Valley fever: the devil in the dust

It's been called Arizona's disease. Sixty percent of valley fever cases are reported in this state, where dust storms often send fungal spores flying through the air, where victims breathe them in.

The fungal infection is acquired by inhaling the spores called coccidioides. They're found in the soil and become airborne when the ground is disturbed.

“People get sick if they breathe it in. It gets in the air with the wind, in a storm, when digging and other activities,” explained Benito Lopez, epidemiologist with the Yuma County Public Health Services District.

“It's in the soil, there's nothing you can do. You could get it walking or running.”

The fungal spores are usually found in the Southwest region. “It's something that is natural in the region,” Lopez said.

People might have it and don't even know it. “Most cases present no symptoms and mild cases resolve on their own,” said Diana Gomez, director Yuma County Public Health Services District.

“Those with weakened immune systems have a higher risk of complications,” Gomez noted.

And those who do have valley fever usually wait before seeking treatment because they think they have the flu. April Parsons, a registered nurse and an infection preventionist at Yuma Regional Medical Center, points out that the disease has symptoms similar to flu: fever, cough, fatigue, headache, chills, body aches.

Some might also confuse it with mononucleosis. However, the length of the illness is a telltale sign that it could be valley fever. A person with the flu is usually sick seven days; with mono, one to three weeks. Valley fever can last up to 62 days.

Statistically, Parsons said, people wait 49 days before seeking treatment. Others might be misdiagnosed.

“It's undertested. Patients are likely to be put on antibiotics, several courses of antibiotics, before they are ever tested for valley fever,” Parsons said.

She suggested people ask to be tested if they suspect they have valley fever.

The only way to make a proper diagnosis is a blood test. It can also can be diagnosed through a culture or biopsy of any affected areas, Lopez said.

Treatment is usually a prescription anti-fungal oral medication.

The disease is more likely to strike those over 60 years old, Parsons said.

Those with weakened immune systems or diabetes and those of certain ethic groups, such as African or Filipino heritage, and pregnant women may be more susceptible. Even pets are vulnerable to the disease.

In humans, valley fever starts out as an respiratory infection in the lungs and can spread to other parts of the body: tissue, joints, bones, nervous system, Lopez explained. In these cases, medical care might be required for many years.

“This happens in one out of a thousand cases. Most people's immune system can stop it. Sixty percent of people show no symptoms,” he said. “They may have a cough, on and off, and think they have something else.”

The disease has an incubation period of one to four weeks from the time of exposure to when a person starts showing symptoms.

Some patients take up to many months to recover and each year, valley fever causes several dozen deaths, according to the University of Arizona Valley Fever Center.

There is no vaccine to prevent the disease. The good news is that it's not transmittable person to person, Lopez said.

About 150,000 new infections are reported annually in the United States, with two-thirds in Arizona, mostly in Maricopa County.

In Yuma County, an annual average of 20 cases are reported. This doesn't mean they're new cases, Lopez noted. The figure could include someone who tested positive for the antibodies, meaning they were exposed, but doesn't necessarily mean they're sick with valley fever.

Lopez lauded the efforts of the UA Valley Fever Center, which recently partnered with St. Joseph's Hospital and opened a center in Phoenix. The center's website, www.VFCE.arizona.edu, is “an excellent place to go” for more information on valley fever, he said.

The Phoenix center started receiving patients in January, under the direction of Dr. John Galgiani. He has researched the disease for 30 years and founded the Valley Fever Center of Excellence in Tucson in 1996.

The center coordinates comprehensive care for patients, educates doctors and supports research to improve the care of valley fever and eventually cure and prevent the disease.

This new center allows for coordination of interdisciplinary care by clinicians across the state, including in Yuma.

“The problem is that patients with valley fever often cannot find the right doctor or they have such complicated problems that they can't get all of the needed expertise coordinated,” Galgiani said.

The center integrates the skills of many specialists, resulting in better care for patients and better support for physicians through coordination and consultation, he added.

Patient information is accessible by all center physicians, whether or not they are physically based at St. Joseph's Hospital, and also offers case management services that are often difficult to obtain for patients when they are not hospitalized, a press release noted.

The center offers “to the most seriously afflicted patients” all available medical and surgical resources and expertise essential for the “best possible results.”

Learn more about valley fever at www.arizonavictimsofvalleyfever.org or the Arizona Department of Health Services website at www.azdhs.gov/phs/oids/epi/disease/cocc.

Mara Knaub can be reached at mknaub@yumasun.com or 539-6856. Find her on Facebook at Facebook.com/YSMaraKnaub or on Twitter at @YSMaraKnaub.