Coccidioidomycosis (Valley Fever)

A patient in Canada with pneumonia does not need a local environmental exposure for coccidioidomycosis to be possible. The decisive clue may be a trip to Arizona several months earlier, a construction project in California, or an older residence in northern Mexico. Because the infection is not endemic in Canada, a deliberate travel history is often the step that prevents a prolonged, unsuccessful search for bacterial causes. Valley fever begins after inhalation of dust-borne fungal particles and is usually confined to the lungs. Most infections are mild or silent. The nursing concern is the smaller group in whom the illness becomes debilitating, chronic, disseminated, or meningeal—especially when cell-mediated immunity is impaired. A patient with pneumonia who has night sweats, weight loss, profound fatigue, rash, arthralgias, or failure to improve after antibacterial therapy deserves that broader differential. The immediate safety distinction is easy to miss: the organism is dangerous to laboratory staff when its mould phase is cultured, but it is not ordinarily spread from an infected patient to other people. Use routine or standard precautions for patient care, and alert...