Joseph Colorafi, MD, is a board-certified pulmonologist (lung specialist) who practices at Banner Estrella Medical Center.
Question: I have heard that Valley Fever is prevalent in the Phoenix area. Should I be concerned? What exactly is Valley Fever? Who is most at risk? How serious is Valley Fever?
Answer: Coccioidomycosis commonly known as “cocci” or “Valley Fever” is an infection resulting from the inhalation of fungal spores from the soil. Primary lung infection is felt by individuals in only 40 percent of cases. Symptoms can range from a mild flu-like illness to severe pneumonia. Valley Fever can also disseminate outside the lung in those with weakened immune systems and go to the skin, bone and even the brain. The disease can also recur or ‘reactivate’ later in life under certain circumstances.
Valley Fever is in the soil in only limited regions in the United States, Mexico, Central and South America. The name does not derive from the metro Phoenix ‘Valley’ but from the San Joaquin Valley of California where it remains highly endemic (frequent in an area). The other highly endemic region is that from just north of Phoenix through Tucson and into northern Mexico.
Since 1995, Valley Fever cases have been on the rise with an increase in reported cases in Arizona of 186 percent. If you live in Phoenix or other endemic areas, your risk of getting the disease whether you are aware of it or nor is about 3 percent per year. In other words, if you live here for 11 years, your risk of contracting the disease to any degree is about 1-in-3.
Risk factors for primary infection include travel or residence in an endemic area. Risk is also seasonal and is highest during dry periods following the rainy season. Certain activities are higher risk for infection including archeological excavation, rock hunting, military maneuvers, model airplane contests, construction work and exposure to cotton bales.
Risks for severe lung disease include underlying diseases such as diabetes, recent cigarette smoking, older age and lower socioeconomic situation. Risk factors for the most severe infections that include the disseminated form include underlying cancer, chemotherapy, HIV infection and organ transplantation. Being pregnant is also a risk factor for severe disease as your body during pregnancy sets its immune system lower. Certain racial and ethnic groups are also at higher risk for severe infection. These include
Hispanics, Native Americans, Filipinos and African Americans.
Question: How do you know if you have contracted Valley Fever? What can I do to prevent getting it?
Answer: A lung infection would develop 10-14 days after exposure of the spores but one would only have symptoms in only 40 percent of cases. If symptomatic, one might experience a fever, cough (sometimes with blood), chest pain, fatigue, arthritis or even a rash. An afflicted person could also experience lower respiratory phlegm production or even weight loss.
If a severe enough lung infection developed, your doctor might see a variety of findings on your chest X-ray or digital image in one or more lobes of your lungs. These include pneumonia (white haziness), nodules or even cavities (holes) in your lung. Enlarged lymph nodes can also be seen. In some unfortunate cases, those with a weak immune system (immunocompromise), the infection will disseminate to other organs such as bone, skin joints and even the brain and spinal cord. It is now one of the leading causes of death by pneumonia in AIDS patients.
Ways in which your primary care physician or specialist will confirm the diagnosis will vary on the presentation and severity of the suspected infection. To confirm the diagnosis, smears and cultures of phlegm or other body fluids may be ordered. Blood tests can also be done but do not always confirm recent or past infection. Occasionally, a routine procedure called bronchoscopy is performed, in which a lung specialist goes down into the lungs and retrieves specimens that can confirm the active infection.
If the “Valley Fever” infection is severe enough, your doctor can treat it with special antibiotics known as anti-fungals. Treatment of patients with this type of fungal infection is different than with bacterial pneumonias. Duration of treatment for pulmonary infection is no less than three months and in those with weak immune systems indefinite suppression.
Unlike other infections, we speak in terms of suppression rather than a cure. A drug in clinical trials now, called Nikkomycin Z, gives us hope of curing the disease. Rarely, the treatment may be surgical removal of a localized infection especially when life-threatening bleeding presents.
Your doctor will watch you closely after treatment begins to ensure progressive disease does not occur. Continued or recurrent night sweats, weight loss, fatigue or respiratory symptoms may be a sign the active disease is not being contained.
You can decrease the chances of acquiring the disease in an area like ours where we all are at risk. Avoid outside dust whether at work or leisure, especially after recent rain.