Complications from Valley Fever can range from none to severe/life threatening resulting in death. Between 50-60% of those infected, there are no complications and these individuals do not even know they have the disease. Individuals who fit into this category are thought to be immune to catching this disease a second time. There are exceptions to catching this disease a second time, but it is rare.
For the 40-50% that seek medical attention, acute pneumonia is the primary complication of infection. Pneumonia usually develops 1 – 3 weeks after the person is infected with the spores causing Valley Fever. Because pneumonia is common in many diseases, clues that it is caused by Valley Fever are: the person has been in an area where Valley Fever is known to exist (San Joaquin Valley, Arizona, etc.), radiographic findings such as X-ray, CT scan or MRI, that shows lobar infiltrates and enlarged lymph nodes behind the lungs are suggestive of Valley Fever. Most cases of acute pneumonia resolve by themselves or with treatment.
When pneumonia lasts longer than 3 months, the illness is classified as chronic progressive pneumonia. Approximately 5% of the cases with symptoms have this complication. Individuals in this group tend to have persistent coughing, sputum production, blood in their sputum, and weight loss.
Pulmonary nodules and cavities develop in approximately 5-10% of the cases with pneumonia. Of those, half will typically disappear within the first two years following discovery. Most nodules and cavities cause no symptoms or problems. The biggest concern for nodules and cavities is that they may represent cancer. This may lead to a person having to undergo unnecessary tests and treatments.
Disseminated disease has occurred when the fungus spreads beyond the lungs or the lymph nodes behind the lungs. This complication occurs in 1-5% of the cases that have normal functioning immune systems. In persons with certain risk factors, the percent of dissemination can be much higher. When dissemination occurs, it typically happens within the first several months following infection in the lungs.
Persons at risk for disseminated disease include diabetics; people of African or Filipino ancestry; those younger than 5 or older than 50 years of age; women in their third trimester of pregnancy; people with immune systems that are not fully functioning (HIV infection, Hodgkin’s disease, organ recipient’s, cancer patients, medications, etc.) and males.
Disseminated disease can spread to any part of the body. The most common sites are: linings of the brain (meninges) , skin, lymph nodes, bones, and joints. The most feared site of spread is the linings of the brain and spinal cord causing meningitis which requires lifetime treatment. Deaths from this complication have decreased from 100% to approximately 30%, since treatment using amphotericin B was discovered over 50 years ago.