Clarisse Tsang, MPH
Clarisse Tsang, MPH, epidemiologist, Office of Infectious Disease Services, Epidemiology and Disease Control Services, Arizona Department of Health Services, Phoenix.
If you have a cough and fever that land you in the doctor’s office and he/she asks if you’ve done any traveling lately, it’s not just small talk — the information you give may help pin down your diagnosis. Doctors all over the US are now on the alert for new cases of a serious health problem affecting residents of and visitors to the southwestern US. Called “valley fever,” this flulike illness is being spread by the spores of ground-dwelling fungi, which are easily stirred up and blown about by the wind. While most people exposed to the fungi don’t fall ill, others get quite sick and may end up missing weeks, even months, of work or school. According to the Directors of Health Promotion and Education in Washington, DC, an affiliate of the Association of State and Territorial Health Officials and an advocate for promoting health and preventing disease, an estimated 50,000 to 100,000 people are affected by valley fever each year.
Valley fever (one popular name for coccidioidomycosis) is now affecting people in Arizona, New Mexico, southern and central California, desert areas in Texas and Nevada, southern Utah, northern Mexico, and parts of Central America and southern South America. It’s not contagious but, I learned from Clarisse Tsang, MPH, an epidemiologist in the Arizona Department of Health Services, it’s more widespread than was initially thought.
Ms. Tsang is the lead author of a paper on valley fever that was published in the November 2010 issue of the Centers for Disease Control and Prevention’s Emerging Infectious Diseases. First documented in Argentina in 1892, the spores are spread when the ground gets stirred up — such as by farming, construction, military field training, archaeology, gardening, etc. In this study, of the 493 patients interviewed, 44% went to an emergency room and 41% were hospitalized. Ms. Tsang told me that researchers found that patients are suffering with the disease longer than expected, with symptoms typically lasting about four months — far longer than the 21-day duration that was previously reported. Symptoms may include coughing, fatigue, fever, headache, joint and muscle aches, rash and/or shortness of breath.
The severe cases — in which the fungus spreads from the lungs to other parts of the body, including the skin, bones, joints or brain — affect about 1% of patients, and African-Americans, Asians and Filipinos, as well as pregnant women and people with compromised immune systems seem to be most vulnerable. Valley fever usually can be treated successfully with prescription antifungal medication (fluconazole and several other drugs known as “azoles”), but the diagnosis often is missed because the symptoms are common to many other illnesses.
You can learn more about this problem from the Valley Fever Center for Excellence (www.vfce.arizona.edu) or the Arizona Department of Health Services (http://www.azdhs.gov/index.php).
If you live in or will be visiting an area where valley fever is known to be a problem, you can follow these simple precautions…
If you have any collection of the symptoms described above for two weeks and are not getting better… and you have visited an area where you may have been exposed to the spores… Ms. Tsang said you should ask your doctor to test you for valley fever. The simple blood or sputum test can be done at a local lab, with results usually available within one to two weeks.
