting it into your system, like sulfuric acid." We
can not recommend the use of sulfur for this disease.
- Nikkomycin Z is a drug created in the 1970's and was
shown in the 80's and 90's to be able to destroy chitin, the material
in Coccidioides cell walls. Hector
RF, Zimmer BL, Pappagianis D. Evaluation of nikkomycins X and Z in
murine models of coccidioidomycosis, histoplasmosis, and blastomycosis.
Chemother. 1990 Apr;34(4):587-93. Later studies have shown
experimental animals' lungs were sterilized of the fungus, meaning
nikkomycin Z could be a cure to Valley Fever. The drug has been nearly
ignored by the medical community for decades while millions of other
victims continued to be infected by Valley Fever. In 2005 nikkomycin Z
was experimentally shown again to work against Coccidioides
both alone and with other antifungal drugs. Hector
RF, Davidson AP, Johnson SM. Comparison of susceptibility of fungal
isolates to lufenuron and nikkomycin Z alone or in combination with
itraconazole. Am J Vet Res. 2005 Jun;66(6):1090-3.
Although the drug appears to be promising, it is worth noting that
previous vaccine candidates had been effective in mice but not in
humans so there is no guarantee of nikkomycin Z's effectiveness. In
2005 the University of Arizona finally purchased the patent for
nikkomycin Z with the intent to research its effectiveness, but as much
as $100 million may be required to test this proposed cure and bring it
to market. We hope that it will truly be a cure and that this
worthwhile endeavor can be financed completely.
- Although there is presently no cure, itraconazole,
fluconazole, and amphotericin B are the most commonly
used drugs to treat VF, along with newer drugs like posaconazole and voriconazole. Unfortunately, these
antifungal drugs may have side effects that are so strong the dose must be lessened. Read about antifungal
drugs and their side effects online at the Fungal Research Trust, available through our links page.
- Like the West Nile Virus, Valley Fever has been
transferred from organ donors to recipients. Increased testing is
- Despite the fact that disseminated coccidioidal
infections spread through the bloodstream, the American Association of
Blood Banks does not check the blood supply for cocci. We believe it is
vital that our blood supply be checked for Coccidiodies
- Hypercalcemia is associated with the Valley Fever
infection. See our glossary
- Studies show that the growth and maturation of Coccidioides
spp. are stimulated by human sex hormones such as testosterone and
progesterone. In addition to the immune system problems corticosteroid
treatments can cause, this may be why some treatments have caused many
cocci cases to worsen. (Jones FL Jr,
Spivey CG Jr. Spread of pulmonary coccidioidomycosis associated with
steroid therapy. Report of a case with a lupus-like reaction to
antituberculosis chemotherapy. J Lancet. 1966 May;86(5):226-30. Gibbs
BT, Neff RT. A 22-year-old Army private with chest pain and weight
loss. Mil Med. 2004 Feb;169(2):157-60. Stevens DA. Coccidioidomycosis.
N Engl J Med. 1995 Apr 20;332(16):1077-82).
- As a result of their Valley Fever infections, some
people have lost their jobs, health insurance, property, and homes.
Some were rendered destitute and unable to pay for dental procedures,
car insurance, electricity, phone charges or even their medication.
- Endemic states do not require veterinarians to
educate their clients about the threat Valley Fever poses to their
pets. Endemic states also allow animals from non-endemic areas to
suffer needlessly by bringing them into local zoos where they can
inhale cocci easily. Too many animals have died and suffered as a
- Employees relocated into endemic states are not told
about Valley Fever, what it can do to them, their children, their pets,
or what they can do to mitigate the risks.
- Real estate companies and their agents in endemic
states are not required to tell any prospective customers about the
existence of Coccidioides and the dangers of Valley
- People in endemic areas are not informed about the
dangers of gardening in their yards, hiking, bike riding or camping in
the desert. All of these activities can disturb the soil and cause
cocci spores to become airborne.
- The Chambers of Commerce and Tourist Bureaus of
endemic areas do not send information about the state's naturally
occurring biohazard in tourism literature. Rather they entice people to
come, go camping in the desert, retire there, etc. without informing
them of the dangers.
- Cotton exported from endemic areas has been known to
contain Coccidioides spores. Nationally and
internationally, workers coming into contact with these have been
infected. At least one person has died as a result.
- Products purchased from roadside stands in endemic
areas have contained Coccidioides spores and tourists need to be
aware of this danger. These souvenirs may be hazardous to your health.
- The USDA does not require food exported from endemic
areas to be checked for cocci. Consider that the next time you smell
fruits for freshness when they came from endemic US areas, Mexico,
Central America or South America!
- Cocci has hampered our military for decades, with the
first extensive studies tracking thousands of cases during World War
- Juvenile hall youth prisoners (14-18 years old) in
1960's California were sent into L.A. County work camps as a part of an
experiment to find the source of a lethal cocci outbreak. The people
conducting the experiment knew cocci killed at least one previous
prisoner and sickened many others, they knew it was in at least one of
their various work camps, and they chose to find it by continuing
to send children into these areas and tracking which kids were infected.
It is hard to imagine our correctional system would have such blatant
disregard for youth prisoners' health. The level of immorality
displayed by this experiment was on par with the 1980's Iranian
military use of children as mine sweepers - sending the kids to
sacrifice their lives by detonating explosives, thereby identifying the
dangerous areas. It's bad enough that residents and visitors are not
warned about the risks of valley fever, but it is a disgrace to subject
children to an experiment that could infect, debilitate, or kill them.
None of the children in this cocci experiment died immediately, however
as many as 26% of those in one work camp studied were infected with
cocci when tested in six months. (Rao S,
Biddle M, Balchum OJ, Robinson JL. Focal endemic coccidioidomycosis in
Los Angeles County. Am Rev Respir Dis 1972 Mar;105(3):410-6).
- “In Arizona, California, and Texas,
increasing numbers of residents are affected by coccidioidomycosis. As
a result, employers in these areas increasingly face lost days from
work and substantial medical costs attributable to coccidioidal
disease. Such organizations as the military, schools, travel agencies,
and employers with national applicant pools actually create the
opportunity for groups to relocate to or visit endemic regions, with
subsequent risk for exposure. For these institutions, the issue is
further complicated by the possible liability for the occurrence of
infections that would otherwise not have happened.”
Coccidioidomycosis: A Regional Disease of National Importance. Ann Int
Med 1999 Vol 130 No 4 (part 1) p293-300.)
We have additional information in the answers to our Frequently Asked Questions and our
page of Common
Misconceptions About Valley Fever.
Read about the dangers of flowers of sulfur, a rumored "Valley
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