DEAR DR. ROACH: I am a 57-year-old male who is healthy and physically fit. I contracted Valley fever last November while visiting Arizona. The initial symptoms were flu-like body aches, a rash and profound night sweats that lasted for about three weeks. After returning to Canada, my family physician ordered a CT scan, which showed nodules in the left lung, the largest being 4 cm. I began to recover (untreated) before an appointment with a pulmonary specialist became available, and my doctor decided to take a wait-and-see approach. I was fully recovered and back cycling long distances in about three months.
Can I assume that this illness is behind me? I’ve met many other people who have had VF, but not one who didn’t receive some kind of antifungal. I have also read that VF can reappear years down the road. Does not having had treatment with antifungals have any influence on a recurrence? – P.B.
ANSWER: The fungus Coccidioides is the cause of Valley fever. Coccidiomycosis, the disease caused by this fungus, is very different when it infects a young and healthy person like yourself from an infection in a person with immune system disease. You had pretty classic symptoms of Valley fever (the name for the infection in otherwise healthy people), and your body was able to overcome the infection with no treatment.
Two studies have looked at whether treatment improves symptoms faster or prevents recurrence. There was no difference between treated and untreated groups in symptoms, and no patients had recurrence of disease in the untreated group. You can be reassured that the illness is behind you.
In people taking medications to suppress the immune system (such as for auto-immune diseases) or have underlying immune system disease (advanced HIV, recent cancer chemotherapy), coccidiomycosis can be much more serious. Pregnant women need treatment as well, even with mild symptoms. Treatment in these cases is with an antifungal medicine, usually for a prolonged time, and I strongly advise treatment by a pulmonary or infectious disease specialist.
DEAR DR. ROACH: Now that we are six months into the pandemic, I could use a refresher on what underlying conditions cause people to fare worse when they contract this virus. I have heard that diabetes and high blood pressure are two risk factors. Do those with controlled diabetes and high blood pressure have the same risk as uncontrolled? – E.T.
ANSWER: Diabetes is clearly a risk for developing complications in people who are infected with SARS-CoV-2, the virus that causes COVID-19. It is likely, but not definitive, that diabetes that has not been well controlled, especially for a long time, is a much greater risk factor than well-controlled diabetes. High blood pressure is also likely a risk factor, and again, those with high blood pressure that was caught early and promptly treated with goals reached are probably less likely to have complications than those with poor control.
Other risk factors include any immune system disease or treatment (HIV, cancer, organ transplant); heart or lung disease; chronic kidney disease; sickle cell and obesity. There are many other conditions that probably increase risk. In fact, a majority of older North Americans will have at least one risk factor, which is why we all need to continue to physically distance and wear masks.