Dear Dr. Gott: My dog, a friend’s dog and three people I know have been diagnosed with valley fever recently. We live in Arizona, a high-risk area for this disease, but it seems odd to have so many friends develop this at the same time. I assume there would be little difference in treatment between canine and human, so I am hoping you can help me with something I have not been able to get an answer for. Would hearing loss (temporary or permanent) be a side effect of either the disease itself or the medication fluconazole? Thanks for any insight you will be able or willing to share.
Dear Reader: Valley fever is caused by a fungus (coccidioides) that is commonly found in the soil of certain areas. When the fungus becomes disturbed — by construction, farming, etc. — it can become airborne. Individuals (or animals) who then breathe in the fungus can then develop valley fever, also known as acute coccidioidomycosis. The fact that three people you know and two pets were all diagnosed recently leads me to believe that you all live within close proximity to one another and that whatever disturbed the fungus is fairly close by as well.
The fungus that causes valley fever thrives in the alkaline desert soil of southern Arizona, Nevada, northern Mexico and the San Joaquin Valley of California. It is also common in areas with mild winters and arid summers, such as Texas, New Mexico and parts of Central and South America.
For some patients, acute valley fever can worsen and develop into more serious forms, such as chronic or disseminated coccidioidomycosis. This is especially true of moderate to severe cases that go untreated. (Mild cases may not need treatment.)
Acute infection is often mild with few or no symptoms. If symptoms do present (typically one to three weeks after exposure), they can include joint pain, fatigue, fever, chills, night sweats, cough, chest pain, headache and shortness of breath. Some may develop a red, spotty rash that may turn brown. It usually appears on the lower legs but can also occur on the chest, back and arms. Occasionally, the rash may have blisters or pimple-like lesions.
People who are infected without symptoms may only discover this when a blood or skin test is positive. Some may also have small nodules of residual infection within the lungs that can appear as tumors during a chest X-ray.
In those with symptoms, the disease is highly variable and can take from six months to one year to recover fully. Joint pain and fatigue can last even longer. Severity depends on general health status before infection and the number of spores inhaled. More spores mean more severe infection.
Chronic infection is most common in those with weakened immune systems who don’t fully recover. This complication is a form of chronic pneumonia that often alternates between periods of recovery and worsening symptoms. These can include cough, weight loss, low-grade fever, lung nodules, chest pain and blood in the sputum (mucous that is coughed up and out of the lungs).
Disseminated infection is the most serious form. It occurs when the fungus spreads outside the lungs to other areas of the body, such as the bones, brain, liver, heart, skin and meninges (coverings of the brain and spinal cord). Symptoms include painful, swollen joints; painful skull, spine or bone lesions; meningitis; and nodules, skin lesions and ulcers.
Most cases of valley fever are treated with bed rest and fluids. Careful monitoring by a physician is required so that prescription medication can be given to those who fail to improve after a reasonable amount of time or whose symptoms worsen.
For those who do require treatment, prescription antifungal medication (fluconazole, itraconazole) is the most commonly used. For the most severe cases, the IV antifungal amphotericin may be used.
These medications all carry some serious side effects that typically disappear after the medication is stopped. These can include allergic reaction, seizures, high cholesterol or triglycerides, insomnia, vertigo, low potassium, tremor, drowsiness and much more.
Now, you specifically asked whether valley fever or fluconazole are linked to hearing loss. Based on the above information, I don’t believe they are; however, because I live in New England, valley fever is not an issue for us, so I am fairly unfamiliar with it. If you are concerned, speak to your physician about it.
Because valley fever can become a chronic lung disorder, I am sending you copy of my Health Report “Pulmonary Disease.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
Dear Dr. Gott: I’ve noticed several over-the-counter medicines for ringing in the ears. Do any really work?
Dear Reader: I recommend you see a physician or otolaryngologist first to make sure there is no discharge, pain, underlying cause or other undiagnosed reason for your condition. Perhaps you are on a medication with tinnitus as a side effect. Should this be the case, a simple modification of the drug strength or brand might be in order. If nothing is found, there are a number of OTCs you might consider, including Lipo-Flavonoid, lignocaine, melatonin, setraline, botulinum toxin and others. Herbals include ginko biloba, vincamine extracted from periwinkle, or sesame seeds. The herbs mentioned are purported to increase the flow of blood to the head and neck. Beyond that, I cannot guarantee you will find relief from OTCs, herbs or prescription drugs. When you speak with your physician, who knows your medical history, ask for a recommendation. Your pharmacist will also be an excellent resource in this regard.