If you’re one of the tens of thousands of people that have migrated to Arizona in the past few years, then you may have not heard of Valley fever. And if you’re a native Arizonan or Californian, you might be wondering: “what’s new with Valley fever?”
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With record-breaking temperatures in the southwest, extreme cycles of rain and dust storms, mask-wearing waning, and evidence of infected monkeys at a farm in Mesa — many are more concerned with Valley fever than ever. Fortunately, Valley fever doesn’t spread through human or animal transmission, however, changes in weather patterns might be partially responsible for increased infections.
Valley fever is caused by inhalation of an insidious fungus called Coccidioides (kok-sid-e-OY-deze), and symptoms mimic other common lung conditions, like COVID-19 or pneumonia. About 20,000 cases are reported each year, with most of them in Arizona and California due to the arid-to-semiarid conditions. These cases lead to long-term symptoms, disabilities, and hospitalizations. In severe cases, the infection can be fatal.
Here’s what you should know about Valley fever, what’s new in 2023, and how to prevent it.
Research of Local Fungal Hotspots
Currently, Northern Arizona University, Arizona State University, and the University of Arizona are all partnering on ongoing research for Valley fever. John Galgiani, MD, the director of the Valley Fever Center for Excellence in Tucson, is leading a research team to focus on Valley fever prevention. Galgiani’s research focuses on singling out where the hotspots are by researching genetic clusters. By learning more about the specific areas where the fungus is coming from, more cases can be prevented.
Galgiani confirms that a vaccine is being developed at the University of Arizona to prevent Valley fever in dogs, which will be a precursor for a human vaccine. Testing has already been successful in mice and dogs, and the veterinary Valley fever vaccine is scheduled to go live in 2024.
Are You at Risk?
Although Valley fever is contracted by humans and pets (especially cats and dogs), Valley fever is not contagious and there is no need to isolate during a Valley fever infection. The greatest risk factor for contracting Valley fever is living in a hotspot for fungal spores.
Certain groups are at a higher risk for Valley fever, including:
- Immunocompromised individuals
- Pregnant women
- Individuals of Asian or African descent
- Those living in a hotspot area (mainly California and Arizona)
Advocate for a Diagnosis
Sun Jones, DNP RN FNP-BC, a curriculum evaluator for the College of Nursing at the University of Phoenix states that many young or healthy patients might not know they contracted Valley fever until they have an incidental finding on a chest x-ray. Others present to the clinic shortly after infection with pneumonia or COVID-like symptoms.
Due to its similarities with other respiratory illnesses, Valley fever is often misdiagnosed, and the necessary treatment is not given. For this reason, it’s difficult to say if Valley fever cases have actually increased, or if cases are now being properly diagnosed and reported more than they were previously.
Symptoms to watch for:
- Persistent cough
- Fatigue/prolonged weakness
- Joint pain
- Body aches
- Chest tightness
Galgiani states that “patients with pneumonia who live where Valley fever is endemic or who recently visited such regions have about a 20% chance that [their infection] is caused by Valley fever.” He recommends they receive blood testing in order to arrive at an official diagnosis. If the blood test comes back negative, the test may need to be repeated in 1 to 2 weeks to officially rule out the condition.
Valley fever is treated with oral antifungal medications. Antifungal medications have side effects, drug interactions with other medications, and can cause complications. However, Jones urges, “it is crucial to finish the treatment, which can last six months or longer”. Close follow-up is essential, as antifungals can potentially cause damage to the liver when taken long-term.
Most symptomatic individuals with Valley fever first go to their primary care provider. Jones affirms this approach, as the initial testing and management are appropriate for a PCP. If a PCP confirms the Valley fever diagnosis, then the patient might be referred to a pulmonologist (lung doctor) or an infectious disease specialist.
Likely to be referred to a pulmonologist:
- Individuals with a history of asthma
- Those with COPD
- Individuals with a history of other underlying lung conditions
- Lab results that show high Valley fever antibodies in the blood Likely to be referred to an infectious disease specialist:
- Those with a history of HIV
- Immunocompromised individuals (have cancer, diabetes, another infection, etc.)
- Infections that have spread to the bones, brain, or other parts of the body
- Lab results that show high Valley fever antibodies in the blood
According to Galgiani, even mild cases of Valley fever last weeks or up to months. In many instances, the case gets better with minimal treatment. When an infection becomes serious, it’s because the fungus has traveled from the lungs into the bloodstream. After circulation in the bloodstream, Valley fever may settle in the skin, skeleton, and central nervous system. When these systematic infections are left untreated, they can be fatal, and the risk is worse for the elderly and immunocompromised.
How to Prevent Valley Fever
It’s not possible to see fungal spores with the naked eye, so preventing Valley fever is difficult. Jones recommends the following tips:
- Follow the dust storm warnings to stay inside
- Avoid outdoor activities when it’s particularly windy and dusty
- Wear a mask when working in a dusty area or digging soil
- Wear a mask if walking through construction areas
- Be particularly vigilant if you are in a high-risk group
- Keep pets inside during dust storms
Know the symptoms and seek medical attention to get on anti-fungal treatment as soon as possible
The Future of Valley Fever
Overall, the future of Valley fever looks unfortunate for Coccidioides, but positive for Arizonans. As the infection is not contagious, treatment can be administered without fear of passing the condition on to family members or healthcare personnel. With a vaccine underway and continued scientific advancements in testing and predicting fungal spore hotspots, it’s possible we won’t see many more cases of Valley fever in the coming decades.
Author: Payton Sy is an Arizona-based registered nurse and health writer. She currently holds nursing licensure in over 40 states and has worked in home health, hospitals, outpatient clinics, and insurance. As a nurse advocate, she strives to inspire other nurses to command respect as educated professionals. To learn more, you can connect with her on LinkedIn or visit her website, Payton, RN Writer.