Suggest treatment for valley fever
Patient: diagnosed as reactive (1-16) to valley fever. office just called to tell me to reduce dosage to 200 mg per day. pharnacy just called to tell me that long time use of simbastatin may be issue and waiting for dr retrun call. just recovered from pnuemonia on left lobe. little confused and dr nurse could not tell me how severe VF is on me.no signs like rash or cough. help!! Doctor: Hello!I have been through your question.Valley Fever (Coccidioidomycosis) usually causes a primary pulmonary infection (as I think you have based on your history) which often resolves without therapy.  In some cases a chronic  pulmonary infection or, rarely, disseminated disease (extrapulmonary infection) may develop. Primary pulmonary cocci usually may not need treatment but it depends from risk factors , illness severity indicators, and findings on follow-up of patient’s symptoms, exam, and serology every two to four weeks. Usually it  treats with fluconazole 400 mg daily or itraconazole 200 mg twice daily until titer is stabilized at ≤ 1:4 and asymptomatic. The  infection  could be clear  when the  titer is usually 1:2, 1:4 or undetectable. Persistence of titer > 1:4  as you have (1-16) may indicate active infection includingdissemination, but to be sure I want to ask this titer result is after starting  the treatment or in the beginning. I think is a good news that your symptoms are improved  but you need to do a physical examination by an Infectious disease specialist,every two weeks titer, lab test  and chest radiography as well to define better your situation. I hope my answer help you.I wish you a quick recovery.