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November 21, 2013

Valley Fever Event Airs Progress, Concerns

Ellen Sussman | Green Valley News and Sun

What is Valley Fever? Who gets it and what are the symptoms? How is it diagnosed and treated? Is it contagious?

These were among the concerns discussed Sunday at the University of Arizona’s Valley Fever Center for Excellence sixth annual public forum.

VFCE director Dr. John Galgiani said Valley Fever — coccidioidomycosis — is endemic to regions of California, Arizona, New Mexico and Texas. Its namesake is the San Joaquin Valley in California.

Two-thirds of diagnosed cases occur in Arizona where there are about 100,000 cases per year. One-third develop symptoms; in about 400 of those cases Valley Fever disseminates through the body. In most cases symptoms are mild and people are unaware they have Valley Fever.

“People who know about the disease have a shorter time to diagnosis verses people (visitors) who don’t know about Valley Fever,” Galgiani told the audience of 65. “It affects a small number in the overall U.S. population but is very concentrated in California and Arizona.”

The University of Arizona is the only major university with studies in the heart of where Valley Fever is happening, Galgiani said In October 2012, a clinical Valley Fever Center opened at St. Joseph’s Hospital in Phoenix.

Heidi Brown, assistant professor of Epidemiology and Biostatistics at the University of Arizona, said sterilizing heat followed by rain promotes fungal growth, and wind aerosolizes Valley Fever spores.

“Wind blows spores. Spores are inhaled,” she said. “More is known about the disease than the organism that causes it.”

Dogs that dig in rodent holes, students on an excavating assignments and archaeologists are susceptible to increased presence of Valley Fever spores. But this doesn’t mean everyone who inhales a spore becomes ill.

Dr. Ken Knox, associate professor of Medicine and Immunobiology at the U of A, said 60 percent of those exposed to the spore show no symptoms, 30 percent will develop symptoms of pneumonia, 5 percent will develop a rash and/or arthritis and 5 percent will develop serious illness.

Acute cases include a cough, fever and breathing pain. Mild cases may include night sweats, fatigue and headaches.

Knox said if a blood test is negative and the patient worsens, a blood test should be repeated. If a patient with Valley Fever has pneumonia and is improving no anti-fungal therapy is indicated.

“Therapy of an anti-fungal medication is only indicated for those with active pneumonia,” Knox said.

One attendee who was misdiagnosed said there is a need for doctors, including those in walk-in clinics, to know the symptoms of Valley Fever to prevent misdiagnosis.

Galgiani agreed and said, “Doctors tend to think what they’re doing is right.”

U.S. Rep. David Schweikert of Arizona’s 6th District spoke briefly. He said residents new to Arizona need to be educated about Valley Fever and he’s working to get Washington to pay attention to Valley Fever.

Valley Fever and pets

Lisa Shubitz, a veterinarian and associate research professor of Veterinary Science and Microbiology at VFCE, spoke about Valley Fever in animals and pets and said for every 50 dogs, one cat is affected.

Dogs may develop a cough, fever, show weight loss, lack of energy and no appetite.

“A diagnosis is not always straight forward. There needs to be a complete Valley Fever blood count and x-rays,” Shubitz said, adding a CT scan or MRI and ultrasound may be needed.

Fluconazole may be prescribed or Sporanox if Fluconazole doesn’t work.

Galgiani spoke about the costs involved in educating doctors, having a referral network, diagnostic testing, developing a promising vaccine Nikkomycin Z, starting clinical trials in dogs, and if effective, then humans.

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