Navigating Valley Fever: A Guide for Rheumatology Patients in Arizona
Navigating Valley Fever

Living in the picturesque state of Arizona, we are surrounded by stunning landscapes and a unique desert climate. While the Grand Canyon State offers a wealth of natural beauty, it also presents certain health challenges, particularly for those with compromised immune systems. These risks apply to patients who call this state home even half the year, or snowbirds, who spend a significant amount of time enjoying our temperate winters.  

Valley fever is on the rise in Arizona. Here’s what you need to know about its transmission, its contagiousness, and why it poses risks for rheumatology patients on biologic or immunosuppressant medications. 

What is Valley Fever? 

Valley fever, (coccidioidomycosis), is an infection caused by the Coccidioides fungus, which thrives in the southwestern soil of the United States, including Arizona. When these soil particles become airborne due to activities like construction, farming, or even just strong winds, individuals can inhale the spores and become infected.  

For those raised in Arizona or who have been living in the state for some time, it’s very common to be exposed to Coccidioides spores. The average person’s immune system can typically ward it off. But if you are someone who is around large amounts of dust or dirt, such as landscape workers, construction workers, or those in agriculture, you may be exposed to large amounts of the fungus and develop valley fever symptoms, even with a healthy functioning immune system.   

How is Valley Fever Spread? 

The primary mode of transmission for valley fever is through the inhalation of fungal spores. In areas with dry and dusty conditions, like Arizona, the risk of exposure is heightened. Certain parts of the state have higher levels of detectable fungus, and due to increases in temperatures, those “zones” are increasing over the years.  

The Center for Disease Control and Prevention (CDC) estimates that approximately 15%-30% of cases of community-acquired pneumonia in Phoenix and Tucson (and areas between) are caused by coccidioidomycosis1.   

The fungus is particularly prevalent in the soil of the state, especially in rural areas and construction zones. Individuals engaging in outdoor activities, such as gardening or hiking, may unknowingly breathe in the spores, leading to infection. Working in areas with damp soil or watering down dusty areas can decrease the aerosolization of spores, though these methods do not entirely prevent the spores from becoming airborne.  

Is Valley Fever Contagious? 

Valley fever is not a contagious disease. Unlike the common cold or flu, valley fever doesn’t spread through person-to-person contact. Instead, it is acquired by inhaling fungal spores present in the environment.  

Patients with valley fever pose no risk to their friends, family, or colleagues. Animals and pets, like humans, can become infected with valley fever, and similarly are not able to transmit the disease to another animal or human.  

Why Valley Fever is a Risk for Patients with Compromised Immune Systems

For those living with autoimmune diseases such as rheumatoid arthritis, lupus, or psoriatic arthritis, managing these conditions often involves the use of immunosuppressant medications or biologics. These medications work by suppressing the immune system to alleviate symptoms and inflammation, but this suppression also leaves patients more vulnerable to certain infections.   

Not all medications prescribed for autoimmune diseases are considered immunosuppressive, so it is important to understand the particular risk of each medication if you are prescribed a treatment.  

Valley fever can be particularly harmful to immunocompromised individuals because their weakened immune response may struggle to contain the fungal infection. Valley fever typically affects the lungs first, as the fungal spores are inhaled and lay dormant in the lungs, often in cavities called granulomas. A functioning immune system can ward off these fungal spores most of the time. But when the immune system functioning is decreased, as is the case with certain immunosuppressants or high doses of steroids like prednisone, the spores can then grow and multiple, creating a full-blown infection.  

The fungus can spread and potentially affect other organs, leading to more severe complications. Some patients exhibit symptoms like joint pain, muscle pain, weight loss, and may not have a fever due to the evasion of the immune system.  

Biologics, which target specific pathways in the immune system, can also impact the body’s ability to fight off infections. This may result in the lack of a fever, or typical flu-like symptoms that are otherwise common with valley fever.  

Therefore, rheumatology patients taking these medications need to be vigilant. At Summit Rheumatology, we test our patients yearly for antibodies to valley fever and prior to beginning or renewing biologic medications. If you are new to Arizona, be sure to ask about how valley fever may impact your immune system while on biologic medications.  

Valley Fever Symptoms 

Valley Fever symptoms can range from mild to severe, resembling those of the flu. Common signs include: 

  • Fatigue 
  • Cough 
  • Fever 
  • Chest pain
  • Joint aches 

These symptoms often resemble pneumonia. In immunocompromised patients, the infection may progress more rapidly, necessitating prompt medical attention. In extreme cases of severe lung infection, hospitalization may be required.  

Rheumatology patients experiencing any of these symptoms should consult their healthcare provider promptly for proper evaluation and diagnosis. 

Valley Fever Diagnosis 

Blood tests and imaging studies, such as chest X-ray or CT scan, are used to detect characteristic patterns associated with valley fever. This may include a hollow nodule in the lungs called a granuloma or a calcified nodule in the lung, along with a positive blood test showing a high titer of fungal antibodies.   

Preventive Measures for Rheumatology Patients: 

Given the high prevalence of valley fever in Arizona, rheumatology patients must take proactive measures to reduce their risk of exposure. Some practical steps include: 

Stay Informed 

Be aware of valley fever and its symptoms. Understanding the risks can empower patients to make informed decisions about outdoor activitiesIf you are on a biologic medication, you do not need to eliminate outdoor activities such as gardening or hiking, but rather be smart about avoiding dust storms and staying clear of dust from construction zones.  

Use Protective Gear 

Wear a mask when outdoors, especially in dusty environments, to reduce the inhalation of airborne spores. Masks do not prevent inhalation of all spores and dust but can decrease the amount that you inhale at a given time.  

Avoid Dusty Areas 

If possible, limit time spent in areas with known high concentrations of dust, such as construction sites or areas with recent excavation. Dampen soil before gardening and try to avoid going outside when it’s windy. 

Consult Healthcare Providers 

Rheumatology patients on immunosuppressant medications should discuss their increased vulnerability to valley fever with their healthcare providers. This allows for tailored guidance on preventive measures and vigilant monitoring. 

By adopting preventive measures and maintaining open communication with their rheumatology team, patients can navigate the beautiful Arizona landscape while minimizing the potential impact of valley fever on their health.  


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