Coccidioidomycosis, also known as valley fever, is caused by the dimorphic 

), which live in the soil in dry and hot environments. In the United States, 

 fungi are most common in the Southwest, specifically in Arizona and Southern California, where it is considered endemic, but also as far north as Washington and as far east as Texas.

 Internationally, it is also seen in Mexico and parts of Central and South America.

Arthroconidia are inhaled from the environment and phagocytosed by alveolar macrophages, where they first develop into a spherule. The spherule then develops hundreds of endospores inside it, which eventually rupture, releasing the endospores. Those endospores cause local pyogranulomatous inflammation and can disseminate via lymphatics to the tracheobronchial lymph nodes and/or hematogenously throughout the rest of the body.

 can range from asymptomatic to life-threatening. Most commonly, dogs experience mild signs such as coughing, lethargy, hyporexia, fever, and weight loss, which can all present acutely or chronically.

 If there is dissemination, clinical signs will vary based on the site, which commonly includes the central nervous system (CNS), bones, eyes, skin, and pericardium. Neurologic signs may include seizures, which are the most common; central vestibular signs; head pressing; and back pain or paresis.

osteomyelitis in the appendicular bones often presents with lameness, pain, or a visible swelling.

 Cardiac/pericardial involvement often leads to right-sided heart failure with ascites and/or pleural effusion.

Coccidioidomycosis can be diagnosed using serology, cytology, histopathology, or fungal cultures. Most commonly, diagnosis is based on antibody serology, consisting of IgM and IgG titers via an agar gel immunodiffusion (AGID) assay.

 IgM antibodies are generally detectable within 2 to 5 weeks, and IgG antibodies in 8 to 12 weeks after initial infection.

 There is no documented correlation of initial titers and disease severity; therefore, dogs with low titers can have significant disease, whereas dogs in endemic areas can have positive titers from exposure alone.

 The author generally treats all dogs with positive results and consistent clinical signs, even with low titers, and will treat asymptomatic dogs with positive results if the titer is 1:8 or higher. False negative results may occur in up to 13% of cases.

Over the past few years, a point-of-care lateral flow assay (LFA), Sōna 

 (IMMY), has also become commercially available and subsequently tested in comparison with AGID in canine patients.

 In comparison with AGID, findings from a study showed that the point-of-care LFA had a positive predictive value of 100% and a negative predictive value of 75%.

 This point-of-care test can be helpful in situations where teams may be looking to provide more information quickly, before either same-day additional procedures/testing or euthanasia. As this is a qualitative test and there can be false negative results, it is still recommended that titers be submitted for confirmation and monitoring.

Cytology results from aspirates, fluid, or skin impressions may also show 

 spherules and/or endospores, but this method has a generally low sensitivity, and results can be easy to miss due to low numbers of organisms.

Fungal cultures can also be used, but this method is not commonly performed due to potentially long incubation time and human health hazards to laboratory workers.

Azole antifungal therapy is the mainstay of treatment for valley fever, with fluconazole being the most common due to its lower cost. In clinical practice, fluconazole is generally dosed at close to 10 mg/kg twice daily.

 Fluconazole comes in generic 50-mg, 100-mg, 150-mg, and 200-mg tablets, which can be easily halved to facilitate dosing close to 10 mg/kg, even in small patients. There is also a generic 40-mg/mL solution available.

Itraconazole is preferred over fluconazole in cases with bone or joint involvement due to increased bone penetration

 and is commonly used in cases with disease refractory to fluconazole. The recommended dosing for itraconazole is 5 mg/kg once daily. Itraconazole comes in 100-mg generic capsules as well as human-labeled and veterinary-labeled liquid solutions in a 10-mg/mL concentration. Newer generation azoles such as posaconazole and voriconazole can also be considered in refractory cases.

 Hepatotoxicity can occur in up to 26% of patients on azole antifungal therapy.

It is recommended to avoid compounding these medications. In findings from a 2018 study comparing compounded, generic, and brand-name itraconazole, 95% of animals in the compounded medication group had subtherapeutic itraconazole blood levels.

 Additionally, findings from a 2017 study on compounded fluconazole showed poor accuracy and precision in compounded fluconazole suspension.

Enucleation may be required for dogs with ocular valley fever, and in dogs with valley fever pericarditis, subtotal pericardectomy and epicardial excision may be required.

 Amphotericin B can be considered in patients with severe infection or refractory disease.

Treatment duration can range from 6 months to many years, but in the author’s experience, the average treatment duration is 9 to 12 months. Antibody titers should decrease with successful treatment.

 Treatment is commonly continued until the titer is 1:2 or lower and the initial lesions have resolved.

Titers are commonly checked every 3 to 6 months.

Many clinicians will treat for an additional 3 to 6 months after the first negative or low (1:1 or 1:2) titer, rechecking the titer again before discontinuing treatment. Osteomyelitis and CNS cases often require long-term to potentially lifelong treatment.

A coccidioidomycosis vaccine, which is an attenuated live vaccine using an avirulent strain of 

, is currently in development by Anivive Lifesciences.

 Findings from a 2021 study where research dogs were vaccinated (initial and a booster at day 28) and then subsequently infected with 

 showed that vaccinated dogs had significantly reduced fungal burden and disease scores, with approximately 90% of those dogs having minimal measures of disease.

 Keep an eye out for more information in the future about more studies on a vaccine, FDA approval, and commercial availability.

Although less common than in dogs, likely due to their indoor lifestyle, valley fever can also be seen in cats. Similar to those in dogs, clinical signs are often related to disease localization, which can include respiratory signs, skin lesions, lameness, neurologic signs, and ocular lesions.

Dissemination is common in cats, with findings from one study reporting dissemination in 60% of cats, with the skin being the most common site of dissemination.

 Diagnosis is generally made from antibody serology and/or cytology, similar to dogs.

 Treatment is with azole antifungal therapy, with fluconazole being the first choice of medication at 50 mg twice daily, with alternative azole therapy (itraconazole and posaconazole) or amphotericin B in refractory cases.

Kelley AJ, Stainback LB, Knowles KE, Moore TW, Plummer SB, Shoup OR. Clinical characteristics, magnetic resonance imaging features, treatment, and outcome for presumed intracranial coccidioidomycosis in 45 dogs (2009‐2019). 

. 2021;35(5):2222-2231. doi:10.1111/jvim.16243

Shaver SL, Foy DS, Carter TD. Clinical features, treatment, and outcome of dogs with Coccidioides osteomyelitis. 

. 2021;260(1):63-70. doi:10.2460/javma.20.12.0696

Heinritz CK, Gilson SD, Soderstrom MJ, Robertson TA, Gorman SC, Boston RC. Subtotal pericardectomy and epicardial excision for treatment of coccidioidomycosis-induced effusive-constrictive pericarditis in dogs: seventeen cases (1999-2003). 

. 2005;227(3):435-440. doi:10.2460/javma.2005.227.435

Johnson LR, Herrgesell EJ, Davidson AP, Pappagianis D. Clinical, clinicopathologic, and radiographic findings in dogs with coccidioidomycosis: twenty-four cases (1995-2000). 

. 2003;222(4):461-466. doi:10.2460/javma.2003.222.461

Shubitz LF, Butkiewicz CD, Dial SM, Lindan CP. Incidence of Coccidioides infection among dogs residing in a region in which the organism is endemic

. 2005;226(11):1846-1850. doi:10.2460/javma.2005.226.1846

Gunstra A, Steurer JA, Seibert RL, Dixon BC, Russell DS. Sensitivity of serologic testing for dogs diagnosed with coccidioidomycosis on histology: fifty-two cases (2012-2013). 

. 2019;55(5):238-242. doi:10.5326/jaaha-ms-6772

Schlacks S, Vishkautsan P, Butkiewicz C, Shubitz L. Evaluation of a commercially available, point-of-care Coccidioides antibody lateral flow assay to aid in rapid diagnosis of coccidioidomycosis in dogs. 

. 2020;58(3):328-332. doi:10.1093/mmy/myz067

Reagan KL, McHardy I, Thompson GR 3rd, Sykes JE. Clinical performance of a point‐of‐care Coccidioides antibody test in dogs. 

. 2021;35(2):965-969. doi:10.1111/jvim.16087

Carter TD, Fuller BD, Shaver SL, Foy DS. Retrospective evaluation of the efficacy of fluconazole for the treatment of coccidioidomycosis in dogs: forty-nine cases (2015-2020). 

. 2022;260(10):1200-1205. doi:10.2460/javma.22.01.0006

Felton T, Troke PF, Hope WW. Tissue penetration of antifungal agents. 

. 2014;27(1):68-88. doi:10.1128/CMR.00046-13

Shubitz LF, Schlacks S, Vishkautsan P, Butkiewicz CD, Worthing KA. Posaconazole treatment of refractory coccidioidomycosis in dogs. 

. 2021;35(6):2772-2777. doi:10.1111/jvim.16282

Raghu C, Reagh C. Novel treatment of disseminated coccidioidomycosis in a dog with voriconazole. 

. 2018;2018:1785748. doi:10.1155/2018/1785748

Mazepa ASW, Trepanier LA, Foy DS. Retrospective comparison of the efficacy of fluconazole or itraconazole for the treatment of systemic blastomycosis in dogs. 

. 2011;25(3):440-445. doi:10.1111/j.1939-1676.2011.0710.x

Renschler J, Albers A, Sinclair-Mackling H, Wheat LJ. Comparison of compounded, generic, and innovator-formulated itraconazole in dogs and cats. 

. 2018;54(4):195-200. doi:10.5326/jaaha-ms-6591

Laporte CM, Cruz-Espindola C, Thungrat K, Schick AE, Lewis TP 2nd, Boothe DM. Quality assessment of fluconazole capsules and oral suspensions compounded by pharmacies located in the United States. 

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Biologics. Anivive Lifesciences. Accessed June 3, 2025. 

https://www.anivive.com/treatments/biologics

Shubitz LF, Robb EJ, Powell DA, et al. Δcps1 vaccine protects dogs against experimentally induced coccidioidomycosis. 

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Articles

Understanding and managing valley fever in veterinary patients.

From soil to systemic disease

In this update from Vet Watch's host Christopher Lee, DVM, MPH, DACVPM, shares more on what normalcy bias is, and how it can impact patients at risk of New World screwworm

Vet Watch Update: Do you have normalcy bias?

On this episode of Vet Watch Update, Christopher Lee, DVM, MPH, DACVPM, shares more on what it means to have normalcy bias, how it can impact patients at your clinic at risk of New World screwworm (NWSW), plus what veterinary teams can do today to help the fight against NWSW.

: Are you a victim of normalcy bias? This is the Vet Watch update, I'm Christopher Lee. 

Normalcy bias is our brain's way of refusing to believe that we're in danger, even when there's ample signs. We ignore all of the warnings until it's too late. Normalcy bias often helps us think, well, nothing horrible will happen because nothing horrible has happened recently, such as when a client thinks that their cat is fine. Well, I mean, because she's been fine for the last 12 years, it's only the last few days that she's not been eating, or when you and your 4 friends decide to split up to look for your lost friend in the haunted house, or when New World screw worm is approaching, if we do not stay vigilant against 

, our patients and their families could pay the price. 

So here's what you can do today. One: submit active myiasis cases to your lab for identification if you suspect New World screwworm. Two: learn to recognize screwworm larvae in my article linked below. And 3: protect pets year-round with isoxazines, which effectively kill these beasties. Don't let normalcy bias leave you unprepared. Act now. Your patients are counting on you.

Videos

In this Vet Watch Update, our host Dr Christopher Lee shares more on what exactly normalcy bias means, and what it means for potential New World screwworm patients.

Vet Watch update: Do you have normalcy bias?

A clinical trial assessing the efficacy of a new vaccine for foot-and-mouth disease (FMD) in cattle has demonstrated success. The research, which was conducted by the Friedrich Loeffler Institute—the Federal Institute for Animal Health of Germany in Greifswald—found that all the animals vaccinated with the novel vaccine were fully protected and showed no signs of viral shedding or adverse effects.

According to the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS), FMD is a serious and highly contagious viral disease that affects cows, pigs, sheep, goats, deer, and other animals with divided hooves. Impacted animals may exhibit fever and blisters on the tongue and lips, in and around the mouth, on the mammary glands, and around the hooves. The blisters then cause erosions, which can lead to depression, anorexia, excessive salivation, lameness, and reluctance to move or stand. Additional symptoms include

Heart disease and death, particularly in newborns

Although the disease is typically not fatal, infected animals are typically left weakened and will no longer be able to produce milk the way they did prior to infection.

According to the USDA APHIS, the disease is global concern and poses a risk of introduction into the United States.

 Recently, Europe has observed outbreaks of FMD in its cattle population. In certain parts of Africa, Asia, and the Middle East, the disease is endemic.

In affected areas, the viral disease also causes significant economic losses.

“FMD is present in countries near to Australia and is front of mind for industry in terms of potential biosecurity risks," said Michael Crowley, Meat & Livestock Australia managing director, in a news release.

The vaccine for FMD in cattle was developed by Tiba Biotech, a preclinical stage biopharmaceutical company that develops next-generation RNA vaccines and therapeutics based on a new dendrimer nanoparticle delivery platform. This type of vaccine delivery system uses dendrimers (treelike synthetic molecules) to carry RNA into cells. The system was initially invented by the Massachusetts Institute of Technology and the Whitehead Institute for Biomedical Research in Cambridge, Massachusetts.

Additionally, the creation of the vaccine was part of an international research partnership involving the Elizabeth Macarthur Agricultural Institute and the RNA Institute at the University of New South Wales. Moreover, the New South Wales Department of Primary Industries and Regional Development and Meat & Livestock Australia provided support.

For the study, researchers investigated humoral immune responses and the vaccine’s ability to protect animals when directly and intentionally exposed to the virus. According to Tiba, the trial’s success builds on previous livestock vaccine research, which received support from the Bill and Melinda Gates Foundation and Canada’s International Development Research Centre.

"Today we are excited to contribute to the future of animal health with this next-generation solution," Tiba cofounder Peter McGrath, who heads Australian operations, said in the news release.

 "Our focus now shifts to working closely with regulators to ensure the vaccine meets the highest standards of safety and effectiveness, and ultimately to make this breakthrough available to the farmers and producers who need it most."

In addition to the FMD vaccine, Tiba has also developed human vaccine and therapeutic candidates. Recently, the organization has made progress in lung disease therapeutics.

Tiba’s RNA delivery platform, RNABL, uses biodegradable nanoparticles that naturally degrade after they deliver an “immune-triggering” RNA payload. The company’s vaccine platform can also be stored at a standard refrigeration temperature long term and at room temperature for up to a month,

 in contrast to other current mRNA vaccines, which often require colder storage temperatures.

According to Tiba, the FMD vaccine still needs to undergo a strict evaluation process with animal health regulators before it can be made commercially available.

Tiba's novel foot-and-mouth disease vaccine provides full protection in cattle study. News release. Tiba Biotech. August 4, 2025. Accessed August 5, 2025. https://prnmedia.prnewswire.com/news-releases/tibas-novel-foot-and-mouth-disease-vaccine-provides-full-protection-in-cattle-study-302520704.html

Foot-and-mouth disease. US Department of Agriculture Animal and Plant Health Inspection Service. February 2021. Accessed August 5, 2025. https://www.aphis.usda.gov/sites/default/files/fs-fmd-general.pdf

Regulatory approval from animal health authorities is still required before the vaccine can be made commercially available.

Novel vaccine for foot-and-mouth disease in cattle shows full protection in clinical trial

The Association of Veterinary Technician Educators (AVTE) is introducing a new online community dedicated to veterinary technician educators. The initiative, which was announced at the AVTE 2025 Annual Conference in Louisville, Kentucky on August 4th, is a collaboration between the AVTE and Chewy Health.

“This collaboration is more than a technology initiative—it’s a tangible step in advancing AVTE’s core concept of One Community, where veterinary technician educators are supported, connected, and inspired through a collective purpose,” reads a news release by the AVTE and Chewy Health.

The upcoming virtual space is expected to launch in late 2025. It will allow veterinary technician educators to connect, exchange resources, navigate common challenges, and participate in discussions centered around the role as veterinary technician educators. The initial costs of the project will be funded by Chewy Health, who will actively contribute to content, join in on conversations, and share teaching resources with the platform’s users.

“We are incredibly grateful to Chewy Health for not only supporting this new community platform but for believing that high-quality education of the next generation of veterinary technicians is vital,” said Tricia Gorham, FVTE, AVTE president, in the news release.

“Their partnership helps us move from idea to action, and we’re excited to take this first step forward—side by side.”

The dynamic hub will be a secure, member-driven space where educators will be able to come together and engage with the platform, which will act as a virtual town hall, resource center, and peer support network. The digital platform will be a place to ask questions, swap classroom tools and find camaraderie and mentorship in one area, according to Chewy Health and AVTE.

“At Chewy Health, we believe that expanding access to educational and professional resources is essential to advancing the veterinary profession,” said Mita Malhotra, president of Chewy Health.

 “This collaboration with AVTE is an extension of our commitment to supporting veterinary professionals at every stage of their journey. With this innovative community platform, we hope to create a space where veterinary technician educators feel empowered, connected and inspired.”

Chewy Health said it hopes its early investment in the new virtual space for this veterinary community will “signal the importance of this effort and inspire other organizations to lend their voices, resources and support to foster the growth of this community.”

Beyond the upcoming platform, the AVTE focuses on supporting and improving the education of veterinary technician students through member groups, other virtual learning opportunities. The organization also hosts a yearly conference, which offers workshops and other educational sessions with best practices for educators to implement into their classrooms.

AVTE and Chewy Health partner to launch online community for veterinary technician educators. News release. Chewy Health, Association of Veterinary Technicians. August 4, 2025.

About. Association of Veterinary Technician Educators. Accessed August 5, 2025. 

“This digital community will serve as a cornerstone of connection, bridging classrooms, institutions, and geographic boundaries to unite veterinary technician educators,” wrote the Association of Veterinary Technician Educators.

New virtual platform for veterinary technician educators to come

To honor National Dolly Parton Day, Pet Poison Helpline shared the story of Dolly Parton, a West Highland white terrier from Pittsburgh, Pennsylvania, who helped herself to a pill that her owner, Mary Jo Coltin, accidentally dropped on the floor. Because of her size, Coltin called Pet Poison Helpline to see what she should do next, because she knows even 1 pill could be dangerous to her pet. After consulting with the team, they let Coltin know that Dolly Parton was safe and did not need a trip to her veterinarian. Their advice was to watch and monitor her at home to be safe. 

Although Dolly Parton was fine, the Pet Poison Helpline team is using her story to shed light on the dangers that over-the-counter (OTC) medications can have on pets.

Dolly Parton, the dog, recently ingested a vitamin D

 pill off the floor, sparking a conversation on the safety of over the counter medications to pets. (Image courtesy of Pet Poison Helpline) 

"Dolly and her family were very lucky that the pill she ingested was not enough to be a concern," said Renee Schmid, DVM, DABT, DABVT, a senior veterinary toxicologist and director of veterinary medicine at Pet Poison Helpline. "Many people assume that [OTC] medications and supplements are safe, but the effects on pets can be dramatically different than in humans. You also must factor in the size difference. Just 1 pill of the right medication or supplement can be dangerous depending on a pet's size and health status."

In Dolly Parton’s case she was able to get the pill off the floor quickly before her owner could grab it, but not all pets ingesting OTC medications are getting them on the floor. Each year, Pet Poison Helpline receives calls after a pet gains access to cabinets or drawers, chews into a container, or climbs on the counter, just like Tucker, a 2-year-old terrier mix from Fort Worth, Texas, who recently ingested 30 vitamin D

"Tucker was from Texas, so of course he went big," Schmid joked in the release. "Because of his size, an ingestion of that many capsules resulted in a severe toxic exposure, resulting in diarrhea, vomiting, decreased appetite, and hypercalcemia, or high levels of calcium in the blood. The team was also concerned with renal impairment that can occur due to negative effects of high calcium on the kidneys."

Tucker's owners were not concerned about the supplement ingestion at first, so he did not receive treatment until he became ill days later. After his owners consulted with Pet Poison Helpline and understood the danger Tucker was in from the ingestion, they took him right to the hospital and he began treatment. The team administered intravenous fluids, corticosteroid medication, gastrointestinal protectants, and medications to decrease the amount of calcium in his system. For vitamin D

, the negative effects are often long-lasting and difficult to manage, which proved to be true in Tucker's case. He needed frequent lab work monitoring and adjustments to his medication throughout the treatment he needed, lasting longer than a week.

"Both of these cases," Schmid said, "illustrate the need to keep all medications, including [OTC] drugs and supplements, out of the reach of pets and children. It's also a good reminder not to take a wait-and-see approach if a pet gets into medication or supplements. We encourage a few extra minutes of vigilance to keep your loved ones safe from a toxic accident. If one does happen, we're here to help."

Dog named Dolly Parton ingests potentially poisonous pill. News release. Pet Poison Helpline. August 5, 2025. Accessed August 5, 2025. https://prnmedia.prnewswire.com/news-releases/dog-named-dolly-parton-ingests-potentially-poisonous-pill-302520460.html

The West Highland white terrier ate the medication after it was mistakenly dropped on the floor by the pet's owner.

Dolly Parton, the dog, ingests vitamin pill

A prescription medical device for promoting natural periodontal tissue repair in dogs has been launched in the US by PRN Pharmacal. The device, ReGum Vet, is a scaffold that fills and supports canine periodontal defects, providing a framework for tissue repair.

The product was developed using patented CellFoam technology by BioChange in Israel. The biodegradable 3D foam is comprised of enzymatically cross-linked gelatin that promotes periodontal tissue repair.

“For the first time, practitioners have a targeted product for dogs with naturally occurring periodontitis that is easy to apply and actively supports the body’s own tissue-repair process,” Amanda Crouthamel, DVM, technical services veterinarian for PRN, said in a news release.

 “We’re excited to partner with veterinary teams nationwide to raise the standard of care for advanced periodontal disease in dogs.”

ReGum Vet is designed to be placed into the periodontal defect to allow space for healthy tissue growth. According to PRN Pharmacal, the device is safe, nontoxic, and biodegradable.

A study of 9 canine patients with periodontitis and 22 affected teeth, published in 

, found ReGum Vet “significantly improved” outcomes when added to open periodontal therapy. These investigators indicated that “the use of this implant can be recommended in addition to open periodontal therapy in dogs with advanced periodontitis, considering the careful selection of the patients and teeth that will truly benefit from the treatment.”

The device was first made available in 2023 in Israel and has subsequently been made available in South Korea and in Europe. It is available in both a conic shape for deep holes and a flat square shape to treat side pockets.

ReGum Vet can be integrated into canine periodontitis procedures, requiring only a few steps for veterinarians, according to PRN Pharmacal. The steps to apply the device are as follows, with additional instructions available with the product

Dip the 3D dry foam in sterile saline or sterile lactated Ringer solution to reconstitute elasticity or use dry.

Insert the product into the surgical site and position as needed.

“Veterinarians implementing dental radiography often find they are extracting more teeth than before the utilization of intraoral radiography,” 

 owner of Family Pet Veterinary Center and Animal Dentistry Referral Services, both in West Des Moines and Norwalk, Iowa, said in the release.

 “ReGum Vet can be used to change the outcome. We can stabilize and reverse specific sites of hidden bone loss when there is still gum tissue present, enabling us to preserve more teeth.”

Studies have shown that 80% to90% of dogs older than 3 years have a component of periodontal disease, making it one of the most common health issues in veterinary medicine. Smaller breeds have a higher risk for periodontal disease, and the rate of incidence increases with age.

According to PRN Pharmacal, signs of the disease range from reversible gingivitis to progressive stages requiring more aggressive treatment. Left untreated, periodontal disease can affect other areas of the body and increase a dog’s risk of cardiovascular, kidney and liver diseases.

PRN Pharmacal launches ReGum Vet to US veterinarians. News release. PRN Pharmacal. July 22, 2025.

Gawor JP, Strøm P, Nemec A. Treatment of naturally occurring periodontitis in dogs with a new bio-absorbable regenerative matrix. 

. June 20, 2022. Accessed August 5, 2025. 

https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2022.916171/full

Periodontal disease. Cornell University College of Veterinary Medicine, Richard P. Riney Canine Health Center. Accessed August 5, 2025. 

https://www.vet.cornell.edu/departments-centers-and-institutes/riney-canine-health-center/health-topics/canine-health-information/periodontal-disease#:~:text=Periodontal%20disease%20is%20one%20of%20the%20most,breeds%2C%20and%20the%20incidence%20increases%20with%20age

PRN Pharmacal is marketing and distributing ReGum Vet by prescription in the US. The product has been available internationally since 2023.