Disease is on the rise in San Diego County
By Janice Arenofsky
April 29, 2013 (San Diego’s East County)--In early April, some of the world’s foremost experts in coccidioidomycosis presented published papers on the epidemiology, laboratory science and clinical status of , a fungal disease endemic to Southwestern states like Arizona, California, New Mexico and Nevada. Valley Fever attacks the human and animal respiratory systems and can disseminate to other organs in the body, proving fatal in some cases.
The 57th Annual Meeting of the Coccidioidomycosis Study Group took place at the Sheraton Pasadena Hotel, and the all-day session was attended by nearly 100 physicians, public health officials, veterinarians, patients and advocates for a cocci cure.
In past years, optimism surrounded the FDA testing of an experimental antifungal drug called Nikkomycin Z, but for unclear reasons, the University of Minnesota has stopped producing it, thus slowing down clinical trials. A vaccine does not appear to be a reality due to heavy expenses and minimal interest from pharmaceutical companies because of cocci’s status as an orphan disease.
Ironically, concern over Valley Fever’s spread has escalated in recent months. According to the Morbidity and Mortality Weekly Report of March 29th, California, whose laboratories began reporting coccidioidomycosis in 2010, documented 5,697 Valley Fever cases for 2011.
But experts say that number typically represents only about two percent of new infections due to misdiagnosis, no diagnosis, false negative blood tests and other limiting factors. The Yearly Summary of Coccidioidomycosis for California (2011), issued by the California Department of Public Health’s Infectious Diseases Branch, indicates wide variance in county incidence-- from a high of 2,568 cases in Kern County (where Bakersfield has historically contributed a heavy infection load) to lows of less than 10 cases in Napa, San Mateo and Imperial counties.
San Diego County reported 150 cases of Valley Fever for 2011, which indicates an upward trend since 2007, according to that county’s Health and Human Services Agency.
(View a report and chart on cases in all California counties from the California Department of Public Health here.)
While California has experienced significant increases in infection in recent years, Arizona’s escalating problems go as far back as the late 1990s. Surprisingly, in a recent study of 250 patients carried out by the Arizona Department of Health, more middle-aged white females contracted cocci than in the past--a trend that could impact future research and treatment.
The study also revealed five top symptoms of the disease: fatigue, fever, cough, headache and shortness of breath; 51 percent of participants had seven or more symptoms, and more than 70 percent were also asthma sufferers. A majority had lived 12-16 years in the state before showing clinical symptoms, which on the average lasted four to six months. Another recent Arizona study of Maricopa County patients in hospital ERs during 2006-2011 showed that African Americans and Native Americans were at highest risk of contracting serious infections.
A paper presented by Los Angeles County public health officer Ramon E. Guevara, MPH, showed that the number of cocci cases exploded in the county between 2008 and 2011, with Hispanics disproportionately represented and a higher mortality rate for patients. Before then, there were about 50 cases per year, experts speculate, but since reporting only began in 2010, that figure may be just the tip of the iceberg.
Guevara said risk increases with age, and people with certain medical conditions (such as HIV, diabetes, cancer and pregnancy) show a greater likelihood of infection as did those exposed to dust storms, earth excavation or RV lifestyles. Three areas--West Valley, Antelope Valley and San Fernando Valley—carry the greatest burden of disease, but perhaps due to the Santa Ana winds, which may factor into the wider dispersal of spores, cocci can travel a 75-mile area throughout L.A. County and to the southern part of San Diego County near Bonita.
Valley Fever is also affecting animals, including pets, in the U.S. and Mexico. Although most speakers stuck to human infection, lecturers addressed cocci positive blood work on dogs living in Mexico. Also, veterinarian F.A. Uzal, of the California Animal Health and Food Safety agency in San Bernardino, presented a rare case of an alpaca fetus with disseminated cocci, most likely due to the blood-placental link between the dam and the embryo. Lisa Shubitz, DVM, of the University of Arizona, reviewed the results of gene protective studies on mice.
Next year’s Study Group will meet in the Phoenix area.
Symptoms of Coccidioidomycosis (Valley Fever)
courtesy of the U.S. Centers for Disease Control
Most people who are exposed to the fungus do not develop symptoms, or have very mild flu-like symptoms that go away on their own. Some people may develop a more severe infection, especially those who have a weakened immune system, are of African-American or Filipino descent, or are pregnant in their third trimester.
Symptoms of coccidioidomycosis include:
Rash on upper trunk or extremities
Joint pain in the knees or ankles
Symptoms of advanced coccidioidomycosis include:
Bone or joint infection
Symptoms of coccidioidomycosis may appear between 1 and 3 weeks after exposure to the fungus. Some patients have reported having symptoms for six months or longer, especially if the infection is not diagnosed right away. If your symptoms last for more than a week, contact your healthcare provider.