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This fungus is found in soil in semiarid areas and is endemic in the southwestern United States, parts of Mexico and South America. A symptomatic infection known as "valley fever" appears in 40 percent of cases and usually presents as influenza-like illness with fever, cough, headaches, rash and myalgias. Valley fever may also present as acute pneumonia, rarely as chronic pneumonia or in disseminated form (affecting skin, bone, and the membranes covering the brain and spinal cord). Severe pulmonary disease may develop in HIV-infected persons.