In early May, Tucson caregiver Volodymyr Kotsur was feeling terrible — he had a fever, cough and was tired all the time.
Health providers at a local urgent care center put Kotsur on penicillin and gave him allergy medicine, but as the days passed he only felt worse. Kotsur, 65, worried he could be contagious and wondered whether he should be going to work and playing with his grandchildren.
On May 30 — 21 days after his symptoms began — he was diagnosed with the respiratory disease valley fever.
Kotsur had never heard of valley fever. It’s virtually unheard of in his native Ukraine.
But in Arizona, Kotsur is far from alone.
Cases of valley fever in Arizona are up by nearly 50 percent over this time last year and new laboratory data suggests a seasonal uptick in the disease is now under way, a local expert in the potentially fatal fungal infection says.
That means anyone with symptoms that look like pneumonia should consider asking their doctor for a valley fever test.
The disease is not contagious, but the reason it’s important to catch valley fever early is that it can be treated with antifungal medications. But if treated with routine antibiotics, including penicillin, the condition could get worse, which is what happened to Kotsur.
Throughout May, Kotsur grew more tired and weak and began to get headaches. He decided on his own to discontinue the penicillin and made an appointment at his doctor’s office.
By the time he visited Dr. John Galgiani, director of the University of Arizona’s Valley Fever Center for Excellence, on June 11, he’d missed 14 days of work, and had seen three health providers in an effort to get well.
There have been 3,343 cases of valley fever reported to the state this year, through May — nearly 1,000 more cases than in the same time period last year.
The state also recorded 48 deaths due to valley fever last year, though the data is provisional and more deaths are likely being processed, Arizona Department of Health Services spokeswoman Nicole Capone said.
“We cannot predict what will happen the rest of this year, and the reason for this increase is uncertain but may be related to environmental factors such as weather and soil conditions,” she wrote in an email.
But Galgiani said newly released data on patient-ordered lab tests through Sonora Quest Laboratories indicate that in a year when valley fever cases are already up, a possible second spike in cases could occur.
UA infectious disease experts first reported a spike in Arizona cases last fall, which was significant because it was a marked change since 2013. Since that time, the number of new valley fever cases reported to the state had been fairly stable.
Percentages of positive patient-ordered valley fever tests are going up, recent numbers show, and Galgiani says those tests are predictive of trends that show up in state data, usually two months later.
“The percents are going up two months before the change is seen in the state data,” he said. “Doctors should be aware of that. If people are sick, it might be valley fever.”
This increase ahead of state statistics is especially pronounced with results for the “early antibodies” test, a term used on the patient-ordered results that usually indicates recent or current infection, Galgiani said.
Galgiani said the patterns he’s seeing with patient-ordered tests suggest cases of valley fever are increasing in Phoenix and Maricopa County, where most patient-ordered tests occur.
He added that seasonal valley fever rates in Tucson and Pinal County closely follow Maricopa County.
“Right now residents, doctors and visitors in these areas should be on a greater lookout for valley fever,” he said.
While the numbers for patient-ordered tests are not very large, increases in the early antibody results are showing up exactly when researchers would expect the seasonal increases to occur based on previous studies, Galgiani said.
He said the first increase was in line with a “grow and blow” climate model that would tie a late and abundant monsoon season in 2016 to a spike in valley fever cases during 2017 and into 2018.
People are most at risk of inhaling a fungal spore during dry periods, which means risk is higher right now — until the monsoon rains arrive.
Sonora Quest Laboratories is a joint venture between Banner Health and Quest Diagnostics. Researchers at the UA Valley Fever Center are working with Sonora Quest data to conduct research and clinical trials to improve understanding of the disease.
Studies currently underway address the value of early antifungal treatment and differences in patients’ immune systems and genetics that are responsible for disease severity.
More than 65 percent of all valley fever cases in the U.S. occur in Arizona and 30 percent occur in California. Most other cases occur in Nevada, Utah and New Mexico.
Current research shows one of every three people who inhales a coccidioides fungal spore gets sick enough to go to a doctor. The incubation period is one to three weeks.
In one of every 200 people who get sick, the valley fever disease disseminates. That means it goes to the bloodstream, moving from the lungs to the skin, bones and joints, the spinal cord and brain.
While antifungal medications are an effective treatment, there is no cure for valley fever. There’s also no prevention, though researchers at the UA are working on a vaccine for both humans and dogs, who also get sick from the disease.
When Kotsur was diagnosed he immediately did research online and ordered a book about valley fever, which fueled fears that his disease might disseminate.
He’s still tired, has lost weight and continues to cough. But his fever is back to normal and he’s hopeful he’s on the mend.
