- Immuno-suppressed Patients
- Adrenal Corticosteroid Therapy
- Third Trimester Pregnancy
Of those patients with Valley Fever that seek medical attention, one to two percent develop disease that has spread (disseminated) to other parts of the body. The most common site of dissemination is the skin. Biopsies of skin lesions may reveal Coccidioides when grown in culture. Bones and joints (especially the knees, vertebrae, and wrists) are other frequent sites of dissemination. The changes in bones and joints due to Valley Fever infection can be seen on x-rays and in CT-scans of the affected body part. Meningitis is the most serious and lethal complication of disseminated disease. Symptoms include headache, vomiting, stiff neck, and other central nervous system disturbances. A spinal tap is required for a definite diagnosis of meningitis.
While there are no racial or gender differences in susceptibility to primary infection with coccidioidomycosis, differences in risk of disseminated infection do appear to exist. Men have a higher rate of dissemination than do women and several studies have shown that the rate of dissemination in African Americans and Filipinos is several times higher than in the rest of the U.S. population. Native Americans, Hispanics and Asians may also have a higher rate of dissemination than the general population, but these population differences are not well defined.
Others at increased risk of disseminated disease are those persons with immune system deficiencies. In areas of the southwestern U.S. where Valley Fever is endemic, it is one of the most frequent opportunistic infections among HIV-infected patients. Patients who are immuno-compromised due to organ transplants, Hodgkin's disease, diabetes, pregnancy (3rd trimester), or chronic corticosteroid therapy also have an increased risk of developing disseminated disease.