Last Updated: 2023-07-07

Author(s): Anzengruber F., Navarini A.

ICD11: 1F25.Z

  • Wernicke 1892
  • Posadas 1892

Coccidioidal granuloma, desert rheumatism, valley fever, California disease, coccidioidomycosis, San Joaquin Valley Fever, valley fever, desert fever, desert rheumatism.

Systemic fungal infection occurring mainly in the Americas.

  • Southern USA, Central and South America
  • Up to 15 times more common in Asians and blacks

  • Pathogen: Coccidioides immitis, a dimorphic fungus
  • Incubation period: 10-18 days
  • Transmission occurs via dust. In primary infection, erythema nodosum or erythema exsudativum multiforme may occur
  • In 1% of cases, haematogenous spread leads to further organ involvement (skin, bone and CNS)
  • Association with immunosuppression

  • The pathogens are inhaled via the lungs, where inoculation occurs. Rarely, infection occurs through the skin
  • Flu-like symptoms (febrile temperatures, thoracic pain, cough, dyspnoea, haemoptysis)
  • Cutaneously, verrucous, scarring healing granulomas are seen, especially in the area of the nasolabial folds and on the capillitium. Abscess and fistula formation may occur

  • Detection of pathogens (pus, sputum, bronchoalveolar lavage, blood, urine or cerebrospinal fluid)
  • Biopsy
  • Serological specific antibody detection
  • Intracutaneous skin test


  • The disseminated form can be lethal if left untreated
  • Frequent relapses

  1. Bialek R, Gonzalez GM, Begerow D, Zelck UE. Coccidioidomycosis and blastomycosis: Advances in molecular diagnosis. FEMS Immunology & Medical Microbiology 2005;45:355-60.
  2. Braverman IM. Protective effects of erythema nodosum in coccidioidomycosis. The Lancet 1999;353:168.
  3. Crum NF, Lederman ER, Stafford CM, Parrish JS, Wallace MR. Coccidioidomycosis. Medicine 2004;83:149-75.
  4. Einstein HE, Johnson RH. Coccidioidomycosis: New Aspects of Epidemiology and Therapy. Clinical Infectious Diseases 1993;16:349-56.
  5. Horsburgh CR, Jr., Cannady PB, Jr., Kirkpatrick CH. Treatment of fungal infections in the bones and joints with ketoconazole. J Infect Dis 1983;147:1064-9.
  6. Kim A, Parker SS. Coccidioidomycosis: Case report and update on diagnosis and management. Journal of the American Academy of Dermatology 2002;46:743-7.
  7. Mathew G, Smedema M, Wheat LJ, Goldman M. Relapse of coccidioidomycosis despite immune reconstitution after fluconazole secondary prophylaxis in a patient with AIDS. Fallbericht. Coccidioidomykose-Ruckfall trotz Immunrekonstitution nach Fluconazol-Sekundarprophylaxe bei einem AIDS-Patienten. Mycoses 2003;46:42-4.
  8. Pappagianis D. Epidemiology of Coccidioidomycosis.  Coccidioidomycosis: Springer Science + Business Media; 1980:63-85.
  9. Polesky A, Kirsch Carl M, Synder Linda S, et al. Airway Coccidioidomycosis–Report of Cases and Review. Clinical Infectious Diseases 1999;28:1273-80.
  10. Ramos-e-Silva M, Saraiva LdES. Paracoccidioidomycosis. Dermatologic Clinics 2008;26:257-69.
  11. Shikanai Yasuda MA. Pharmacological management of paracoccidioidomycosis. Expert Opinion on Pharmacotherapy 2005;6:385-97.
  12. Tsukadaira A, Okubo Y, Sato E, Kubo K. Chronic coccidioidomycosis. The Lancet 2002;360:977.