Battling a nagging fever, cough and exhaustion? You might want to get to the doctor.
Cases of valley fever, offiically called coccidioidomycosis, in Arizona through October are up 24 percent over the same period last year, but what’s got the attention of epidemiologists is a dramatic spike in recent months. State data from July through October show 138 percent more cases of the potentially deadly respiratory disease statewide as during those same four months in 2014.
State officials have assigned “disease detectives” to investigate why this is happening. But one theory is that a wet winter in 2014-15 caused more valley fever-causing coccidioides species of fungus to grow and then spread to humans and animals during the dry pre-monsoon season.
It takes inhaling just one coccidioides fungal spore to get valley fever. A rising caseload is a public health concern because of the toll the disease takes. State data shows 42 deaths in Arizona from valley fever last year, though that is likely an underestimate, state epidemiologist Shane Brady said.
Most people who inhale a coccidioides spore don’t get sick — but for those who do, the results can be debilitating.
“It is definitely significant, and important to find out the reason for the increase,” Brady said. “A lot of things can affect the number — increased awareness or changes in the environment that could affect the growth and spread of the fungus.”
WEATHER INFLUENCE
A predicted El Niño could continue the local surge in valley fever cases, said Dr. John Galgiani, who is director of the University of Arizona Valley Fever Center for Excellence. Galgiani cites studies that attribute annual changes in valley fever cases to rainfall, where a wetter winter could cause more of the fungal spores to grow in the spring. Conversely, an early monsoon season could decrease cases by minimizing blowing dust.
During a recent talk to about 100 people at the Senior Academy at Tucson’s East Side Academy Village, Galgiani had a typical response when he asked how many people had experienced valley fever. Three people raised their hands. In addition, one man said his neighbor died of it and his dog has it now. A woman said her father in Michigan had valley fever that had disseminated into his bloodstream and was causing him all kinds of health problems.
Likely more people have had valley fever than those who raised their hands — they just don’t know they had it because they never got sick. Galgiani says the number of cases reported to the state for that reason is likely an undercount. He places the annual caseload in Arizona at about 100,000.
Due to the recent spike in cases, officials with the Arizona Department of Health Services are working on increasing awareness of valley fever among the public and even health-care providers, who frequently mistake the disease for pneumonia and therefore miss crucial opportunities for treatment with anti-fungal medication.
Education and awareness are particularly important in a state like Arizona where so many people — including physicians — are not from here and therefore may not have heard about valley fever.
Valley fever is most common in Arizona and the San Joaquin Valley of California. Two-thirds of all cases in the U.S. occur in a “valley fever corridor” that runs through Pima, Pinal and Maricopa counties.
The disease also been found in Nevada, New Mexico, Texas and Utah, and in parts of Mexico, Central and South America.
looks like PNEUMONIA
Valley fever manifests itself in many ways, which can complicate and delay diagnoses. If often looks like pneumonia with chest pain, a cough or a low-grade fever. But numerous other symptoms can occur, including painful red bumps that turn brown, vomiting and disturbances of the central nervous system.
Brady, of the Arizona Department of Health Services, advises Arizonans to stay out of blowing dust, and to be aware of the signs and symptoms of valley fever.
Seeing an increase in cases is frustrating to David Filip and his mother, Sharon , Washington state residents who started a support group called Valley Fever Survivor after Sharon nearly died from valley fever following a visit to Tucson in 2001.
The Filips, who run a closed Facebook page and maintain the website valleyfeversurvivor.com, recently started a Change.org petition to Congress and President Obama demanding a government warning about valley fever, as well as financial support for moving along a vaccine and a cure, which are both in development at the UA.
“Congress and the president should appropriate and approve the funding necessary for the valley fever vaccine and cure projects. It could cost $100 million to bring the current vaccine and cure work to completion,” the petition says. “This is a tiny sum compared to the billion dollars the disease is hemorrhaging from our health care system every year. “
A VACCINE AND A CURE
While health officials encourage testing in order to start treatment, both diagnostics and treatment could be improved. False negatives are common with blood tests for valley fever, particularly in the early phases. A vaccine in development at the UA, called delta-CPS1, has prevented valley fever in mice and could be effective in preventing the disease in both humans and animals.
Valley fever is three times more likely to occur in dogs than in humans. Cats can get valley fever as well. A young lion at Tucson’s Reid Park Zoo last month died of issues related to kidney disease and valley fever.
In addition to delta-CPS1, an antifungal valley-fever drug called Nikkomycin Z (NikZ). was recently fast-tracked to market by the U.S. Food and Drug Administration.
The NikZ development program was acquired by the UA in 2005 and the UA has licensed development rights to a Tucson startup called Valley Fever Solutions Inc. NikZ is the first of a new class of antifungal drugs that attack the formation of “chitin,” a major component of the fungal cell wall. Given to mice with the valley-fever fungus, NikZ seemed to cure the infection.
Both the vaccine and cure will require more money before they can get to market, Galgiani said.
“If Congress truly heard what valley fever is doing to people, they would come up with the funding,” David Filip said. “It should be able to fund a deadly, debilitating disease.”
