Coccidioidomycosis (Valley Fever)

An adult with community-acquired pneumonia after exposure to desert soil may initially look as though they have a routine bacterial infection. The pattern changes when the patient lives in or recently visited an endemic region, develops erythema nodosum, or fails to improve after 48–72 hours of empiric antibiotics. Those clues should prompt testing for Valley fever rather than automatic broadening of antibacterial therapy. Coccidioides enters through inhalation, changes into spherules in pulmonary tissue, and usually remains confined to the lungs. In a minority of patients, especially those with impaired cell-mediated immunity or severe illness, it spreads through the bloodstream to the skin, bones, joints, or central nervous system. The nurse's priority is to recognize that change in pattern early: pulmonary symptoms may be monitored outpatient when uncomplicated, but neurologic findings, progressive respiratory illness, or extrapulmonary lesions require urgent escalation. Testing begins with a Coccidioides enzyme immunoassay for IgM or IgG. A negative early test does not end the evaluation; repeat serology in 2–4 weeks when suspicion remains high. Treatment follows severity: oral fluconazole is used for uncomplicated pulmonary disease when...