Valley Fever: It's Nothing like Spring Fever!

Ready or not, spring fever infects us all! In Arizona, spring fever brings Major League Baseball's (MLB) spring training Cactus League games. All through March, Phoenix area hotels, resorts, and time-share condominiums are brimming with enthusastic fans of the Kansas City Royals, Chicago Cubs, Anaheim Angels, Seattle Mariners, Oakland Athletics, San Diego Padres, Arizona Diamondbacks, and Milwaukee Brewers. Likewise, the Tucson area lodging options are packed with passionate fans of the Colorado Rockies and Chicago White Sox teams. Coincidentally, valley fever infects the Southwestern United States, and particularly Arizona, as the spring temperatures begin to rise alongwith the roar of the MLB cheering fans!

If you don't live in the American Southwest, why is this important to know?

The answer is simple. Everyone breathes. If you 'just visit' Arizona, New Mexico, Texas, Nevada, Utah, California, or Mexico, you breathe the same dry, hot desert air everyone else does. That dry, dusty air is a 'fiesta' for valley fever. It is a lung infection caused by a fungus. The infection can lead to pneumonia, and even death. The medical community has named the fungus, coccidioidomycosis, and more commonly call it cocci (pronounced kok-see).

Valley fever is documented across the Southwest, but the highest incidents of cocci are reported in the Arizona counties of Maricopa, Pinal, and Pima. The University of Arizona's Medical Center, in Tucson, is home to the Valley Fever Center for Excellence (VFCE). The center is teamed-up with Arizona Community Physicians, also in Tucson's Pima County, to track the occurrences and details of the valley fever cases in Arizona. All cocci lab tests are sent there for analysis, and all x-ray reports regarding cocci are documented. "Arizona state statistics show that reported cases of valley fever are at record levels. . . four times the five-year average for the (2006) January-April time period . . . "(from research page at www.vfce.arizona.edu, accessed 18 March 2007)

Since Arizona, and particularly the Phoenix area, is among the fastest growing populations in the United States, there is a phenomenal amount of ongoing road, housing and business construction. Long-term proof is yet to come to fruition, but evidence points to Arizona's rapid growth as a major contributing factor in its designation as the valley fever hot spot of the American Southwest.

Researchers are working on a vaccine to prevent cocci. In the meantime, residents and visitors of the American Southwest and Mexico can empower themselves with the answers to just a few specific questions.

Is it contagious?

No, you cannot give it or get it from a person or animal of any kind. People, dogs, cattle, pigs, horses, sheep, cats and other animals can contract it, but only through breathing-in the fungal spores that live in the dusty desert air. Valley fever is not contagious.

How long is it between contracting the fungus and showing symptoms?

Symptoms can occur in as little as a week, or as much as several months after exposure.

Who gets valley fever?

Not everyone. Only about a third of the people in the Southwest ever get valley fever. Some studies have shown that, if newcomers to the Southwest are going to get cocci, it tends to appear between the 5^th and 7^th year of residency in the desert. However, tourists who have visited the Southwest for a short time can even get valley fever. It does not discriminate.

Some people obviously are at significant risk to contracting valley fever, such as people who are outdoors most of the time, like military personnel in desert training, construction employees, landscaping and road workers, and the homeless. Other vulnerable populations include pregnant women, the elderly, and people with suppressed immune systems, such as patients with HIV, asthma, lupus, diabetes, or those having had recent major surgery.

What are the symptoms?

The fungus causing valley fever lives in the dry, sandy, desert dirt. When wind or construction, or even hiking and gardening stirs up dust, people breathe in the microscopic cocci fungus in the hot air. It settles in the lungs, and most people never get an infection. Many who do become infected, do not even know they have it. They might think they have a minor cold, if anything at all, and heal nicely without diagnosis or treatment.

Others show symptoms such as incessant coughing, loss of appetite, shortness of breath, weight loss, extreme fatigue and chest pain. Some people develop pneumonia, psoriasis-like rashes, rheumatism, infections in the brain, and some even die. Medication can help control some symptoms, but there is no cure. It has to run its course, which can take from a few weeks to years. Stress and viruses, like colds and flu, can either push it out of dormancy and into relapse, or worsen symptoms already present.

Less than 6% develop lung nodules. In a chest x-ray, the nodules can look like lung cancer, so often physicians recommend a chest ct scan to look closer, or even a biopsy. A few patients develop lung cavities from the cocci fungus. Sometimes the cavities rupture, causing breathing problems and pain, sometimes requiring surgery. Often cavities disappear on their own, and the nodules may stay - sort of as if they were a scar - but many never bother the patient.

Who can help determine if someone has the valley fever infection?

Family doctors in the Southwest are very familiar with the coccidioidomycosis fungus, so routinely test for cocci. However, doctors in other parts of the country are not as familiar with valley fever. Sometimes a rheumatologist or pulmonologist is needed to help determine diagnosis. For people living outside the American Southwest and Mexico, who believe they might be symptomatic, it is up to the patient to self-advocate, so their physicians are made aware of the possibility of exposure to the fungus. The Valley Fever Center for Excellence may be able to refer the patient to physicians near their hometowns who are knowledgeable about cocci. Experts on lung disease, such as pulmonology may be helpful in diagnosing valley fever also.

How is valley fever diagnosed?

A blood test or a chest x-ray may indicate that the cocci fungus is present, but sometimes it takes a computed tomography (CT scan) to determine if a valley fever nodule is in the lung.

Is there a cure for valley fever?

Valley fever has no cure, not yet anyway. Most patients get over valley fever without any treatment at all. Keeping rested and hydrated much like caring for colds or flu is standard protocol. For patients with nodules, simple monitoring, with additional CT scans at about three month intervals, to look for changes or additional nodules is often all that is needed.

For patients suffering with an incessant cough, the prescription, Benzonatate, is often helpful for symptom control. If a cavity ruptures, surgery might be necessary. Very serious symptoms may require anti-fungal prescriptions for the patient's comfort, but the disease must still run its course. "The medications used include ketoconazole, itraconazole and fluconazole in chronic, mild-to-moderate disease, and amphotericin B, given intravenously or inserted into the spinal fluid, for rapidly progressive disease. Although these treatments are often helpful, evidence of disease may persist and years of treatment may be required." (from the "What are the treatments?" section of online article "Valley Fever" at Project Inform; http://www.projinf.org/fs/vfever.html) Cocci symptoms may last just a few weeks, months, or even a few years. People very rarely die of valley fever.

Some research indicates that once a person has had valley fever, they will be immune for life, but studies continue because it is difficult to determine whether a person relapsed because they were not fully recovered to begin with, or because the fungal infection cannot ever be fully beaten.

Can valley fever be prevented?

There is really no concrete prevention of valley fever. Because the cocci fungus is easily carried in the dry, dusty, hot desert air, it is not entirely preventable, but you can decrease your odds of contracting it. Wearing a dust mask, particularly during high winds, may help prevent contraction of the cocci fungus. Other preventative measures include wetting down the ground before gardening, staying indoors during high winds or dust storms, and keeping windows and doors closed.

What does the future hold?

The winter of 2006-07 was relatively kind to the American Southwest. More often than not, winters are relatively dry, but this winter brought some welcome rains. Time will tell if it was enough moisture to help curb the number of valley fever cases diagnosed this year. If the dust remains settled, valley fever may settle too.

Clinical trials will hopefully resume soon. Arizona's Governor, Janet Napolitano, recently approved nearly two million dollars in funding research and development in treating, curing and preventing valley fever.

Bibliography:

www.gvn.com Green Valley News & Sun
www.valleyfeversurvivor.com Valley Fever Survivors
www.opa.medicine.arizona.edu The University of Arizona, Health Sciences Center
www.vfce.arizona.edu Valley Fever Center of Excellence, Tucson, Arizona
www.valleyfever.org Valley Fever Connections
www.mayoclinic.com Mayo Clinic
www.phoenix.about.com About Phoenix.Com
www.cdc.gov The Center For Disease Control
http://www.projinf.org/fs/vfever.html Project Inform: Valley Fever