Valley Fever is the favorite name for the disease called coccidioidomycosis caused by the fungus Coccidioides immitis(2). This fungus grows in the San Joaquin Valley and south central California, Arizona, Original Mexico, western Texas, southern Nevada, the south western corner of Utah, and northern Mexico (1). First reported in the United States in 1894, Valley Fever was officially declared an epidemic by the Arizona health department in 2006 after 5,500 cases were reported that year, including 33 deaths (3). In approximately 60 percent of the time the infection is asymptomatic and the host has no conception that they had contracted it. The other forty percent gain symptoms ranging from peaceful to severe, including death. This emerging disease has had a astronomical finish on the human and animal populations in the endemic areas.
When soil containing these fungal spores is fearful they become airborne and can be inhaled by humans and animals. This disturbance can be caused by anything from humans digging and animals playing in the soil to dust storms and earthquakes. Immunocompromised patients, young children, the elderly and members of several ethnic minorities have a higher risk of contracting Valley Fever (4). Although these groups have a higher level of risk, coccidioidomycosis has been known to affect a wide range of individuals from prison inmates and archaeologists, to drug sniffing dogs along the Mexican border. In fresh years, cases in prisoners at a California Central Valley correctional have reached as high as 1 inmate in every 10 tested (4).
The significant things to understand when learning about this disease are its cause, what is being done to prevent and cure it, its prevalence, and risk factors. This paper has been assembled to address these issues regarding Valley Fever. This paper focuses on four main stakeholders in this Valley Fever epidemic, the medical industry, infected individuals and insurance companies, infected animals and construction companies.
Medical Industry
Valley Fever is a respiratory disease caused by airborne fungi spores from Coccidioides immitis that enter and grow inside the lungs and cause infections. About 60% of the people do not realize that they have this disease because it can cause no recognizable symptoms and can only be positively identified by a skin test. The 40% of the remaining population can procure still to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each invent ranges from minor to severe consequences. Most critical of all, is to know what the symptoms of Valley Fever are. There are ways to sing if someone might be infected and those symptoms include chest pain-which is a constriction that makes it difficult to breath, fever, muscle stiffness, joint stiffness, wheezing, cough, loss of appetite, chills, and change in mental region. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will launch to effect painful rashes and or lumps on the lower area of the legs. Symptoms that can be linked with the disease once contacted include joint swelling, joint distress, arthritis, ankle, feet, leg swelling. All of theses symptoms may not accrue in everyone and can vary from unexcited in some people to severe in others. Showing more then one of these symptoms should be a fine indicator that the person has contracted the disease and should consult a doctor.
Once a body is infected, Valley Fever will display up in one of three forms acute, chronic, or disseminated. Some of the forms are more rare then others. Depending on the accomplish that Valley Fever takes, the severity of the effects on the body and how risky it can be will vary. The acute accomplish is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will reveal the development of the disease. This can happen at any time during the year or any season. It affects both men and women equally and the systems will recede like the body has caught the flu. Chronic get is rarer and less popular then the acute beget. It is more unsafe than the acute build and can cause more problems. The chronic create can become evident and design after 20 or more years from when the person first got the infection. This may not have been found, treated, or even discovered by the person with the disease.
Valley Fever can cause infections in the body and fabricate lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural position or the site between the lungs and the ribs. This can cause serious pain to the lungs and the person will have a difficult time breathing. Other symptoms include crude grade fever, weight loss, and nodules in the lungs. The disseminated make is the most unsafe and severe out of the three. This is when the disease spreads to the different parts of the body. The infection gets into the person’s bones, lungs, liver, meninges, brain, skin, heart, and around the heart. It is found that 30% to 50% of those people infected with this invent also salvage meningitis. This build can be very deadly as it can cause swelling around the brain and spinal cord. With this design, healthcare providers often seek ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening manufacture and can cause death if not treated correctly. It can cause brain harm as well and can affect the brain/mental dwelling of the person.
Everyone in the world is different and so not every person is going to be infected the same intention. People of different color or run can contract the disease more readily then others of another speed can. The people of Asian, Hispanic and African descent are more susceptible to the diseases than Caucasians. Even though it is really unclear why, those of color are 10-20 times more likely to fetch the disease. Most cases that ended up in the emergency rooms were of Hispanic or African origin. Other people that have a high infection rate are people that are diabetics or weakened immune systems such as those with AIDS. Also women that are pregnant, in their third trimester or apt after their babies are born, are at an increased risk of getting Valley Fever. All of these factors will accomplish it easy for them to procure the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight aid as well causing them to score worse quicker and will be more severe. Age is a grand factor as well seeing as older adults have a higher chance of developing Valley Fever then an younger age. This is because their immune systems are less active or have other medical conditions that lower their ability to fight off the infection. Individuals with outmoded immune systems are at higher risk for complications which may lead to the disseminated manufacture. It lets the disease spread easier through out the body and lets it accept into the significant systems of the body. This can develop the body more susceptible to other types of infections because of the further weakening in the immunity from Valley Fever.
Valley Fever, as stated, gets stirred up into the air from unusual construction or gardening, allowing one to breathe it in. Once it gets into the lungs it sticks in the inner piece of the lungs. There it will grow and multiply inside the lungs. Depending on what build it takes it can determined up from there or release pus. This pus then can fetch absorbed into the body and stick to different types of organs. It can especially target places where it can invent up in such as joints, feet, and legs. This is because the fungi find into the blood stream which will come by absorbed by muscles, bones, and under the skin where it can deposit and grow. If the immune system is not strong enough, it can not ruin the infection which allows it to further mitigate as it builds in different spots of the body. Since it goes into the body’s blood stream it can secure to where ever the blood is flowing. This includes vessels around brain and the spine. This will cause different reactions such as the person affected might lose some perception and awareness because of the lack of desirable blood being given to the brain. With the fungi being deposited in places such as the feet or skin it causes swelling because it will build liquid or more pus-like substance. This will cause the joints to swell up because of excess liquid causing arthritis. Besides looking at the symptoms of the person there are many other ways to settle if there is a Valley Fever infection. Different medical professions spend different ways to settle the infection in the body and depending on the degree of the disease.
A chest x-ray can be taken to figure out if one is infected. In the x-ray the doctor would be looking for light areas in the lungs that are poorly defined or patch areas. The plot where disease is growing will point to up usually reach or next to the ribs as most of it grows and deposits there. A skin test can be given as well and it is called the spheriulin skin test. This test looks to study if the person is infected with the fungus and since it is more sensitive it can acquire up signs of an earlier infection accurately. Spheriulin is an antigen that is connected with the fungi that causes Valley Fever. This substance is injected honest a dinky below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will gape at the arm or the area it was injected at 24 and 48 hours after the test. If the body has antibodies to the fungus, and it is in their system, the body with react and the state will become red and swollen. Although this test is not being broken-down as distinguished anymore because it is not as specific, it however is broken-down in researching to understand the disease. A more celebrated test is a sputum culture. This is where the doctor or nurse retrieves sputum from the patient. Sputum is the mucus-like secretion in the bronchi tubes or where the air goes to the lungs, and comes up with deep coughing. The doctor or nurse will ask the patient to cough deeply and spit up any sputum into a sterile cup. This will be taken to a lab that allows it to grow to witness if Valley Fever is indicate. The doctor my tap on the chest or have the person inhale steam-like mist to encourage cough up the sputum in order to pick up a better sample. One of the last tests that may be done is a coccidiodes antibody test. This test is where the blood is taken to analyze if there are any antibodies to the fungus in the body. If the antibodies are expose it can mean that there is an ongoing infection or a prior one. The test and blood may be taken a couple of weeks after to behold if there is a rise in the antibody count which determines the infection and how severe it may be. The higher the titer or antibody counts the worse the infection it is. These are all tests that the doctors may expend in determining more accurately if the disease is explain in the body. This is the only draw to be 100% obvious that there is an infection.
Depending on the magnitude of the infection different treatment options will be provided by the doctors. Some of the forms may even dissipate with no medical interactions as well. The acute disease will usually go away without medical intervention. Popular management is bed rest and treatment for flu symptoms until the fever goes away. With any of the other forms, medication would be needed to steal care of the disease. If the quandary persists or if there is a higher possibility of complications and it is in its more severe build, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic obtain or more acute design that won’t go away, amphotericin B is usually the medication given to abet fight off the disease. Then the person is monitored as to acquire obvious the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to consume care of lesions that are localized. For the disseminated produce fluconazole or itraconzole is commonly mature. The dosage is usually 400mg per day and in some cases 2000 mg of fluconazole or 800mg of itraconzole per day may have to be taken in 200mg doses. Amphoterican B may be musty as an alternate in this dwelling if lesions are getting worse more posthaste and is mature to diffuse pneumonia. Surgery is indispensable in this case and in most reports at this stage it is indispensable. This is veteran to seize care of mountainous abscesses, destructive lesions or bony sequestrations instability of the spine or the movement on important organs such as the heart or tissues such as the spine. Since this get is the worst and in most of the time fatal more actions are required in recovery as compared to the more acute forms. Treatment of the disease does not form it go away for capable as relapses can occur or the person can come by it again.
The disease can have short affects and long term effects on the body. Depending on the person or the amount of spores inhaled, this will settle the longevity and affects of the person. The short affects include flu like symptoms and will go away. It is an annoyance objective like any time someone gets sick and the person can go on with their life with no damage. These people probably have higher immune systems. However, the longer the disease stays around in the body the more hurt it will do. If it is prolonged in the body for an extended time it will inaugurate having more harsh affects on the body. The infection can spread to the bones in the body and cause deterioration or holes in the bones. This will pause with the patient through out their life. If it is in the body for the extended time it can cause variations of getting better then getting worse fluctuations as well as can cause relapses of the disease where it can advance benefit. If not treated, the non-acute beget will worsen over time and in most cases catch into other organs of the body and make the disseminated type. Taking care of the infection early on would be a reliable strategy as Valley Fever can cause death if not treated at the accurate time. If the disease is prolonged it can cause other diseases or illnesses. These include forming pneumonia and meningitis which compose the condition that noteworthy more deadly and difficult to treat. As both of those diseases are fatal as well and can acquire awful mixes with Valley Fever. Bleeding and lung abscesses could earn which have to be medically treated and in some cases have to be done with surgery. Prolonged exposure can attach the person at gross discomfort as the pus gets into the lungs and fills the lungs making them feel like they’re drowning and can’t breathe. This can cause many unpleasant effects as the body can’t rep enough oxygen into the body. People that already have respiratory problems such as asthma can be compromised and hinder the lungs from working efficiently. This can cause a more acute design such as short of breath to something more perilous as not getting any air in and finish breathing without medication or immediate treatment. Most importantly the disease should not be taken as lightly as it can cause death if overly prolonged or gets into its most hazardous forms in the body. Many problems and complications would have to happen in order for it to gain to that severe of stage. As long as the disease is recognized and treated (if need be) then the affected person can easily recover.
Many people who have Valley Fever don’t even know they have had it because the severity changes in everyone and 40% of the people would prove symptoms and require puny to major treatment. This disease changes over longer periods of time. A person may have some time to go gape a doctor before they feel the severity of the disease. Though, as stated earlier, waiting for long periods of time to sight medical care would not be superior to one’s health. This disease is taken in most of the medical field taken very lightly even though misdiagnosis and prolonged exposure to the disease can be fatal to the person’s health. It can have affects on the body that finish with them for years at a time or even there entire life. This is something that if in demand consulting a doctor would be the best course of action so treatment can commence so complications don’t arise.
Infected Individuals & Insurance Companies
There are many valuable stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the scream of Valley Fever. Arguably, the role of infected persons or those that enjoy a fresh vulnerability to the disease is top priority on the decision-maker’s list. Each year, thousands of people are diagnosed with Coccidioidomycosis in Arizona alone. In a 2007 article, the Washington Post wrote that Valley Fever cases diagnosed in 2006 were up fifty-six percent from a year earlier. This prompted Arizona health officials to sign the disease at, “epidemic proportions,” as thousands of other cases likely went undocumented. It has also been reported that anyone who has spent enough time in Arizona, or any other fragment of the Southwestern United States where soils enjoy the Valley Fever fungus, will contract the disease at some point. Only a microscopic percentage of people, however, are diagnosed with a severe enough make of the infection where medical treatment is needed. Anti-fungal medication is the most current treatment for Valley Fever. But, there are rare cases where surgery is required to fully recover from the disease. Overall, tens of thousands of cases are reported around the United States annually and the number of Valley Fever-related deaths is estimated at 50-100 each year. It is well-known to peek individuals currently struggling with the disease as well as those who have recovered from a serious beget of Coccidioidomycosis as a stakeholder with regards to this utter because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an distress to better abet this claim, the lives of two patients that contracted a serious originate of the infection, will be addressed and analyzed in the following paragraphs.
Before introducing specific cases, it is significant to review some fresh facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Portray in October 2008. The characterize, co-compiled by the Office of Infectious Disease Services and the Bureau of Epidemiology and Disease Control, presents the amount of Coccidioidomycosis cases reported in 2007 through a myriad of graphs. These graphs shriek the research information in a thorough and comprehensive device to the reader by dividing up Valley Fever statistics for the 2007 year in a multitude of categories. Some of these categories include: cases reported in ‘07 according to specific age groups compared years past and a five-year average, separating the number of Valley Fever cases reported by counties in Arizona, and separating the number of Valley Fever cases reported in both mining and non-mining areas within the set. Although many people mediate of this disease as a level-headed illness similar to the well-liked wintry, Valley Fever is a key grunt amongst Arizona residents as well as both local and national governments. In 2008, the Arizona Department of Health Services received funds for Valley Fever prevention and control from a legislative appropriations committee. The Center for Disease Control and Prevention (CDC) also awarded the department funds for continued research. As fraction of the 2007 characterize, Health Services interviewed roughly ten percent of all Arizonans diagnosed with Coccidioidomycosis during that year. According to the ADHS, the following are some of the most alarming facts that were discovered from the interviews:
• People missed an average of 1 month of work, for a total of 4,918 days
• People with Valley Fever could not get daily activities for an average of 3 months or a total of 92 years
• People with the disease waited an average of 44 days before seeking healthcare
• Patients saw their doctors three times before they were tested for Valley Fever
• There were $86 million dollars in hospital charges for Valley Fever in 2007
Furthermore, Arizona has the highest number of reported Valley Fever cases annually in the United States, accounting for sixty percent nationwide. In total, more than 150,000 people across the country are estimated to contract some earn of Coccidioidomycosis each year. The Arizona Department of Health Services reports that the severity of Valley Fever in the place continues to grow as do the overall number of persons infected each year. Due to the fact that currently there is no cure or vaccine for the disease, every person that is susceptible to the effects of Valley Fever certainly shares some kind of stake in the debates of the thunder. Examining the personal accounts of two anonymous patients afflicted with a serious compose of Coccidioidomycosis can bring further clarity to this claim. Any and all personal information for the following accounts has either been fictionalized, changed or generalized to hold complete anonymity.
The first case will interrogate the horrible effects of Coccidioidomycosis on a male patient of early adulthood age. This individual will be referred to as Patient “V” throughout this paragraph. Patient “V” began his ordeal with Valley Fever in the summer months of 2001. A younger man in the final years of adolescence, Patient “V” experienced generic, flu-like symptoms, which he disregarded as nothing distinguished like most other sufferers decide to do. “At first, I noticed that my lymph nodes in my neck were unusually swollen…I figured it was unprejudiced a chilly or some itsy-bitsy infection or something like that.” Soon after the initial stages of the disease, Patient “V” began experiencing constant, severe injure in the left side of his chest. Although he made numerous medical appointments for this quandary, the harm would subside by the time Patient “V” arrived, making it difficult to diagnose the plight. “What was happening was my left lung had a hole in it and it kept collapsing and then re-inflating by the time I got to the doctor’s office.” Eventually, a chest x-ray was performed on Patient “V” and this revealed a itsy-bitsy, dismal plot on his left lung. The place indicated a relatively slight, but essential hole through the lung. The scrape required corrective surgery and Patient “V” was admitted to one of Arizona’s hospitals in August, 2001. Surgeons sewed up the hole in Patient “V’s” left lung and released him after a day of recovery. Within weeks following the surgery, Patient “V” experienced a relapse of his earlier symptoms. “…I was playing Volleyball one night and in an instant, there was this intense injure in my chest…I felt dizzy and could hardly breathe.” Patient “V” immediately returned to the hospital sometime in November of that year where further tests concluded that the infected section of his left lung was, indeed, Coccidioidomycosis. Another surgery to completely buy this part of infected lung was performed successfully and Patient “V” spent more time recovering in the hospital. “The effects from the disease itself were painful enough, but the worst harm came from the chest tubes that were inserted into me in the hospital…At one point, they shoved one of the tubes through my ribcage and into my lung and I wasn’t even on wound medication.” Fortunately for Patient “V”, the second surgery was successful and he survived his brush with Valley Fever. In many cases, patients who contract and fend off the infectious spore form up life-long immunities. However, reports have also shown that patients in remission from Coccidioidomycosis can be more vulnerable to a reoccurrence of the disease than those that have never contracted it. Following his surgical recovery, Patient “V” was prescribed an anti-fungal medication called Diflucan, a accepted drug distributed to sufferers of the infection. Patient “V” was required to catch this medication daily for 2-3 years. He now receives chest x-rays once a year to check for any returning signs of the fungus. Patient “V’s” scar tissue has also become virtually unrecognizable after nearly a decade of recovery.
The second case to be analyzed will be that of a middle-aged female patient. Appropriately, this patient will be referred to as Patient “F” throughout the analysis. Patient “F” contracted Valley Fever in slow 1995. Early symptoms experienced in this patient included chronic loss of breath and gross joint discomfort. The create of Coccidioidomycosis contracted by Patient “F” was not diagnosed correctly until 2 ½ years after symptoms began. Before visiting a pulmonologist, Patient “F” was given a chest x-ray, where a astronomical, round nodule was located somewhere on her left lung. The patient was admitted to the hospital in 1998 and underwent a wedge resection, to bewitch the infected fragment (removed in wedge earn) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at stout strength for six elephantine months; and then half the dosage for another six months. The patient continued to have fevers following the surgery. She also had an excess amount of fluid in her lung. Patient “F” returned for a second surgery to further dapper the infected station and completed another sequence of antibiotics afterwards. The time spent in the hospital for recovery totaled at six days for each surgery. Patient “F” was fortunate enough to have flexible employment benefits to fully recover. “My company provided short-term disability; up to 6 months with 100% pay…I was very lucky.” As far as medical coverage is concerned, Patient “F” had miniature out-of-pocket costs through United American. However, she was mild unnerved to watch the total amount owed from her stop in the hospital. “The bill after six days in the hospital, which included one day in ICU and five days on a regular floor, was unbelievable. Unbiased for room and board and a shrimp medication, the bill was $28,000.00.” Today, Patient “F” has fully recovered from the infection and only has one suggestion with regards to the drawl of Valley Fever. “Educate physicians on the east fly and west flee, all over the Untied States to properly test for Valley Fever.”
Needless to say, there are always financial burdens associated with any type of surgery as well as prescription medication. In the case of Patient “V”, a total of nearly $180,000.00 was accrued in hospital bills after the two surgeries were performed. Additionally, the drug Diflucan can range from 36 dollars to 60 dollars for 100mg/10 pills depending on the space of steal. It is considerable to sight medical insurance companies as a stakeholder with regards to the yell of Valley Fever as well. Because there is no cure or vaccination for the infection, insurance companies limit the amount of coverage to persons with preexisting conditions. If a cure were to be developed and released into the market, insurance companies would most likely include Valley Fever coverage into any understanding. Unfortunately, without medical insurance, the overall amount of money needed to recover from a serious infection like Valley Fever is simply insurmountable for the majority of Americans. Even with sufficient medical insurance, however, people who have had Valley Fever in the past are typically not covered for a relapse of the infection. Patient “V” currently receives individual health insurance under a PPO from Blue Horrible Blue Shield of Arizona. As mentioned earlier, however, major insurance companies like this one tend to limit coverage to individuals with preexisting conditions. According to an article on www.howstuffworks.com, a preexisting condition is a health condition or illness that you have had before your first day of coverage on a unique concept with an insurance company. Typically under group coverage, such as that offered by a corporation under an employee’s benefits, a person with a preexisting condition can earn pudgy coverage, but will have to wait anywhere from nine months to a year before it kicks in. This period is enforced by insurance companies to insure that a patient is not constantly having relapses of the same condition. However, a person with a preexisting condition will rarely receive private health coverage that includes their condition. This is referred to as the preexisting conditions exclusion. Our attempts to contact major medical insurance companies or medical insurance agents for further clarity on this disclose went unanswered. Unfortunately, people like Patient “V” who have preexisting conditions, are self-employed and do not qualify for group medical insurance will have to pay out-of-pocket if their conditions return. “I would have to order bankruptcy if that happened…” Patient “V” explained. “I live in fright because I know that if I were to find it again, that would be disastrous.”
Currently, a vaccination for Coccidioidomycosis is under development at the BIO5 Institute on the campus of the University of Arizona. Leading the development is Dr. John Galgiani, Director of the Valley Fever Center for Excellence and Chief Medical Officer for Valley Fever Solutions, Inc. This vaccination will be intended for both humans and dogs, which can also contract deadly forms of Valley Fever (this topic will be further discussed in later sections of this glance). In March, 2008, Dr. Galgiani teamed up with fellow BIO5 colleague Dr. David Nix of the Department of Pharmacy Practice and Science to research the vaccination. “We had some complimentary expertise and mine’s mainly in the location of drug development and drug development science and so on. And Dr. Galgiani is kind of the world’s expert on Valley Fever,” Dr. Nix reported in a 2008 Valley Fever instructional video produced by the University of Arizona. The two physicians, under the company name Valley Fever Solutions Inc., are financially backed by the University, private donors and C-Path, a Unusual York based foundation. They are currently testing an anti-fungal called Nikkomycin Z, which was first conventional to prevent fungal degradation in originate. With approval from the U.S. Food and Drug Administration, Nikkomycin Z is in Phase 1 of drug safety trials. According to a news release published on the BIO5 Institute’s website, “The company has already obtained a Science and Translational Technology Research (STTR) grant from the National Institutes for Health that will back fund pharmacology studies that will assist earn future clinical trials. The first phase of that grant is worth more than $100,000, with the potential for an additional $700,000.” If this vaccination proves to be a viable cure for Coccidioidomycosis, many aspects of the yell of Valley Fever would certainly change. Once a cure hits the market, the number of deaths and serious cases as a result of Valley Fever would topple significantly. Debates between the government, politicians and special interest groups would decrease as well if no one were in any trusty threat of the infection anymore. Briefly returning to the topic of medical insurance, people with Valley Fever as a preexisting condition will be able to feel more fetch because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Deplorable Blue Shield, Cigna and Humana will more freely distribute elephantine coverage in instances of Valley Fever. Like most vaccinations and cures to celebrated infections or diseases, there would be many determined outcomes to releasing this drug into the medical market, pending the completion of all drug safety trials.
As considerable stakeholders with regards to the divulge of Valley Fever, both infected persons and medical insurance companies would be greatly affected if an executive decision were to be made, or possibly a vaccination released into the market. While the future looks satisfactory with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people secure a plan to acquire health insurance coverage to some capacity. It is also primary that individuals with preexisting conditions that aren’t on group medical plans lobby for their rights to complete insurance coverage. In considering the base effects of Valley Fever, there are many people who judge this topic is fair as distinguished to the animal world as well.
Infected Animals
Valley Fever does not only affect people but it is now more commonly being found in animals. Animals are unprejudiced as likely to gain Valley Fever as humans are. Animals collect Valley Fever in the same blueprint as humans do, by breathing the fungus. It has been found that more and more animals are being reported of becoming ill due to this fungus. It has been found the 30-40% of animals who breathe in the fungus acquire sick. Some of the most approved animals to be reported with Valley Fever are dogs, cats, llamas, non human primates, horses, and zoo animals (3).
A golden retriever went into the vet’s office; the dog wasn’t feeling well and wasn’t acting himself. The vet takes an x-ray of the dog’s lungs and sees white spots in the lung position where there should normally be unlit patterns. The white spots present that the dog might have cancer in its lungs. The dog is only four years old-fashioned, which is when a dog should be at its prime and not getting lung cancer. Lung cancer isn’t usually found at this young of an age and doesn’t seem to fabricate as fleet as it has in this golden retriever. The owner had said unprejudiced two weeks prior to going to the vet that the dog was fleshy of energy on their vacation. The veterinarian doesn’t all the facts add up for the dog to have cancer so she decided to rush a few more test before she starting treatment for lung cancer. The dog’s health over the course of time starts to go downhill and very speedy. The dog starts to cough, has a loss of appetite, and small to no energy. The vet then found out where the human family had recently traveled and they were in the Southwest. After hearing this, the vet sure that it must be a fungal disease and it was objective that, it was Valley Fever (1).
Dogs are the largest infected and most commonly reported animals with Valley Fever. Dogs find Valley Fever in the same device that humans do and in the same regions as humans do. The fungus is spread through spores which dogs can easily inhale. Once the fungus is inhaled, the spores grow into spherules which enlarge and eventually burst into hundreds of endospores (3). This causes the spreading of the infection into the lungs. A dog’s immune system should answer and surround the infection to waste it. Dogs that do not become sick due to the fungus are considered to be asymptomatic (2). When a dog does become sick from Valley Fever, their immune system fails to demolish off the infection and the infection continues to spread into the lungs and then can recede throughout the dog’s body (3).
Once a dog is infected with Valley Fever, there are obvious symptoms that become note. Some of the symptoms that are seen in dogs are weight loss, coughing, fever, lack of appetite, and lack of energy (3). The cough in dogs can be seen as early as the first week of getting the infection to as behind as 3 weeks. The cough that dogs net is due to the development of pneumonia which is visible on x-rays. The coughing can be caused due to pressure on the lymph node arrive the heart and puts pressure on the dogs windpipe which as a result irritates it (3). After the cough is show the loss of appetite and energy is soon to follow. If the infection is not controlled it can become considerable worse and spread throughout the body. When the fungus is spread throughout the body it causes systemic or disseminated disease (3). When this happens the symptoms and condition of the dog becomes grand worse. The symptoms that become point to are: swelling of the limbs, benefit and neck harm, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, contemplate inflammation, and non-healing skin ulcerations (3). Not all symptoms are expose proper away and it can seize several months before sure symptoms appear. It can be several months after a cough appears that other symptoms become demonstrate. There is typically an order that the fungus spreads throughout the dog’s body. The first organ to be effected is lung, and then the infection usually spreads into the bone, than eyes, heart, testicles, brain, spinal cord, and finally abdominal organs (2).
To resolve if a dog has Valley Fever there are different test that can be done. Some of the most popular test done to choose if a dog has been infected is blood tests, chest x-rays, bone and joint x-rays, and Valley Fever blood test (3). Test results may demonstrate up negative up to 3-4 weeks of receiving the infection so in some cases test need to be repeated to confirm that the dog does or does not have Valley Fever (2).
There are different treatments that be done to attend fight the fungus. The process of treating Valley Fever may be long; medication can be given for up to one year (2). The length of time that the treatment will occupy usually depends on how far the fungus has spread throughout the body. Most commonly oral antifungal medication is given to the dog. These antifungal medications are ketoconazole, itraconazole, and fluconazole (2). Ketoconazole is the most commonly prescribed medication due to the fact that is it the least expensive. This drug is usually given twice daily and with food. Itraconazole is a more expensive medication but has fewer side effects than ketoconazole. Itraconazole is also better for dogs that are having problems keeping their food down because it has a faster absorption rate (3). The third medicine most commonly given out for treatment is Fluconazole and it is also expensive with shrimp side effects. This is usually given to dogs that have injure done to their spinal cord and nervous system (3).
Cats, llamas, non human primates, horses, and zoo animals are other animals that have been reported with Valley Fever. Cats that have Valley Fever present the same symptoms as dogs do but it less likely for a cat to find Valley Fever than it is for a dog. Cats pick up Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats regain the fungus their symptoms are usually a puny more advanced than dogs. Two of the major symptoms seen in cats that have Valley Fever are unexplained weight loss and skin ulcerations that won’t go device. The same treatment for dogs can be faded to treat cats with Valley Fever (3).
Horses are another animal that have been found to obtain Valley Fever. There have not been very many cases reported but in the ones that have only one horse has survived Valley Fever with treatment. All the other horses that were reported with Valley Fever had to be euthanized. The reports of these cases are not very unusual though, and with medical technology improvement chance of survival with original medicine is remarkable better for horses today (3). Llamas are another animal that have been infected with Valley Fever. Llamas are very sensitive to this fungus. In most cases, if a llama has Valley Fever death is almost always the outcome.
Zoo’s that are located in the Southwest are very aware of Valley Fever. Many zoos have lost animals due to Valley Fever before they were aware of what is was and how to treat for it. When animals become sick, Valley Fever is something that is tested early so treatment can be started. In zoos, the most celebrated animals to derive Valley Fever are: Monkeys, Apes, and other primates. These animals consume the same treatment process as dogs and cats but is usually consists of a lifetime treatment (3).
Valley Fever is a very serious dispute that is rising in animals. Currently there are no preventatives for Valley Fever. The treatments for Valley Fever for animals has become better and better over time. The near in technology has allowed for veterinarians to be able to detect Valley Fever at a less reach stage. The early stage that Valley Fever is caught at allows for a better chance of survival of animals infected with the fungus.
Construction
There is no doubt that construction companies contribute significantly to Valley Fever. According to the MayoClinic, institution known for prominence in the medical field recognized the increase in sincere estate has contributed to the spew of “thousands of tons” of dust carrying this fungus into the air. The article looks at how in the 1990s the accounts of Valley Fever increase in the states of Arizona and California due to some essential factors. Among those factors like dry climate, the unusual building booms have been one of the most significant factors that have contributed to such increases. The snappily clearing and building were a primary source for the increase in reported cases of Valley Fever. Among all the contributing factors of Valley Fever, environmental exposure ranks high, if not the considerable cause. Experts also added that almost half of the people who live in areas where Valley Fever is prevalent have contracted the disease. Interestingly, people who are at most risk are those who are exposed to directly to dust like those who construct jobs in the field of construction, ranching and agricultural work (1).
The decade following the 90’s has had a vast increase in reported cases of Valley Fever. Those areas that have reported such increases are the states of California and Arizona. These states have been induced with a massive building suppose. The mass migration to these “sun belt” states made for a widespread land clearing and construction, which ultimately directly contributed the spread of the air borne fungus (2). Importantly, some measures are currently in region to purposely crop the amount of dust construction companies contribute to the environment.
The Environmental Protection Agency (EPA) is an agency of the federal government of the United States who is in charge of protecting human health by maintaining the natural environment agreeable (3). This implies its commitment and dedication to monitoring and posing regulations for anything threatening the quality of the air. The EPA has status limits on how mighty pollution is allowed to be in the air. In its goal to hold and manage the air we breathe, EPA has passed several pieces of legislation that have reduced the amount of smog and pollutants in the air. Among well-known legislation is the Desirable Air Act which has been passed to enforce super air standards and improve human health. The Elegant Air Act is an outline for what national, plot, and local authorities must follow in order to protect air quality. Under the Desirable Air Act, local and dwelling authorities are responsible for abiding by the national ambient air quality standards. The Environmental Protection Agency states Maricopa Country cannot exceed the federal health standard for particulate pollution more than three times in a three year period (4).
According to the Environmental Protection Agency (EPA), Maricopa County has been in violation of particulate pollution since 1996. Particularly 2008, there have been nine different days where at least one of the monitors exceeded the federal health standard for particulate pollution. The health standard for particulate pollution is that it cannot exceed more than 150 micrograms per cubic meter measured over a 24 hour period of time. It’s notable to know Maricopa County has 24 air monitoring sites in the Valley. The location of Arizona, under the Arizona department of environmental quality has its possess air monitoring sites as well. If any of these monitors exceeds the federal health standard for a given pollutant, the EPA will occupy Maricopa County accountable. According to the Environmental Protection Agency (EPA), Maricopa County failed to approach attainment for particulate pollution and thus is under federal orders to carve particulate matter pollution. In an attempt to address the protest, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a idea to the EPA to note how the county plans to prick PM10 emissions by five percent each year until estimable levels are reached. The Five Percent Belief outlined more than 50 commitments to slit dust. Of these commitments, some affect the procedures and guidelines on construction entities (4).
Speaking with Erin Dunsey of Maricopa County Air Quality Department, the county is currently working hard to pose regulations on construction companies in order to lower dust emissions and ultimately lowering the potential threats from Valley Fever. The principle responsibility for The Maricopa County Air Quality Department’s Dust Compliance Division is to protect the public from the dangers that reach from airborne particulate matter (7). This division of dust compliance deals with fugitive dust sources and the rules to minimize the production of it. This means that fugitive dust from any source, including constructions areas, must be restricted in their construction operations to have within capable dust standards. As fragment of the compliance, Maricopa County has devised that all sites with alarmed surface areas of dust must comply with “Rule 310″ (5).
Under Rule 310, the Dust Compliance Division has established limitations and requirements for the implementation of process controls as well as other guidelines that will relieve enforce obedient fugitive dust control measures. One of the first major steps for construction companies to follow is the obtainment of a permit. The Air Quality Department requires a construction permit for companies who idea to conduct activities any that will disturb a surface state equal to or greater than 0.1 acre. Complying with the construction permit requirements is often a considerable and daunting task. Before applying for a permit, a opinion that outlines the measures that will prevent the creation of dust must be presented. This conception also describes all the measures that will be implemented at anytime during the phase of construction. Therefore, this guideline requires dust generating sources to meet standards and at the same time apply best the available control measures in order to attempt to minimize fugitive dust emissions. This way being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on location understand their responsibility while on situation (6).
Another hassle that companies have to deal with is the logging of control measures. Once again, under Maricopa County’s Rule 310, construction companies who conduct a dust generating operations that require a Dust Control Concept must hold a written log recording the exact application and execution of the control measures previously outlined and favorite by the Dust Control Understanding. This is a daily detailed recordkeeping which records what actions are being conducted in dust-generating operations in what may include daily inspections for crusted or damp soil. Another section of portray keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and own scared surfaces must install a trackout control devise. These devises are vast contributors to the retention of fugitive dust. Trackout is simply the particulate matter from tires and other sources that have fallen onto paved areas that are accessible to the public. The rule states that trackout must be petite to 25 cumulative linear feet (6).
Rule310 is an extensive and overwhelming status of requirements established to lower dust emissions. Fragment 309 list another requirement under Rule310 that companies must abide by. The rule says that if the plot of interest is more than one acre a series of dust control training must bewitch plot. All workers directly interested in the containment of dust like the water truck drivers and water pull drivers must pick a basic dust control training class in which attendees will ultimately become certified if successfully completed the training class. An extension from this fraction lists that a dust control coordinator must be display on job spot if the dimension of the job location is five acres and up (5). These onsite coordinators must have completed a comprehensive dust control training in which they are given friendly training on regulating emission of fugitive dust and learn practical methods to do so, such as neat up, water and dust suppressant applications (6).
Construction companies are required by dwelling and federal law to implement a diligent worry to control dust pollution. If at any time violations are committed, these companies will be subject a fines and penalties. This has been yet another jam companies have had to face on a regular basis. The penalty policy held by the Maricopa County Air Quality Department seeks to prevent future violations. Fines that are placed upon companies are positive by the severity of the violation committed. Several factors are old-fashioned to calculate the amount of a penalty. In case there has been an economic abet of noncompliance by the company, the penalty will consist of weighing out the benefits that were looked to have been extracted.
Dust control compliance has also become a financial setback for construction entities. The Maricopa County Air Quality Department announced that in the month of October $452,589.90 in air quality violations was mild (9). In the month of September, the amount of $471,613.30 was composed in violations all related in one method or another to air quality control. This is the misfortune construction company’s face for not correctly using effective measures to nick dust in the construction sites, therefore causing potential problems to advance residents and workplaces, eventually becoming a financial quandary due to fines.
There is no better plan to understand how troublesome the strict regulations have become a burden for construction companies. While searching for construction companies within the valley, Turner Construction Inc. drew attention as it is well known as a huge construction company that has a corporate office in Tempe, AZ. With a inquire of to content to a construction manager, a brief conversation was held with a construction project manager from Turner Construction. The conversation revolved around how Valley Fever has affected their procedures during construction or related tasks. Immediately it became distinct unbiased how grand companies who are in the construction industry are affected by laws to aid lop the incidents of Valley Fever. Jason Jones, who is a project manager at Turner Construction Company, explained that all construction companies have been hit hard by Maricopa County. Amongst the things mentioned was the fact that the main anguish for the county is dust control. As a result for the growing anguish over dust control, they have to follow a “rigorous dust program” to comply with regulations. Jason explained how they are currently working on a 242 acre development complex and have had to expend around 400,000-750,000 gallons of water to control dust governed by Maricopa country. He added that this adds to the costs of the construction project as trucks and workers are veteran to acquire fugitive dust. If they ever do not comply with these regulations, fines originate from about $1,000 to 10’s of thousands of dollars. He added that Maricopa is the “worst county in America for dust regulations” (8).
The main pickle is that construction companies have to follow strict regulations on their dust production. The county of Maricopa has been enforcing even stricter laws to prevent and wait on hold dust levels to a minimum as they have recently been under serious scrutiny from the Environmental Protection Agency. If for some reason these companies are not correctly using effective measures to slit dust in the construction sites, enormous fines will follow. This is yet another thunder companies are dealing with. To the load even greater, these companies also deal with the economical site backs from following these regulations. For companies to nick and comply with county regulation, thousands of dollars are being forcefully spent by such companies. The contributions construction companies compose to Valley Fever is not underestimated. As a result, strict regulations are followed and posed upon companies to cut the incidence of Valley Fever cases. Valley Fever has approach to cost companies thousands of dollars and is becoming every day more of an disaster.
Conclusion
After studying the stakeholders keen in Valley Fever, it is easy to observe favorite themes between them. There is no doubt that while not known as a risky disease, Valley Fever has the potential to be one. With the number of cases increasing each year and relatively limited research being done for prevention and cures, Valley Fever has earned the title as an emerging epidemic. While Coccidioides immitis only lives in a few occupy areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and bright to endemic areas. It also must not be forgotten that Valley Fever has the capability to affect animals as well humans increasing the cost of the disease for these species. It is certain that because of this, action must be taken in order to slit the number of cases and to decrease the severity of the cases.
This case eye points to a few relatively easy steps to remove in order to decrease the severity of Valley Fever cases. The most famous and most definite step is early detection. It was shown that the earlier that the disease is diagnosed, the less severe the symptoms and the less impact it has on the infected individual. Despite this easy solution, doctors saw their patients and average of three times before they tested for Valley Fever and the patients on average waited 44 days before treatment. These statistics point to a general lack of awareness this disease in both the patient and the medical world. In order to promote early detection, there must be better instruction of symptoms and complications fervent in prolonged disease available to both the medical community and the population of endemic areas. This in theory would design an awareness of the disease and support earlier testing for it.
There are a few steps that can be taken in order to cut the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also serve sever the number of cases. Public awareness of Valley Fever would gash the number of cases by providing the people with knowledge of its causes and ways to avoid exposure to the Coccidioides immitis spores. The second step that should be taken is a national focus on research in vaccines and cures for this disease. From this case seek it is positive that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the set in some circumstances. These high costs are unacceptable when relatively runt investment is being made in the research of a cure or vaccination.
When considering these recommendations, it is primary to review the facts about this disease. Valley Fever is caused by the spores of a fungus that can become airborne when soil is stupefied. This fungus is endemic to ample portions of the American southwest including Phoenix, Arizona, the nation’s fifth largest city. Statistically, anyone living in endemic areas is likely to catch this disease at least once in their lifetime. On top of those living in endemic areas, those visiting the situation have a high chance of contracting the disease. The number of cases has risen consistently each year for at least the last seven years. After reviewing these facts it is definite that Valley Fever has had a primary impact on our society and that steps need to be taken to sever its prevalence.
References
Introduction
(1) Chuang, Amy. “Disseminated Coccidioidomycosis in an Immunocompetent Person Living in Novel York City”. Journal of Urban Health: Bulletin of the Novel York Academy of Medicine, Vol. 82, No. 2, doi:10.1093/jurban/jti057
(2) Comrie, Andrew C. “Climate factors influencing coccidioidomycosis seasonality and outbreaks. Environmental Health Perspectives. June 2005 http://findarticles.com/p/articles/mi_m0CYP/is_/ai_n14816419
(3) DiSalvo, Dr. Arthur. Mycology – Chapter Six Dimorphic Fungi. 21 Nov. 2008 http://pathmicro.med.sc.edu/mycology/mycology-6.htm
(4) McKinley, Jesse. “Valley Fever hits epidemic numbers from Texas to Northern California”. Fresh York Times. 30 Dec. 2007 http://www.sfgate.com/cgi bin/article.cgi? f=/c/a/2007/12/30/MN12U6OGF.DTL&feed=rss.news
(5) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .
Medical Industry
(1) “Coccidioidomycosis..” NGC – National Guideline Clearinghouse . 1 Nov. 2005. 2 Nov. 2008
(2) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .
(3) “Valley Fever – Valley Fever Connections.” Valley Fever – Valley Fever Connections. 22 Nov. 2008 .
(4) “Valley fever – MayoClinic.com.” Mayo Clinic medical information and tools for healthy living – MayoClinic.com. 15 Mar. 2008. 22 Nov. 2008 .
(5) Interview Roni Cummings, Quality risk management: Notes in hand
Infected Individuals & Insurance Companies
(1) Arizona Department of Health Services. (2008). Valley Fever Annual Portray 2007 (1st ed.). Phoenix, AZ: Arizona Department of Health Services, Division of Public Health Services.
(2) Interview with Anonymous Patient #1: Patient “V”. (Personal Communication, November 15, 2008).
(3) Interview with Anonymous Patient #2: Patient “F”. (Personal Communication, November 17, 2008).
(4) The Associated Press (2007, January 11). Ariz. Valley Fever Cases Soared in 2006. The Washington Post. All Pages.
(5) Unknown Author. (2008, October 29). Arizona Company Seeks Valley Fever Cure. BIO5 Institute News Archives. All Pages.
(6) Arizona Department of Health Services Webmaster. (2008, November 3). Infectious Disease Epidemiology. Retrieved November 15, 2008, from http://azdhs.gov/phs/oids/epi/disease /cocci/index.htm
(7) Author Unknown. (Last modified October 30, 2008). How Pre-Existing Conditions Work. Retrieved November 15, 2008, from http://health.howstuffworks.com/pre-existing-condition.htm
(8) BIO5 Institute at the University of Arizona. (2008). BIO5 Institute Home Page. Retrieved November 15, 2008, from http://bio5.arizona.edu/index.php
(9) Pfizer Inc. (Unknown Date). Pfizer Products. Retrieved November 15, 2008, from http://www.pfizer.com/products/rx/rx_product_diflucan.jsp
(10) Roerig, Division of Pfizer. (Last revised March 2008). Diflucan (LAB-0099-10.0). Retrieved November 15, 2008, from http://media.pfizer.com/files/products/uspi_diflucan.pdf
(11) The Mayo Clinic. (2006, March 17). Diseases and Conditions Valley Fever. CNN.com & MayoClinic.com. Retrieved from http://azdhs.gov/phs/oids/epi/disease/cocci/index.htm
(12) The University of Arizona. (Video Production). (2008, March 8). Innovation Day at UA 2008, UA @ the Leading Edge [Episode 1]. Development of the Valley Fever Vaccine. Video retrieved from http://www.youtube.com/watch? v=kgT0hFo49G4
(13) Valley Fever Center for Excellence at the University of Arizona. (2003). Valley Fever Center for Excellence: Coccidioidomycosis. Retrieved November 15, 2008, from http://www.vfce.ar izona.edu/
Infected Animals
(1) Mitchell, Chris. Blastomycosis, Cryptococcosis, Coccidioidomycosis (Valley Fever), Histoplasmosis, Disease and more. Animal Shelter Org. 2004. November 4, 2008.
(2) Valley Fever (Coccidiodomycosis). Mar Vista Animal Medical Center. 2006. November 5, 2008. http://www.marvistavet.com/index.html
(3) Valley Fever in Dogs. Valley Fever Center for Excellence. 2008. October 18, 2008.
Construction
(1) “Valley Fever” 1998-2008 Mayo Foundation for Medical Education and Research. Outbreak grips Arizona. March 17, 2006
(2) Benjamin J. Park, Keith Sigel, Victorio Vaz, Ken Komatsu, Cheryl McRill, Maureen Phelan, Timothy Colman, Andrew C. Comrie, David W. Warnock, John N. Galgiani, and Rana A. Hajjeh. “An Epidemic of Coccidioidomycosis in Arizona”, 1998-2001. The Journal of Infectious Diseases, 2005. 1 June.
(3) U.S Environmental Protection Agency. The tidy air act amendments of 1990. Clean Air Act. November 10th, 2008.
(4) MAG 2007 Five Percent Thought For PM-10 For The Maricopa County Nonattainment Plot. December 2007. Maricopa Association of Governments. < (www.mag.maricopa.gov)>
(5) Maricopa Air Quality Department. (2008). Dust Control. [Brochure]. Dust Compliance Resources Maricopa County.
(6) Maricopa County Air Pollution Control Regulations, Regulation III-Control of Air Contaminants Rule 310.
(7) Toribio, Jeovanny. “Maricopa County and dust regulations.” E-mail to Erin Dunsey. Oct. 21, 2008.
(1) Jason Jones, Turner Construction Inc, Oral interview, Done 10-21-2008
Notes in Authors hand
(2) Maricopa County Air Quality Department. “Air Quality Violators pay over $452K in October”. November 3, 2008. News.
Valley Fever is the popular name for the disease called coccidioidomycosis caused by the fungus Coccidioides immitis(2). This fungus grows in the San Joaquin Valley and south central California, Arizona, Recent Mexico, western Texas, southern Nevada, the south western corner of Utah, and northern Mexico (1). First reported in the United States in 1894, Valley Fever was officially declared an epidemic by the Arizona health department in 2006 after 5,500 cases were reported that year, including 33 deaths (3). In approximately 60 percent of the time the infection is asymptomatic and the host has no notion that they had contracted it. The other forty percent bag symptoms ranging from still to severe, including death. This emerging disease has had a expansive attain on the human and animal populations in the endemic areas.
When soil containing these fungal spores is petrified they become airborne and can be inhaled by humans and animals. This disturbance can be caused by anything from humans digging and animals playing in the soil to dust storms and earthquakes. Immunocompromised patients, young children, the elderly and members of several ethnic minorities have a higher risk of contracting Valley Fever (4). Although these groups have a higher level of risk, coccidioidomycosis has been known to affect a wide range of individuals from prison inmates and archaeologists, to drug sniffing dogs along the Mexican border. In current years, cases in prisoners at a California Central Valley correctional have reached as high as 1 inmate in every 10 tested (4).
The indispensable things to understand when learning about this disease are its cause, what is being done to prevent and cure it, its prevalence, and risk factors. This paper has been assembled to address these issues regarding Valley Fever. This paper focuses on four main stakeholders in this Valley Fever epidemic, the medical industry, infected individuals and insurance companies, infected animals and construction companies.
Medical Industry
Valley Fever is a respiratory disease caused by airborne fungi spores from Coccidioides immitis that enter and grow inside the lungs and cause infections. About 60% of the people do not realize that they have this disease because it can cause no recognizable symptoms and can only be positively identified by a skin test. The 40% of the remaining population can procure quiet to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each earn ranges from minor to severe consequences. Most vital of all, is to know what the symptoms of Valley Fever are. There are ways to narrate if someone might be infected and those symptoms include chest pain-which is a constriction that makes it difficult to breath, fever, muscle stiffness, joint stiffness, wheezing, cough, loss of appetite, chills, and change in mental station. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will inaugurate to originate painful rashes and or lumps on the lower residence of the legs. Symptoms that can be linked with the disease once contacted include joint swelling, joint wound, arthritis, ankle, feet, leg swelling. All of theses symptoms may not accrue in everyone and can vary from quiet in some people to severe in others. Showing more then one of these symptoms should be a edifying indicator that the person has contracted the disease and should consult a doctor.
Once a body is infected, Valley Fever will note up in one of three forms acute, chronic, or disseminated. Some of the forms are more rare then others. Depending on the obtain that Valley Fever takes, the severity of the effects on the body and how risky it can be will vary. The acute compose is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will expose the development of the disease. This can happen at any time during the year or any season. It affects both men and women equally and the systems will disappear like the body has caught the flu. Chronic earn is rarer and less current then the acute beget. It is more hazardous than the acute effect and can cause more problems. The chronic do can become evident and obtain after 20 or more years from when the person first got the infection. This may not have been found, treated, or even discovered by the person with the disease.
Valley Fever can cause infections in the body and create lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural dwelling or the place between the lungs and the ribs. This can cause serious injure to the lungs and the person will have a difficult time breathing. Other symptoms include grievous grade fever, weight loss, and nodules in the lungs. The disseminated build is the most uncertain and severe out of the three. This is when the disease spreads to the different parts of the body. The infection gets into the person’s bones, lungs, liver, meninges, brain, skin, heart, and around the heart. It is found that 30% to 50% of those people infected with this produce also score meningitis. This gain can be very deadly as it can cause swelling around the brain and spinal cord. With this develop, healthcare providers often eye ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening obtain and can cause death if not treated correctly. It can cause brain wound as well and can affect the brain/mental state of the person.
Everyone in the world is different and so not every person is going to be infected the same procedure. People of different color or hasten can contract the disease more readily then others of another hurry can. The people of Asian, Hispanic and African descent are more susceptible to the diseases than Caucasians. Even though it is really unclear why, those of color are 10-20 times more likely to procure the disease. Most cases that ended up in the emergency rooms were of Hispanic or African origin. Other people that have a high infection rate are people that are diabetics or weakened immune systems such as those with AIDS. Also women that are pregnant, in their third trimester or correct after their babies are born, are at an increased risk of getting Valley Fever. All of these factors will build it easy for them to catch the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight wait on as well causing them to glean worse quicker and will be more severe. Age is a astronomical factor as well seeing as older adults have a higher chance of developing Valley Fever then an younger age. This is because their immune systems are less active or have other medical conditions that lower their ability to fight off the infection. Individuals with used immune systems are at higher risk for complications which may lead to the disseminated execute. It lets the disease spread easier through out the body and lets it gather into the well-known systems of the body. This can fabricate the body more susceptible to other types of infections because of the further weakening in the immunity from Valley Fever.
Valley Fever, as stated, gets stirred up into the air from unique construction or gardening, allowing one to breathe it in. Once it gets into the lungs it sticks in the inner section of the lungs. There it will grow and multiply inside the lungs. Depending on what originate it takes it can certain up from there or release pus. This pus then can win absorbed into the body and stick to different types of organs. It can especially target places where it can originate up in such as joints, feet, and legs. This is because the fungi rep into the blood stream which will earn absorbed by muscles, bones, and under the skin where it can deposit and grow. If the immune system is not strong enough, it can not slay the infection which allows it to further mitigate as it builds in different spots of the body. Since it goes into the body’s blood stream it can derive to where ever the blood is flowing. This includes vessels around brain and the spine. This will cause different reactions such as the person affected might lose some perception and awareness because of the lack of tidy blood being given to the brain. With the fungi being deposited in places such as the feet or skin it causes swelling because it will invent liquid or more pus-like substance. This will cause the joints to swell up because of excess liquid causing arthritis. Besides looking at the symptoms of the person there are many other ways to choose if there is a Valley Fever infection. Different medical professions exercise different ways to decide the infection in the body and depending on the degree of the disease.
A chest x-ray can be taken to figure out if one is infected. In the x-ray the doctor would be looking for light areas in the lungs that are poorly defined or patch areas. The plot where disease is growing will prove up usually arrive or next to the ribs as most of it grows and deposits there. A skin test can be given as well and it is called the spheriulin skin test. This test looks to inspect if the person is infected with the fungus and since it is more sensitive it can acquire up signs of an earlier infection accurately. Spheriulin is an antigen that is connected with the fungi that causes Valley Fever. This substance is injected fair a petite below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will witness at the arm or the residence it was injected at 24 and 48 hours after the test. If the body has antibodies to the fungus, and it is in their system, the body with react and the region will become red and swollen. Although this test is not being ancient as worthy anymore because it is not as specific, it however is broken-down in researching to understand the disease. A more current test is a sputum culture. This is where the doctor or nurse retrieves sputum from the patient. Sputum is the mucus-like secretion in the bronchi tubes or where the air goes to the lungs, and comes up with deep coughing. The doctor or nurse will ask the patient to cough deeply and spit up any sputum into a sterile cup. This will be taken to a lab that allows it to grow to peek if Valley Fever is demonstrate. The doctor my tap on the chest or have the person inhale steam-like mist to back cough up the sputum in order to secure a better sample. One of the last tests that may be done is a coccidiodes antibody test. This test is where the blood is taken to analyze if there are any antibodies to the fungus in the body. If the antibodies are exhibit it can mean that there is an ongoing infection or a prior one. The test and blood may be taken a couple of weeks after to notice if there is a rise in the antibody count which determines the infection and how severe it may be. The higher the titer or antibody counts the worse the infection it is. These are all tests that the doctors may utilize in determining more accurately if the disease is demonstrate in the body. This is the only blueprint to be 100% positive that there is an infection.
Depending on the magnitude of the infection different treatment options will be provided by the doctors. Some of the forms may even dissipate with no medical interactions as well. The acute disease will usually go away without medical intervention. Favorite management is bed rest and treatment for flu symptoms until the fever goes away. With any of the other forms, medication would be needed to grasp care of the disease. If the predicament persists or if there is a higher possibility of complications and it is in its more severe design, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic invent or more acute effect that won’t go away, amphotericin B is usually the medication given to abet fight off the disease. Then the person is monitored as to earn determined the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to pick care of lesions that are localized. For the disseminated originate fluconazole or itraconzole is commonly archaic. The dosage is usually 400mg per day and in some cases 2000 mg of fluconazole or 800mg of itraconzole per day may have to be taken in 200mg doses. Amphoterican B may be musty as an alternate in this area if lesions are getting worse more expeditiously and is ancient to diffuse pneumonia. Surgery is famous in this case and in most reports at this stage it is essential. This is stale to recall care of gigantic abscesses, destructive lesions or bony sequestrations instability of the spine or the movement on essential organs such as the heart or tissues such as the spine. Since this create is the worst and in most of the time fatal more actions are required in recovery as compared to the more acute forms. Treatment of the disease does not fabricate it go away for kindly as relapses can occur or the person can accumulate it again.
The disease can have short affects and long term effects on the body. Depending on the person or the amount of spores inhaled, this will settle the longevity and affects of the person. The short affects include flu like symptoms and will go away. It is an annoyance objective like any time someone gets sick and the person can go on with their life with no pain. These people probably have higher immune systems. However, the longer the disease stays around in the body the more wound it will do. If it is prolonged in the body for an extended time it will open having more harsh affects on the body. The infection can spread to the bones in the body and cause deterioration or holes in the bones. This will discontinue with the patient through out their life. If it is in the body for the extended time it can cause variations of getting better then getting worse fluctuations as well as can cause relapses of the disease where it can reach benefit. If not treated, the non-acute fabricate will worsen over time and in most cases derive into other organs of the body and obtain the disseminated type. Taking care of the infection early on would be a generous strategy as Valley Fever can cause death if not treated at the true time. If the disease is prolonged it can cause other diseases or illnesses. These include forming pneumonia and meningitis which fabricate the condition that great more deadly and difficult to treat. As both of those diseases are fatal as well and can create unpleasant mixes with Valley Fever. Bleeding and lung abscesses could design which have to be medically treated and in some cases have to be done with surgery. Prolonged exposure can save the person at improper discomfort as the pus gets into the lungs and fills the lungs making them feel like they’re drowning and can’t breathe. This can cause many dreadful effects as the body can’t score enough oxygen into the body. People that already have respiratory problems such as asthma can be compromised and hinder the lungs from working efficiently. This can cause a more acute accomplish such as short of breath to something more unsafe as not getting any air in and halt breathing without medication or immediate treatment. Most importantly the disease should not be taken as lightly as it can cause death if overly prolonged or gets into its most perilous forms in the body. Many problems and complications would have to happen in order for it to collect to that severe of stage. As long as the disease is recognized and treated (if need be) then the affected person can easily recover.
Many people who have Valley Fever don’t even know they have had it because the severity changes in everyone and 40% of the people would explain symptoms and require itsy-bitsy to major treatment. This disease changes over longer periods of time. A person may have some time to go look a doctor before they feel the severity of the disease. Though, as stated earlier, waiting for long periods of time to contemplate medical care would not be sterling to one’s health. This disease is taken in most of the medical field taken very lightly even though misdiagnosis and prolonged exposure to the disease can be fatal to the person’s health. It can have affects on the body that cease with them for years at a time or even there entire life. This is something that if in quiz consulting a doctor would be the best course of action so treatment can start so complications don’t arise.
Infected Individuals & Insurance Companies
There are many distinguished stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the yell of Valley Fever. Arguably, the role of infected persons or those that contain a new vulnerability to the disease is top priority on the decision-maker’s list. Each year, thousands of people are diagnosed with Coccidioidomycosis in Arizona alone. In a 2007 article, the Washington Post wrote that Valley Fever cases diagnosed in 2006 were up fifty-six percent from a year earlier. This prompted Arizona health officials to effect the disease at, “epidemic proportions,” as thousands of other cases likely went undocumented. It has also been reported that anyone who has spent enough time in Arizona, or any other piece of the Southwestern United States where soils gain the Valley Fever fungus, will contract the disease at some point. Only a exiguous percentage of people, however, are diagnosed with a severe enough accomplish of the infection where medical treatment is needed. Anti-fungal medication is the most accepted treatment for Valley Fever. But, there are rare cases where surgery is required to fully recover from the disease. Overall, tens of thousands of cases are reported around the United States annually and the number of Valley Fever-related deaths is estimated at 50-100 each year. It is principal to stare individuals currently struggling with the disease as well as those who have recovered from a serious produce of Coccidioidomycosis as a stakeholder with regards to this pronounce because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an wretchedness to better succor this claim, the lives of two patients that contracted a serious develop of the infection, will be addressed and analyzed in the following paragraphs.
Before introducing specific cases, it is notable to review some fresh facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Describe in October 2008. The recount, co-compiled by the Office of Infectious Disease Services and the Bureau of Epidemiology and Disease Control, presents the amount of Coccidioidomycosis cases reported in 2007 through a myriad of graphs. These graphs pronounce the research information in a thorough and comprehensive blueprint to the reader by dividing up Valley Fever statistics for the 2007 year in a multitude of categories. Some of these categories include: cases reported in ‘07 according to specific age groups compared years past and a five-year average, separating the number of Valley Fever cases reported by counties in Arizona, and separating the number of Valley Fever cases reported in both mining and non-mining areas within the situation. Although many people judge of this disease as a tranquil illness similar to the popular chilly, Valley Fever is a key content amongst Arizona residents as well as both local and national governments. In 2008, the Arizona Department of Health Services received funds for Valley Fever prevention and control from a legislative appropriations committee. The Center for Disease Control and Prevention (CDC) also awarded the department funds for continued research. As portion of the 2007 characterize, Health Services interviewed roughly ten percent of all Arizonans diagnosed with Coccidioidomycosis during that year. According to the ADHS, the following are some of the most alarming facts that were discovered from the interviews:
• People missed an average of 1 month of work, for a total of 4,918 days
• People with Valley Fever could not build daily activities for an average of 3 months or a total of 92 years
• People with the disease waited an average of 44 days before seeking healthcare
• Patients saw their doctors three times before they were tested for Valley Fever
• There were $86 million dollars in hospital charges for Valley Fever in 2007
Furthermore, Arizona has the highest number of reported Valley Fever cases annually in the United States, accounting for sixty percent nationwide. In total, more than 150,000 people across the country are estimated to contract some beget of Coccidioidomycosis each year. The Arizona Department of Health Services reports that the severity of Valley Fever in the set continues to grow as do the overall number of persons infected each year. Due to the fact that currently there is no cure or vaccine for the disease, every person that is susceptible to the effects of Valley Fever certainly shares some kind of stake in the debates of the converse. Examining the personal accounts of two anonymous patients afflicted with a serious acquire of Coccidioidomycosis can bring further clarity to this claim. Any and all personal information for the following accounts has either been fictionalized, changed or generalized to possess complete anonymity.
The first case will put a question to the contaminated effects of Coccidioidomycosis on a male patient of early adulthood age. This individual will be referred to as Patient “V” throughout this paragraph. Patient “V” began his ordeal with Valley Fever in the summer months of 2001. A younger man in the final years of adolescence, Patient “V” experienced generic, flu-like symptoms, which he disregarded as nothing indispensable like most other sufferers resolve to do. “At first, I noticed that my lymph nodes in my neck were unusually swollen…I figured it was fair a frosty or some runt infection or something like that.” Soon after the initial stages of the disease, Patient “V” began experiencing constant, severe afflict in the left side of his chest. Although he made numerous medical appointments for this spot, the afflict would subside by the time Patient “V” arrived, making it difficult to diagnose the quandary. “What was happening was my left lung had a hole in it and it kept collapsing and then re-inflating by the time I got to the doctor’s office.” Eventually, a chest x-ray was performed on Patient “V” and this revealed a dinky, dim residence on his left lung. The position indicated a relatively runt, but primary hole through the lung. The pickle required corrective surgery and Patient “V” was admitted to one of Arizona’s hospitals in August, 2001. Surgeons sewed up the hole in Patient “V’s” left lung and released him after a day of recovery. Within weeks following the surgery, Patient “V” experienced a relapse of his earlier symptoms. “…I was playing Volleyball one night and in an instant, there was this intense wound in my chest…I felt dizzy and could hardly breathe.” Patient “V” immediately returned to the hospital sometime in November of that year where further tests concluded that the infected fraction of his left lung was, indeed, Coccidioidomycosis. Another surgery to completely capture this part of infected lung was performed successfully and Patient “V” spent more time recovering in the hospital. “The effects from the disease itself were painful enough, but the worst harm came from the chest tubes that were inserted into me in the hospital…At one point, they shoved one of the tubes through my ribcage and into my lung and I wasn’t even on harm medication.” Fortunately for Patient “V”, the second surgery was successful and he survived his brush with Valley Fever. In many cases, patients who contract and fend off the infectious spore perform up life-long immunities. However, reports have also shown that patients in remission from Coccidioidomycosis can be more vulnerable to a reoccurrence of the disease than those that have never contracted it. Following his surgical recovery, Patient “V” was prescribed an anti-fungal medication called Diflucan, a celebrated drug distributed to sufferers of the infection. Patient “V” was required to steal this medication daily for 2-3 years. He now receives chest x-rays once a year to check for any returning signs of the fungus. Patient “V’s” scar tissue has also become virtually unrecognizable after nearly a decade of recovery.
The second case to be analyzed will be that of a middle-aged female patient. Appropriately, this patient will be referred to as Patient “F” throughout the analysis. Patient “F” contracted Valley Fever in leisurely 1995. Early symptoms experienced in this patient included chronic loss of breath and obscene joint discomfort. The obtain of Coccidioidomycosis contracted by Patient “F” was not diagnosed correctly until 2 ½ years after symptoms began. Before visiting a pulmonologist, Patient “F” was given a chest x-ray, where a substantial, round nodule was located somewhere on her left lung. The patient was admitted to the hospital in 1998 and underwent a wedge resection, to catch the infected share (removed in wedge beget) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at bulky strength for six bulky months; and then half the dosage for another six months. The patient continued to have fevers following the surgery. She also had an excess amount of fluid in her lung. Patient “F” returned for a second surgery to further orderly the infected location and completed another sequence of antibiotics afterwards. The time spent in the hospital for recovery totaled at six days for each surgery. Patient “F” was fortunate enough to have flexible employment benefits to fully recover. “My company provided short-term disability; up to 6 months with 100% pay…I was very lucky.” As far as medical coverage is concerned, Patient “F” had tiny out-of-pocket costs through United American. However, she was collected timid to inspect the total amount owed from her discontinue in the hospital. “The bill after six days in the hospital, which included one day in ICU and five days on a regular floor, was extraordinary. Unbiased for room and board and a limited medication, the bill was $28,000.00.” Today, Patient “F” has fully recovered from the infection and only has one suggestion with regards to the grunt of Valley Fever. “Educate physicians on the east cruise and west flee, all over the Untied States to properly test for Valley Fever.”
Needless to say, there are always financial burdens associated with any type of surgery as well as prescription medication. In the case of Patient “V”, a total of nearly $180,000.00 was accrued in hospital bills after the two surgeries were performed. Additionally, the drug Diflucan can range from 36 dollars to 60 dollars for 100mg/10 pills depending on the space of capture. It is distinguished to view medical insurance companies as a stakeholder with regards to the exclaim of Valley Fever as well. Because there is no cure or vaccination for the infection, insurance companies limit the amount of coverage to persons with preexisting conditions. If a cure were to be developed and released into the market, insurance companies would most likely include Valley Fever coverage into any idea. Unfortunately, without medical insurance, the overall amount of money needed to recover from a serious infection like Valley Fever is simply insurmountable for the majority of Americans. Even with sufficient medical insurance, however, people who have had Valley Fever in the past are typically not covered for a relapse of the infection. Patient “V” currently receives individual health insurance under a PPO from Blue Imperfect Blue Shield of Arizona. As mentioned earlier, however, major insurance companies like this one tend to limit coverage to individuals with preexisting conditions. According to an article on www.howstuffworks.com, a preexisting condition is a health condition or illness that you have had before your first day of coverage on a fresh conception with an insurance company. Typically under group coverage, such as that offered by a corporation under an employee’s benefits, a person with a preexisting condition can procure paunchy coverage, but will have to wait anywhere from nine months to a year before it kicks in. This period is enforced by insurance companies to insure that a patient is not constantly having relapses of the same condition. However, a person with a preexisting condition will rarely receive private health coverage that includes their condition. This is referred to as the preexisting conditions exclusion. Our attempts to contact major medical insurance companies or medical insurance agents for further clarity on this jabber went unanswered. Unfortunately, people like Patient “V” who have preexisting conditions, are self-employed and do not qualify for group medical insurance will have to pay out-of-pocket if their conditions return. “I would have to affirm bankruptcy if that happened…” Patient “V” explained. “I live in dread because I know that if I were to derive it again, that would be disastrous.”
Currently, a vaccination for Coccidioidomycosis is under development at the BIO5 Institute on the campus of the University of Arizona. Leading the development is Dr. John Galgiani, Director of the Valley Fever Center for Excellence and Chief Medical Officer for Valley Fever Solutions, Inc. This vaccination will be intended for both humans and dogs, which can also contract deadly forms of Valley Fever (this topic will be further discussed in later sections of this peek). In March, 2008, Dr. Galgiani teamed up with fellow BIO5 colleague Dr. David Nix of the Department of Pharmacy Practice and Science to research the vaccination. “We had some complimentary expertise and mine’s mainly in the spot of drug development and drug development science and so on. And Dr. Galgiani is kind of the world’s expert on Valley Fever,” Dr. Nix reported in a 2008 Valley Fever instructional video produced by the University of Arizona. The two physicians, under the company name Valley Fever Solutions Inc., are financially backed by the University, private donors and C-Path, a Unique York based foundation. They are currently testing an anti-fungal called Nikkomycin Z, which was first old to prevent fungal degradation in develop. With approval from the U.S. Food and Drug Administration, Nikkomycin Z is in Phase 1 of drug safety trials. According to a news release published on the BIO5 Institute’s website, “The company has already obtained a Science and Translational Technology Research (STTR) grant from the National Institutes for Health that will abet fund pharmacology studies that will wait on create future clinical trials. The first phase of that grant is worth more than $100,000, with the potential for an additional $700,000.” If this vaccination proves to be a viable cure for Coccidioidomycosis, many aspects of the affirm of Valley Fever would certainly change. Once a cure hits the market, the number of deaths and serious cases as a result of Valley Fever would descend significantly. Debates between the government, politicians and special interest groups would decrease as well if no one were in any valid threat of the infection anymore. Briefly returning to the topic of medical insurance, people with Valley Fever as a preexisting condition will be able to feel more get because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Faulty Blue Shield, Cigna and Humana will more freely distribute plump coverage in instances of Valley Fever. Like most vaccinations and cures to accepted infections or diseases, there would be many certain outcomes to releasing this drug into the medical market, pending the completion of all drug safety trials.
As famous stakeholders with regards to the snarl of Valley Fever, both infected persons and medical insurance companies would be greatly affected if an executive decision were to be made, or possibly a vaccination released into the market. While the future looks helpful with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people salvage a diagram to collect health insurance coverage to some capacity. It is also considerable that individuals with preexisting conditions that aren’t on group medical plans lobby for their rights to complete insurance coverage. In considering the wrong effects of Valley Fever, there are many people who judge this topic is objective as significant to the animal world as well.
Infected Animals
Valley Fever does not only affect people but it is now more commonly being found in animals. Animals are unbiased as likely to earn Valley Fever as humans are. Animals glean Valley Fever in the same diagram as humans do, by breathing the fungus. It has been found that more and more animals are being reported of becoming ill due to this fungus. It has been found the 30-40% of animals who breathe in the fungus secure sick. Some of the most popular animals to be reported with Valley Fever are dogs, cats, llamas, non human primates, horses, and zoo animals (3).
A golden retriever went into the vet’s office; the dog wasn’t feeling well and wasn’t acting himself. The vet takes an x-ray of the dog’s lungs and sees white spots in the lung state where there should normally be sunless patterns. The white spots present that the dog might have cancer in its lungs. The dog is only four years archaic, which is when a dog should be at its prime and not getting lung cancer. Lung cancer isn’t usually found at this young of an age and doesn’t seem to construct as rapid as it has in this golden retriever. The owner had said unprejudiced two weeks prior to going to the vet that the dog was plump of energy on their vacation. The veterinarian doesn’t all the facts add up for the dog to have cancer so she decided to hasten a few more test before she starting treatment for lung cancer. The dog’s health over the course of time starts to go downhill and very fleet. The dog starts to cough, has a loss of appetite, and runt to no energy. The vet then found out where the human family had recently traveled and they were in the Southwest. After hearing this, the vet clear that it must be a fungal disease and it was unbiased that, it was Valley Fever (1).
Dogs are the largest infected and most commonly reported animals with Valley Fever. Dogs score Valley Fever in the same diagram that humans do and in the same regions as humans do. The fungus is spread through spores which dogs can easily inhale. Once the fungus is inhaled, the spores grow into spherules which enlarge and eventually burst into hundreds of endospores (3). This causes the spreading of the infection into the lungs. A dog’s immune system should acknowledge and surround the infection to ruin it. Dogs that do not become sick due to the fungus are considered to be asymptomatic (2). When a dog does become sick from Valley Fever, their immune system fails to end off the infection and the infection continues to spread into the lungs and then can move throughout the dog’s body (3).
Once a dog is infected with Valley Fever, there are distinct symptoms that become indicate. Some of the symptoms that are seen in dogs are weight loss, coughing, fever, lack of appetite, and lack of energy (3). The cough in dogs can be seen as early as the first week of getting the infection to as gradual as 3 weeks. The cough that dogs pick up is due to the development of pneumonia which is visible on x-rays. The coughing can be caused due to pressure on the lymph node approach the heart and puts pressure on the dogs windpipe which as a result irritates it (3). After the cough is explain the loss of appetite and energy is soon to follow. If the infection is not controlled it can become grand worse and spread throughout the body. When the fungus is spread throughout the body it causes systemic or disseminated disease (3). When this happens the symptoms and condition of the dog becomes worthy worse. The symptoms that become display are: swelling of the limbs, aid and neck damage, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, witness inflammation, and non-healing skin ulcerations (3). Not all symptoms are expose true away and it can acquire several months before positive symptoms appear. It can be several months after a cough appears that other symptoms become prove. There is typically an order that the fungus spreads throughout the dog’s body. The first organ to be effected is lung, and then the infection usually spreads into the bone, than eyes, heart, testicles, brain, spinal cord, and finally abdominal organs (2).
To decide if a dog has Valley Fever there are different test that can be done. Some of the most favorite test done to choose if a dog has been infected is blood tests, chest x-rays, bone and joint x-rays, and Valley Fever blood test (3). Test results may indicate up negative up to 3-4 weeks of receiving the infection so in some cases test need to be repeated to confirm that the dog does or does not have Valley Fever (2).
There are different treatments that be done to befriend fight the fungus. The process of treating Valley Fever may be long; medication can be given for up to one year (2). The length of time that the treatment will rob usually depends on how far the fungus has spread throughout the body. Most commonly oral antifungal medication is given to the dog. These antifungal medications are ketoconazole, itraconazole, and fluconazole (2). Ketoconazole is the most commonly prescribed medication due to the fact that is it the least expensive. This drug is usually given twice daily and with food. Itraconazole is a more expensive medication but has fewer side effects than ketoconazole. Itraconazole is also better for dogs that are having problems keeping their food down because it has a faster absorption rate (3). The third medicine most commonly given out for treatment is Fluconazole and it is also expensive with itsy-bitsy side effects. This is usually given to dogs that have pain done to their spinal cord and nervous system (3).
Cats, llamas, non human primates, horses, and zoo animals are other animals that have been reported with Valley Fever. Cats that have Valley Fever prove the same symptoms as dogs do but it less likely for a cat to regain Valley Fever than it is for a dog. Cats bag Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats come by the fungus their symptoms are usually a minute more advanced than dogs. Two of the major symptoms seen in cats that have Valley Fever are unexplained weight loss and skin ulcerations that won’t go arrangement. The same treatment for dogs can be extinct to treat cats with Valley Fever (3).
Horses are another animal that have been found to secure Valley Fever. There have not been very many cases reported but in the ones that have only one horse has survived Valley Fever with treatment. All the other horses that were reported with Valley Fever had to be euthanized. The reports of these cases are not very new though, and with medical technology improvement chance of survival with unusual medicine is considerable better for horses today (3). Llamas are another animal that have been infected with Valley Fever. Llamas are very sensitive to this fungus. In most cases, if a llama has Valley Fever death is almost always the outcome.
Zoo’s that are located in the Southwest are very aware of Valley Fever. Many zoos have lost animals due to Valley Fever before they were aware of what is was and how to treat for it. When animals become sick, Valley Fever is something that is tested early so treatment can be started. In zoos, the most celebrated animals to rep Valley Fever are: Monkeys, Apes, and other primates. These animals utilize the same treatment process as dogs and cats but is usually consists of a lifetime treatment (3).
Valley Fever is a very serious teach that is rising in animals. Currently there are no preventatives for Valley Fever. The treatments for Valley Fever for animals has become better and better over time. The arrive in technology has allowed for veterinarians to be able to detect Valley Fever at a less arrive stage. The early stage that Valley Fever is caught at allows for a better chance of survival of animals infected with the fungus.
Construction
There is no doubt that construction companies contribute significantly to Valley Fever. According to the MayoClinic, institution known for prominence in the medical field recognized the increase in right estate has contributed to the spew of “thousands of tons” of dust carrying this fungus into the air. The article looks at how in the 1990s the accounts of Valley Fever increase in the states of Arizona and California due to some necessary factors. Among those factors like dry climate, the unusual building booms have been one of the most indispensable factors that have contributed to such increases. The expeditiously clearing and building were a vital source for the increase in reported cases of Valley Fever. Among all the contributing factors of Valley Fever, environmental exposure ranks high, if not the famous cause. Experts also added that almost half of the people who live in areas where Valley Fever is prevalent have contracted the disease. Interestingly, people who are at most risk are those who are exposed to directly to dust like those who obtain jobs in the field of construction, ranching and agricultural work (1).
The decade following the 90’s has had a gargantuan increase in reported cases of Valley Fever. Those areas that have reported such increases are the states of California and Arizona. These states have been induced with a massive building command. The mass migration to these “sun belt” states made for a widespread land clearing and construction, which ultimately directly contributed the spread of the air borne fungus (2). Importantly, some measures are currently in location to purposely lop the amount of dust construction companies contribute to the environment.
The Environmental Protection Agency (EPA) is an agency of the federal government of the United States who is in charge of protecting human health by maintaining the natural environment kindly (3). This implies its commitment and dedication to monitoring and posing regulations for anything threatening the quality of the air. The EPA has area limits on how worthy pollution is allowed to be in the air. In its goal to gain and manage the air we breathe, EPA has passed several pieces of legislation that have reduced the amount of smog and pollutants in the air. Among vital legislation is the Super Air Act which has been passed to enforce well-organized air standards and improve human health. The Dapper Air Act is an outline for what national, set, and local authorities must follow in order to protect air quality. Under the Orderly Air Act, local and station authorities are responsible for abiding by the national ambient air quality standards. The Environmental Protection Agency states Maricopa Country cannot exceed the federal health standard for particulate pollution more than three times in a three year period (4).
According to the Environmental Protection Agency (EPA), Maricopa County has been in violation of particulate pollution since 1996. Particularly 2008, there have been nine different days where at least one of the monitors exceeded the federal health standard for particulate pollution. The health standard for particulate pollution is that it cannot exceed more than 150 micrograms per cubic meter measured over a 24 hour period of time. It’s notable to know Maricopa County has 24 air monitoring sites in the Valley. The location of Arizona, under the Arizona department of environmental quality has its gain air monitoring sites as well. If any of these monitors exceeds the federal health standard for a given pollutant, the EPA will possess Maricopa County accountable. According to the Environmental Protection Agency (EPA), Maricopa County failed to arrive attainment for particulate pollution and thus is under federal orders to slit particulate matter pollution. In an attempt to address the content, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a idea to the EPA to expose how the county plans to gash PM10 emissions by five percent each year until fine levels are reached. The Five Percent View outlined more than 50 commitments to cut dust. Of these commitments, some affect the procedures and guidelines on construction entities (4).
Speaking with Erin Dunsey of Maricopa County Air Quality Department, the county is currently working hard to pose regulations on construction companies in order to lower dust emissions and ultimately lowering the potential threats from Valley Fever. The principle responsibility for The Maricopa County Air Quality Department’s Dust Compliance Division is to protect the public from the dangers that advance from airborne particulate matter (7). This division of dust compliance deals with fugitive dust sources and the rules to minimize the production of it. This means that fugitive dust from any source, including constructions areas, must be restricted in their construction operations to own within obedient dust standards. As fraction of the compliance, Maricopa County has devised that all sites with scared surface areas of dust must comply with “Rule 310″ (5).
Under Rule 310, the Dust Compliance Division has established limitations and requirements for the implementation of process controls as well as other guidelines that will befriend enforce first-rate fugitive dust control measures. One of the first major steps for construction companies to follow is the obtainment of a permit. The Air Quality Department requires a construction permit for companies who view to conduct activities any that will disturb a surface position equal to or greater than 0.1 acre. Complying with the construction permit requirements is often a valuable and daunting task. Before applying for a permit, a notion that outlines the measures that will prevent the creation of dust must be presented. This notion also describes all the measures that will be implemented at anytime during the phase of construction. Therefore, this guideline requires dust generating sources to meet standards and at the same time apply best the available control measures in order to attempt to minimize fugitive dust emissions. This draw being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on location understand their responsibility while on area (6).
Another hassle that companies have to deal with is the logging of control measures. Once again, under Maricopa County’s Rule 310, construction companies who conduct a dust generating operations that require a Dust Control Idea must maintain a written log recording the sincere application and execution of the control measures previously outlined and celebrated by the Dust Control Concept. This is a daily detailed recordkeeping which records what actions are being conducted in dust-generating operations in what may include daily inspections for crusted or damp soil. Another fragment of represent keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and enjoy shocked surfaces must install a trackout control devise. These devises are large contributors to the retention of fugitive dust. Trackout is simply the particulate matter from tires and other sources that have fallen onto paved areas that are accessible to the public. The rule states that trackout must be tiny to 25 cumulative linear feet (6).
Rule310 is an extensive and overwhelming position of requirements established to lower dust emissions. Fragment 309 list another requirement under Rule310 that companies must abide by. The rule says that if the place of interest is more than one acre a series of dust control training must choose space. All workers directly keen in the containment of dust like the water truck drivers and water pull drivers must select a basic dust control training class in which attendees will ultimately become certified if successfully completed the training class. An extension from this portion lists that a dust control coordinator must be prove on job space if the dimension of the job plot is five acres and up (5). These onsite coordinators must have completed a comprehensive dust control training in which they are given expedient training on regulating emission of fugitive dust and learn practical methods to do so, such as tidy up, water and dust suppressant applications (6).
Construction companies are required by set and federal law to implement a diligent anguish to control dust pollution. If at any time violations are committed, these companies will be subject a fines and penalties. This has been yet another quandary companies have had to face on a regular basis. The penalty policy held by the Maricopa County Air Quality Department seeks to prevent future violations. Fines that are placed upon companies are definite by the severity of the violation committed. Several factors are extinct to calculate the amount of a penalty. In case there has been an economic attend of noncompliance by the company, the penalty will consist of weighing out the benefits that were looked to have been extracted.
Dust control compliance has also become a financial setback for construction entities. The Maricopa County Air Quality Department announced that in the month of October $452,589.90 in air quality violations was peaceful (9). In the month of September, the amount of $471,613.30 was calm in violations all related in one device or another to air quality control. This is the anxiety construction company’s face for not correctly using effective measures to cut dust in the construction sites, therefore causing potential problems to reach residents and workplaces, eventually becoming a financial quandary due to fines.
There is no better blueprint to understand how troublesome the strict regulations have become a burden for construction companies. While searching for construction companies within the valley, Turner Construction Inc. drew attention as it is well known as a immense construction company that has a corporate office in Tempe, AZ. With a expect to divulge to a construction manager, a brief conversation was held with a construction project manager from Turner Construction. The conversation revolved around how Valley Fever has affected their procedures during construction or related tasks. Immediately it became determined honest how noteworthy companies who are in the construction industry are affected by laws to encourage crop the incidents of Valley Fever. Jason Jones, who is a project manager at Turner Construction Company, explained that all construction companies have been hit hard by Maricopa County. Amongst the things mentioned was the fact that the main effort for the county is dust control. As a result for the growing worry over dust control, they have to follow a “rigorous dust program” to comply with regulations. Jason explained how they are currently working on a 242 acre development complex and have had to expend around 400,000-750,000 gallons of water to control dust governed by Maricopa country. He added that this adds to the costs of the construction project as trucks and workers are venerable to fill fugitive dust. If they ever do not comply with these regulations, fines initiate from about $1,000 to 10’s of thousands of dollars. He added that Maricopa is the “worst county in America for dust regulations” (8).
The main jam is that construction companies have to follow strict regulations on their dust production. The county of Maricopa has been enforcing even stricter laws to prevent and aid acquire dust levels to a minimum as they have recently been under serious scrutiny from the Environmental Protection Agency. If for some reason these companies are not correctly using effective measures to lop dust in the construction sites, gigantic fines will follow. This is yet another roar companies are dealing with. To the load even greater, these companies also deal with the economical state backs from following these regulations. For companies to prick and comply with county regulation, thousands of dollars are being forcefully spent by such companies. The contributions construction companies effect to Valley Fever is not underestimated. As a result, strict regulations are followed and posed upon companies to crop the incidence of Valley Fever cases. Valley Fever has arrive to cost companies thousands of dollars and is becoming every day more of an worry.
Conclusion
After studying the stakeholders keen in Valley Fever, it is easy to survey well-liked themes between them. There is no doubt that while not known as a uncertain disease, Valley Fever has the potential to be one. With the number of cases increasing each year and relatively microscopic research being done for prevention and cures, Valley Fever has earned the title as an emerging epidemic. While Coccidioides immitis only lives in a few bewitch areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and animated to endemic areas. It also must not be forgotten that Valley Fever has the capability to affect animals as well humans increasing the cost of the disease for these species. It is sure that because of this, action must be taken in order to crop the number of cases and to decrease the severity of the cases.
This case contemplate points to a few relatively easy steps to occupy in order to decrease the severity of Valley Fever cases. The most significant and most definite step is early detection. It was shown that the earlier that the disease is diagnosed, the less severe the symptoms and the less impact it has on the infected individual. Despite this easy solution, doctors saw their patients and average of three times before they tested for Valley Fever and the patients on average waited 44 days before treatment. These statistics point to a general lack of awareness this disease in both the patient and the medical world. In order to promote early detection, there must be better instruction of symptoms and complications fervent in prolonged disease available to both the medical community and the population of endemic areas. This in theory would gain an awareness of the disease and help earlier testing for it.
There are a few steps that can be taken in order to carve the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also attend prick the number of cases. Public awareness of Valley Fever would nick the number of cases by providing the people with knowledge of its causes and ways to avoid exposure to the Coccidioides immitis spores. The second step that should be taken is a national focus on research in vaccines and cures for this disease. From this case ogle it is determined that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the plot in some circumstances. These high costs are unacceptable when relatively shrimp investment is being made in the research of a cure or vaccination.
When considering these recommendations, it is well-known to review the facts about this disease. Valley Fever is caused by the spores of a fungus that can become airborne when soil is jumpy. This fungus is endemic to tall portions of the American southwest including Phoenix, Arizona, the nation’s fifth largest city. Statistically, anyone living in endemic areas is likely to find this disease at least once in their lifetime. On top of those living in endemic areas, those visiting the spot have a high chance of contracting the disease. The number of cases has risen consistently each year for at least the last seven years. After reviewing these facts it is certain that Valley Fever has had a notable impact on our society and that steps need to be taken to nick its prevalence.
References
Introduction
(1) Chuang, Amy. “Disseminated Coccidioidomycosis in an Immunocompetent Person Living in Unique York City”. Journal of Urban Health: Bulletin of the Unusual York Academy of Medicine, Vol. 82, No. 2, doi:10.1093/jurban/jti057
(2) Comrie, Andrew C. “Climate factors influencing coccidioidomycosis seasonality and outbreaks. Environmental Health Perspectives. June 2005 http://findarticles.com/p/articles/mi_m0CYP/is_/ai_n14816419
(3) DiSalvo, Dr. Arthur. Mycology – Chapter Six Dimorphic Fungi. 21 Nov. 2008 http://pathmicro.med.sc.edu/mycology/mycology-6.htm
(4) McKinley, Jesse. “Valley Fever hits epidemic numbers from Texas to Northern California”. Unique York Times. 30 Dec. 2007 http://www.sfgate.com/cgi bin/article.cgi? f=/c/a/2007/12/30/MN12U6OGF.DTL&feed=rss.news
(5) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .
Medical Industry
(1) “Coccidioidomycosis..” NGC – National Guideline Clearinghouse . 1 Nov. 2005. 2 Nov. 2008
(2) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .
(3) “Valley Fever – Valley Fever Connections.” Valley Fever – Valley Fever Connections. 22 Nov. 2008 .
(4) “Valley fever – MayoClinic.com.” Mayo Clinic medical information and tools for healthy living – MayoClinic.com. 15 Mar. 2008. 22 Nov. 2008 .
(5) Interview Roni Cummings, Quality risk management: Notes in hand
Infected Individuals & Insurance Companies
(1) Arizona Department of Health Services. (2008). Valley Fever Annual Relate 2007 (1st ed.). Phoenix, AZ: Arizona Department of Health Services, Division of Public Health Services.
(2) Interview with Anonymous Patient #1: Patient “V”. (Personal Communication, November 15, 2008).
(3) Interview with Anonymous Patient #2: Patient “F”. (Personal Communication, November 17, 2008).
(4) The Associated Press (2007, January 11). Ariz. Valley Fever Cases Soared in 2006. The Washington Post. All Pages.
(5) Unknown Author. (2008, October 29). Arizona Company Seeks Valley Fever Cure. BIO5 Institute News Archives. All Pages.
(6) Arizona Department of Health Services Webmaster. (2008, November 3). Infectious Disease Epidemiology. Retrieved November 15, 2008, from http://azdhs.gov/phs/oids/epi/disease /cocci/index.htm
(7) Author Unknown. (Last modified October 30, 2008). How Pre-Existing Conditions Work. Retrieved November 15, 2008, from http://health.howstuffworks.com/pre-existing-condition.htm
(8) BIO5 Institute at the University of Arizona. (2008). BIO5 Institute Home Page. Retrieved November 15, 2008, from http://bio5.arizona.edu/index.php
(9) Pfizer Inc. (Unknown Date). Pfizer Products. Retrieved November 15, 2008, from http://www.pfizer.com/products/rx/rx_product_diflucan.jsp
(10) Roerig, Division of Pfizer. (Last revised March 2008). Diflucan (LAB-0099-10.0). Retrieved November 15, 2008, from http://media.pfizer.com/files/products/uspi_diflucan.pdf
(11) The Mayo Clinic. (2006, March 17). Diseases and Conditions Valley Fever. CNN.com & MayoClinic.com. Retrieved from http://azdhs.gov/phs/oids/epi/disease/cocci/index.htm
(12) The University of Arizona. (Video Production). (2008, March 8). Innovation Day at UA 2008, UA @ the Leading Edge [Episode 1]. Development of the Valley Fever Vaccine. Video retrieved from http://www.youtube.com/watch? v=kgT0hFo49G4
(13) Valley Fever Center for Excellence at the University of Arizona. (2003). Valley Fever Center for Excellence: Coccidioidomycosis. Retrieved November 15, 2008, from http://www.vfce.ar izona.edu/
Infected Animals
(1) Mitchell, Chris. Blastomycosis, Cryptococcosis, Coccidioidomycosis (Valley Fever), Histoplasmosis, Disease and more. Animal Shelter Org. 2004. November 4, 2008.
(2) Valley Fever (Coccidiodomycosis). Mar Vista Animal Medical Center. 2006. November 5, 2008. http://www.marvistavet.com/index.html
(3) Valley Fever in Dogs. Valley Fever Center for Excellence. 2008. October 18, 2008.
Construction
(1) “Valley Fever” 1998-2008 Mayo Foundation for Medical Education and Research. Outbreak grips Arizona. March 17, 2006
(2) Benjamin J. Park, Keith Sigel, Victorio Vaz, Ken Komatsu, Cheryl McRill, Maureen Phelan, Timothy Colman, Andrew C. Comrie, David W. Warnock, John N. Galgiani, and Rana A. Hajjeh. “An Epidemic of Coccidioidomycosis in Arizona”, 1998-2001. The Journal of Infectious Diseases, 2005. 1 June.
(3) U.S Environmental Protection Agency. The orderly air act amendments of 1990. Clean Air Act. November 10th, 2008.
(4) MAG 2007 Five Percent Understanding For PM-10 For The Maricopa County Nonattainment Plot. December 2007. Maricopa Association of Governments. < (www.mag.maricopa.gov)>
(5) Maricopa Air Quality Department. (2008). Dust Control. [Brochure]. Dust Compliance Resources Maricopa County.
(6) Maricopa County Air Pollution Control Regulations, Regulation III-Control of Air Contaminants Rule 310.
(7) Toribio, Jeovanny. “Maricopa County and dust regulations.” E-mail to Erin Dunsey. Oct. 21, 2008.
(1) Jason Jones, Turner Construction Inc, Oral interview, Done 10-21-2008
Notes in Authors hand
(2) Maricopa County Air Quality Department. “Air Quality Violators pay over $452K in October”. November 3, 2008. News.
