PNEUMONIA SYMPTOMS?
WHEN TO CONSIDER VALLEY FEVER (COCCI OR COCCIDIOIDOMYCOSIS) TESTING
You live in or have recently traveled to areas known to have the Valley Fever fungus (Coccidioides)*
+
You have respiratory symptoms suggestive of pneumonia (such as fever, chills, cough, shortness of breath, chest pain, and fatigue)
Fever
Chills
Cough
Shortness of Breath
Chest Pain
Fatigue
OR
You developed a rash after you had respiratory symptoms
*The areas potentially affected by Coccidioides continue to expand. See Dr. Spec’s commentary.
Consider asking about fungal testing for:
Consider Valley Fever (coccidioidomycosis) Testing When Symptoms
Persist Despite a Course of Antibiotics
You live in or have recently traveled to an area affected by Valley Fever (coccidioidomycosis)
+
You have respiratory symptoms suggestive of pneumonia
+
Your pneumonia symptoms persist
after at least one course of antibiotics given without confirmation of a bacterial infection (empiric therapy).
↓
You should get tested for Valley Fever (coccidioidomycosis) before getting another round of antibiotics.
Consider Coccidioides Testing for High Exposure Risk
You have respiratory symptoms suggestive of pneumonia.
+
↓
You should be tested when you first see a healthcare provider for your illness.
HOW DOES TESTING USUALLY WORK?
Blood Tests for Antibodies
Serum Enzyme-Linked Immunoassay (EIA)
- Source: Blood
- What it’s testing for: Antibodies (part of the immune response) to the Valley Fever fungus Coccidioides
- Advantages:
- Fast, yes/no results (quick turnaround time)
- Often accessible to a lot of practices
- Disadvantages
- Can be negative early in the disease course (because antibodies haven’t been produced yet)
- Not as specific (distinguishing Valley Fever from other infections) as some other tests, so can give false positives
- For both of these reasons, confirmation with a second test is often recommended
Immunodiffusion
Source: Blood
- What it’s testing for: Antibodies to the Valley Fever fungus Coccidioides
- Advantages:
- The test is very specific and simple
- Provides a yes/no answer
- Works well when combined with other serologic tests (for example, to confirm the EIA result)
- Disadvantages:
- Takes a while to provide results (long turnaround time)
- May miss some cases, especially if the patient is immunocompromised
Complement fixation (CF)
Source: Blood
- What it’s testing for: Antibodies to Cocci, provides a numeric result
- Advantages:
- Picks up most cases
- Also helpful for measuring disease severity and progression over time
- Disadvantages:
- Testing done in very few labs
- Long turnaround time
Antigen testing
- What it is testing for: fungal antigen (fungal material in the blood recognized by the test)
- Source: Blood (but also available for urine and cerebrospinal fluid)
- What it’s testing for: Parts of the fungus (antigens)
- Advantages:
- May be positive earlier than antibody-based tests
- Quick turnaround time
- Urine test is convenient
- Disadvantages:
- Tested mostly in patients who have problems with their immune systems
- May react with other fungal infections
- Because it misses a lot of cases, should not be routinely used in pneumonia
Other Testing:
Beyond imaging that is typically used to evaluate the pneumonia, other tests are also sometimes used to test for the Valley Fever fungus (Coccidioides). These test are used less frequently because they are not available in all clinics, haven’t been extensively tested, or require specialized sampling or laboratory resources. For a discussion of these tests, please see Testing Algorithm for Coccidioidomycosis.