Valley Fever

[Grand Rapids]

Has anyone here heard of, or experienced lung nodules as a result of coccidioidomycosis (a.k.a. "Valley Fever" which is caused by a mold spore that is prevalent in the southwest, especially Arizona)

I had a routine annual physical with a chest x-ray that showed a small nodule 2 weeks ago. A following CT scan showed that nodule was 1.9 x 2.0 cm in my lower right lung and also found a smaller 4 mm nodule on my upper left lung. There is no involvement of adjacent tissue, thankfully.

My pulmonolgist tested me for coccidioidomycosis and the test was positive for the IgG antibody and a comp fixation of 1:4. Apparently, the coccidioidomycosis can produce lung nodules that mimic lung cancer nodules. There are a significant number of documented cases where this has occurred. In addition, it frequently causes ongoing flu like symptoms and fatigue that can last for months - something from which I suffered all during January February and much of March. Tourists are most susceptible to infections because residents tend to develop immunities.

I had a biopsy of the larger nodule, but the results were “inconclusive”,

The docs here in Michigan don’t seem to give much, if any, credence to a connection between my lung nodules and the Valley Fever.   I am awaiting PET scan results but the data I have seen so far suggests that won’t be conclusive for malignancy versus coccidioidomycosis.

Any help or advice would be greatly appreciated.

[National Jewish]

It is surprising that the biopsy of the larger nodule was "inconclusive."  If adequate tissue was obtained it should have been diagnostic.  You should request that all the tissue obtained be processed and that the pathologist who does the review of the tissue be familiar with Valley Fever (Coccidiomycosis).  It should be easy to find one in Tucson or Phoenix, Arizona to ship the slides to.

The complement fixation blood test, which measures IgG antibodies to coccidioidin, is a powerful diagnostic and prognostic tool.  This test becomes positive more slowly, persists longer, and correlates with the severity of disease.  These antibodies may reflect either active infection or the recovery stage.

Your symptoms and the nodules certainly fit with the diagnosis of Valley Fever (Coccidiomycosis).  However, if you have not been in the southwest or California, the diagnosis is very unlikely.  There have been reports of people being exposed to Coccidiomycosis spores in Michigan from items being shipped from the southwest or California.  A positive Coccidiomycosis skin test would be highly suggestive of the diagnosis, if you have not been west of Michigan.  Histoplasmosis is common in most of the Midwest, especially in the Ohio and Mississippi River Valleys.  This would be a much more likely diagnosis since you are in Michigan.

[enaj]

I'm in Michigan too and just had the second CT scan to follow up on "something" in my lung. I will get the results in a day or two. I will suggest that the doctor look at this. Have you been out West lately? I haven't. Can it lie dormant for a time?

[Grand Rapids]

From the research I have done - which has been considerable, I've read of many cases where it has laid dormant for as long as 20 years before symptoms flared up.  Apparently, about 1/2 the people that get it initially don't even show symptoms, or the symptoms may be minor and attributed to a cold or flu.  Then later on, in some cases, it can flare up with severe symptoms.  I just read a story about a guy who lived in southern California for many years and then left there in 1993.  He was just diagnosed recently with a lung cavity and the docs told him he had Valley Fever.  I've also read that the blood serum test can show negative results up to 30% of time with people who have lung nodules and lung cavities.

I would be very interested in how your case develops if you are willing.  The incidence of this infection is enormous, far more than imagined when I first learned of it.  There is a very good website at valleyfeversurvivor.com that has been an immense help to me.

Wish you all the best.

[Grand Rapids]

THANK YOU NJC-R.N.-DC

I will follow up with your suggestion to get the biopsy slides sent to a doctor in Arizona.  I neglected to say in my original post that I had been in Arizona twice last year, the most recent in early November.  In late December, I came down with the severe flu like symptoms and fatigue that lasted for 2 1/2 months.

Also, I received the results of my PET scan today and there was not any unusual uptake of F 18 FDG in the nodule (or anywhere else)  I am celebrating tonight!!!

Just further validation that not every lung nodule is malignant.  Now that said, the radiologist did caution that bronchioloaveolar cell carcinoma has a very low metabolic activity, but the lack of radiotracer uptake is somewhat reassuring in that this very well could represent a post infectious granuloma.

Thank you again.  You and your institution are providing an invaluable forum for thousands of people.  God bless you.

[bactitech]

As a microbiologist, I am amazed that docs in GR are skeptical about valley fever in your diagnosis, especially since you have been to Arizona. In med tech school, this is a typical test question and is common knowledge amongst micro techs.

Were your nodules cultured for fungus? I'm not sure how long this organism takes to grow. It's also known as a dimorphic fungus: it grows as a yeast at 37 degrees C and as a filamentous fungus at 25 degrees C. The latter form is very dangerous to work with even with bio safety cabinets in a lab, so the cultures are usually sent out for analysis, rather than manipulated in the lab to make preparations for microscopic examination.

http://www.avma.org/reference/zoonosis/znsystem.asp

This page is interesting in that it has a map down at the bottom of the endemic areas for cocci, Histoplasmosis, and Blastomycosis.

Calcofluor examination of tissue sections from your nodule can also be done. Fungal elements fluoresce bright green.

http://content.nejm.org/cgi/content/short/329/26/1935

Histology departments can also do silver stains for fungal hyphae. I would definitely ask your doc if these tests have been done. If they haven't, they can pull the paraffin block from your tissue, cut some more slides and stain them. Labs do these tests ALL the time. I know that GR has some big labs there that can accommodate these requests. I used to work for an independent lab that became the Quest laboratory in town. I know there's a big hospital in town also.

Keep pushing - good luck.

[SueT]

I also have been dealing with a pulmonary nodule found in August 1.55X1.85cm and multiple tiny 2mm nodules. Positive low PET(Dr's say in the gray area) Fine needle biopsy showed inflammatory cells but when sent to Cedars, they said not enough speciman.  I had a pneumothorax for 3 weeks.  I am always asked if I have Valley Fever at my CT scans and doctors visits.  They did a Valley Fever test twice locally and it was negative and now another was done and sent to UC Davis and it showed immunity  and "unsure result" on fixation of complement.  This nodule had become translucent in Nov and then more solid in Feb. Repeat CT in March show slightly smaller with 3mm compared to the 5mm scans I had been having.  I am 41 and non smoker.

[Grand Rapids]

SueT

I suspect you live somewhere in the endemic area for coccidioidoycosis if the doctors are inquiring about you having Valley Fever.  There is a website I found that is truly outstanding and totally dedicated to this subject.  You will learn more there about Valley Fever than from all the doctors combined.  It’s www.valleyfeversurvivor.com

Sit back and read the threads from the discussion forum and the personal stories and you will see there are many of us out there.  I hope this helps you.

Tom

[Gemini116]

A related discussion, Is it possible to get encephalits with Valley Fever? was started.