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Valley Fever Infections Are Increasing In the United States

The number of people diagnosed with the infection Valley fever is increasing. According to a CDC (Centers for Disease Control and Prevention) report released this week, individuals diagnosed with the infection called Valley fever or Coccidioidomycosis has increased 74% since 2014.

Valley Fever is an infection caused by the fungus Coccidioides spp., which is typically found in the soil of warm, arid regions of the southwestern US (Arizona, California). It is found in a lesser degree in Nevada, New Mexico, Utah, and Texas, but has even been found as far north as central Washington. The fungus is inhaled and goes to the lungs, where it can cause a respiratory illness, but sometimes can also lead to disease throughout the body.

The CDC says on the Valley fever page: "People can get Valley fever by breathing in the microscopic fungal spores from the air, although most people who breathe in the spores don’t get sick. Usually, people who get sick with Valley fever will get better on their own within weeks to months, but some people will need antifungal medication. Certain groups of people are at higher risk for becoming severely ill. It’s difficult to prevent exposure to Coccidioides in areas where it’s common in the environment, but people who are at higher risk for severe Valley fever should try to avoid breathing in large amounts of dust if they’re in these areas."

What are the symptoms? Many people infected don't have any symptoms, while others (about 40%) may have flu-like symptoms lasting weeks to months, which may go away on their own. Valley fever can include symptoms such as: fatigue, cough, fever, shortness of breath, headache, night sweats, muscle aches or joint pain, and perhaps a rash on the upper body or legs. There is usually a 1 to 3 week incubation period. Unfortunately it may look like pneumonia, but typical pneumonia treatment with antibiotics does not help.

Much is still unknown in how to treat the illness, including whether antifungal medications lessen symptom duration or intensity in patients with uncomplicated Valley fever. [Antifungal medications are used to treat complicated cases.] About 5 to 10% of patients develop life-threatening severe lung (pulmonary) disease and in about 1% of people the infection spreads from the lungs to other parts of the body (e.g. brain and spinal cord, skin, or bones and joints). Some people may need lifelong treatment. While anyone can get Valley fever, the CDC says some risk factors include: immunosuppression (e.g. have had an organ transplant, have HIV, are on corticosteroids), being pregnant, having diabetes, people who are black or Filipino. The CDC lists some tips in preventing getting this fungus.

From Medscape: Valley Fever on the Rise and Spreading, CDC Says 

The number of Coccidioidomycosis cases, also known as valley fever, has risen nearly 75% since 2014, according to the Centers for Disease Control and Prevention (CDC). Most of those cases were from Arizona and California, but the Coccidioides fungus has been found as far north as central Washington. The reasons for the increase are unclear but could be related to environmental factors, such as weather and changes in land use, as well as changes in the at-risk population and surveillance.

The report, by Kaitlin Benedict, MPH, from the CDC, and colleagues from the Arizona Department of Health Services in Phoenix and the California Department of Public Health in Richmond and in Sacramento, was published online today in Morbidity and Mortality Weekly Report.

"Despite the limited scope and depth of current coccidioidomycosis surveillance practices, these data indicate that the disease persists as an important national public health problem, with cases occurring across the country, and a major public health problem for parts of Arizona and California, where rates of reported cases in some counties exceed 100 per 100,000 population," the authors explain.

A total of 95,371 cases from 26 states and the District of Columbia were reported to the CDC from 2011 to 2017. After falling from 22,634 cases in 2011 to 8232 cases in 2014, the number of reported cases increased steadily to 14,364 in 2017.

Patient demographic characteristics resembled those in previous years. Valley fever was concentrated among males and among adults older than 60 years in Arizona and among adults aged 40 to 59 years in California.

The authors urge healthcare providers to consider Coccidioides infection in patients who reside or work in or who have traveled to affected areas. Clinicians should understand that those areas may extend farther than previously thought.

Valley fever is a potentially fatal infection caused by the Coccidiodes fungus, which is found in soil in warm, dry regions. Seen largely in the southwestern United States, the fungus has been found as far north as central Washington. The fungus usually causes respiratory illness, although it can also cause disseminated illness.

 The fungus Coccidioides. Credit: CDC

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