Once a diagnosis of coccidioidal infection is established, the next step is to review any possible risk factors that might make the patient particularly susceptible to complications. This is usually accomplished during a complete history and physical examination. Unless specific concerns are raised during the clinic visit, additional testing is not required.

Immunosuppression

By far the most clearly demonstrable risk of progression of coccidioidomycosis is the co-existence of major immunosuppressing conditions that adversely affect cellular immunity. For example, the risk of infections extending beyond the lungs in renal transplant recipients has been shown to be about 75%. This is much greater than the risk of a similar complication in the general population.

Immunosuppressing conditions that affect humoral immunity appear to have relatively little risk for complications of coccidioidal infection. Similarly, splenectomy, hypocomplementemia, or neutrophil dysfunction syndromes are not major risk factors for this disease.

Diabetes mellitus

Diabetic patients appear to have an increased risk of pulmonary complications. While many diabetics resolve their initial infection without residual problems, a disproportionate number seem to develop symptoms related to pulmonary cavities and chronic pneumonia. There is little or no evidence that this group of patients is at increased risk for developing extrapulmonary infection.

Pregnancy

Women who contract Valley Fever during pregnancy are at particular risk of serious infection. Those at highest risk for serious infection are women diagnosed during the third trimester or immediately postpartum. Infections are often life-threatening and should be regarded as complicated management problems.

Other risk factors

There are additional factors which should be considered relevant to the risk of complications from coccidioidal infection. Complications are more frequent in men than in women and in adults than in children. Life-threatening infections are more common in the elderly. Whether this association is purely age-related or a reflection of the accumulation of other co-morbidities as person's age is not known. Also, there appears to be an increased risk of disseminated infection among African Americans, Filipinos, and perhaps other racial groups. Racial predilection for complications is somewhat conjectural since the exact definitions of racial groups are in dispute and carefully controlled epidemiologic studies are not available. Even if racial differences exist (as most authorities believe) the increase in risk may be only two- or three-fold above that of the population as a whole. Finally, certain occupational exposures may increase risk of infection. However, exactly which occupations and what the proportions of the increase over ambient risk are not currently well defined.