If you get infected with Cocci, it may affect you in a number of ways. You may not get sick at all; you might have a mild lung problem; or, more rarely, you will have serious complications. Read on to learn about how Cocci may affect you.
Who Gets Sick and Who Gets Diagnosed?
Before we get into the symptoms of coccidioidomycosis (Cocci), it’s important to appreciate that not everyone who is infected with Cocci gets sick. Let’s take a look at the numbers (Figure 1). When we think about Cocci, the most common presentation is a mild lung illness like a cold or flu but lasting noticeably longer. Chronic or complex lung issues or infections occurring outside the lungs are less common.
Figure 1. Typical distribution of Cocci cases in 100 infected people.
Valley Fever Symptoms
Let’s start by looking at those 40% of patients who have flu-like or pneumonia-like symptoms. This is the group of people affected by Valley Fever. Symptoms usually start about two weeks after exposure. Figure 2 shows the common symptoms associated with Valley Fever.
Figure 2. Common Symptoms Associated With Valley Fever
Fatigue
Cough
Shortness of breath (or Chest pain)
Fever
Night sweats
Muscle or joint pain
Weight loss
Rash
Headache
Loss of Appetite
Chronic Pulmonary or Disseminated Cocci
Sometimes the primary Cocci infection of the lungs is complicated, does not go away (chronic pulmonary Cocci), or spreads (disseminates) from the lung to other organs. Patients with disseminated disease typically have symptoms that last a long time after the infection. As shown in Figure 3, Cocci typically spreads to the skin, bones, brain, and the meninges. Chronic or complicated pulmonary or dissemination Cocci can lead to a range of symptoms as shown in the Table.
Figure 3. Sites of Cocci dissemination
Table: Areas of involvement and symptoms of chronic, complicated, or disseminated Cocci. Note the symptoms that are considered red flags are bolded and marked. These symptoms need urgent treatment and evaluation.
Area Involved |
Symptom |
| Complicated or chronic pulmonary disease | Chronic cough, weight loss, chest pain, trouble breathing, hemoptysis (coughing up blood) |
| Central nervous system (meninges) | Severe headaches, blurred vision, neck stiffness, hearing changes, confusion Note: Cocci meningitis is a medical emergency. These symptoms need to be evaluated immediately. Patients with undiagnosed Cocci meningitis can end up having seizures or strokes and suffer permanent damage that will not get better even after the infection is controlled. |
| Skin | Nodules, draining, nonhealing ulcers (breaks in the skin), and abscesses in the skin |
| Lymph node | Swollen or draining lymph node |
| Bone | Pain in the bones, often involving the spine (back bones), leg bones, feet, and skull. These changes can result in height loss, worsening back and neck pain, lower extremity weakness, and hunchback. Sometimes the infection can spread locally, leading to abscesses. |
| Joints | Painful, swollen, warm joints, especially knees or ankles |
Science Sidebar:
INFLAMMATION VS DISSEMINATION—WHAT’S THE DIFFERENCE?
Skin and joints can be involved with both primary (lung) Cocci or disseminated disease. What’s the difference?
The activation of the immune system in response to the Cocci infection can cause rashes, joint pain, fatigue, red eyes, and ulcers in the mouth. The skin can also show this immunologic reaction to the fungus. As shown in Figure a, this can look like a reddish or purple rash. However, sometimes the skin manifestations associated with Cocci of the lung can be raised (nodular). With disseminated disease, the skin lumps and bumps are often more complex—while some may be severe, other sites can be less noticeable (Figure b circled area).
How can your provider tell the difference? If the skin problems are more complex, localized, and happen weeks to months after the initial syndrome, your doctor may do a biopsy for culture to check for disseminated disease.
Figure a. Reddish rash in primary coccidioidomycosis.
Figure b. Disseminated coccidioidomycosis. This patient has a raised (nodular) area on his face that is broken (ulcerated) in the middle.
Joint issues (arthralgias) are also very common with Valley Fever. This is where the term desert rheumatism comes from. Joint issues in patients with Cocci confined to the lung usually appear as symmetrical, painful joints without a lot of joint fluid buildup. Commonly affected joints include the knees, ankles, hips, and elbows. The disseminated form affecting joints is less likely to be symmetrical. With disseminated disease, permanent damage is more likely, which can show up on imaging tests such as x-rays, computed tomography (CT or CAT) scans, magnetic resonance imaging (MRI), or other types of imaging. Your provider will look at your symptoms, time from disease onset, and test results to determine if the joint issues are associated with disseminated disease. Your provider may also perform a biopsy to look for Cocci organisms.