• Mark L. Johnson

Cocci Chronicles IV-Treatment

This is the fourth Part of a series about Valley Fever (coccidioidomycosis). It is presented in a form that provides the essentials. More detailed/scientific information can be found at the University of Arizona Valley Fever Center of Excellence.


As reported in Part III, 60% of those who inhale Cocci spores have No or Mild symptoms and require no professional medical attention. However, the 30% with Moderate symptoms and 10% with Severe symptoms do require some degree of medical care.


There is some good news for those who get infected:


Valley Fever is not contagious.


Once infected you have lifetime immunity.


However, if you have Moderate symptoms, early and responsible treatment will help clear up your infection over time and prevent it from advancing to the Severe stage.



The Drugs


Once my Valley Fever (Moderate-High) was diagnosed, the Allergist prescribed 400 mg/ day of fluconazole (anti-fungal drug). In the old days, amphotericin B was the only drug available to fight Valley Fever but the side effects were very severe. Then in the 1980's came various azol anti-fungal drugs with fluconazole being the most effective and most often used for Moderate cases. See chart below with listing of Valley Fever drugs.



How Does Fluconazole Work?


Fluconazole does not zap fungal cells and immediately destroy them. This drug interferes with the production of Ergosterol---a component of the fungal cell wall. The fungal cell wall fails due to loss of Ergosterol and eventually kills the fungal cell. See image below taken from There's A Fungus Among Us: A Beginners Guide To Anti-Fungals. Therefore, fluconazole treatment for Valley Fever takes time (months).



Long-Term Valley Fever Care


I actually started taking fluconazole on October 28, 2020 prior to getting the positive blood test results (11/3/20) because I begged the Allergist to start treatment because the symptoms were so bad---night sweats, neck/back ache, headache, foot/ankle aches and fatigue. Plus, the Chest CT Scan showed nodules most likely caused by Valley Fever.


Not long after this, the Allergist told me that he could not handle my long-term Valley Fever Care. My Primary Care Physician told me the same. Yikes--now we need Physician #4!


So I had to engage an Infectious Disease Physician in Tucson to handle my case. I met with him on November 11, 2020. He confirmed the diagnosis and that my treatment with fluconazole would be at least 5-6 months with another Chest CT Scan in 5 months to determine effectiveness of the treatment.


After starting fluconazole, the Valley Fever symptoms did not disappear right away. Immediately, the side-effects from taking fluconazole started----bumps on my forehead/eyebrows, swollen and chapped lips, minor but annoying plumbing issues and more. By mid-November (3 weeks after starting fluconazole) the major Valley Fever symptoms subsided. However, I still got tired easily and the side-effects from the fluconazole continued (except for the forehead/eyebrow bumps which disappeared). The side effects were not painful---just annoying.


On March 23, 2021, a Chest CT Scan showed that many of the nodules had disappeared except for a 1 cm nodule in the left lung and two smaller nodules in the right lung. The Infectious Disease Physician said I could stop taking fluconazole after 5 months of treatment! Hallelujah!


However, the saga is not completely over. I have to check in monthly via Patient Portal for a year to provide an update on my health. If any symptoms reappear---back to the fluconazole.


I have been off fluconazole for about one month. It took about three weeks for the fluconazole side effects to subside. I am feeling good but still have a slight chest congestion (when idle) and get tired after (not during) physical activity. Last Sunday, I hiked the uphill section of the Wild Burrow Trail from trailhead to the Alamo Spring in 55 minutes which is back to my pre-Valley Fever pace. However, a good nap was required later in the day!


Severe Symptoms


As cited in Part III, 10% of Valley Fever infections can become severe. Disseminated Valley Fever occurs when the infection travels via the bloodstream and infects the brain, bones, skin, lymph nodes or joints. Patients with compromised immune systems are the most vulnerable. Approximately, 140 deaths from Severe Infections occur each year in the US. This is why early and responsible treatment is so important to avoid becoming a Severe case.



Part V will present Conclusions and Recommendations