Valley Fever is the accepted 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 thought that they had contracted it. The other forty percent accumulate symptoms ranging from quiet to severe, including death. This emerging disease has had a spacious enact on the human and animal populations in the endemic areas.
When soil containing these fungal spores is paralyzed 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 unique years, cases in prisoners at a California Central Valley correctional have reached as high as 1 inmate in every 10 tested (4).
The famous 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 collect smooth to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each accomplish ranges from minor to severe consequences. Most valuable of all, is to know what the symptoms of Valley Fever are. There are ways to train 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 plot. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will originate to invent painful rashes and or lumps on the lower situation 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 level-headed in some people to severe in others. Showing more then one of these symptoms should be a worthy indicator that the person has contracted the disease and should consult a doctor.
Once a body is infected, Valley Fever will present up in one of three forms acute, chronic, or disseminated. Some of the forms are more rare then others. Depending on the beget that Valley Fever takes, the severity of the effects on the body and how hazardous it can be will vary. The acute construct is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will explain 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 go like the body has caught the flu. Chronic obtain is rarer and less well-liked then the acute gain. It is more risky than the acute beget and can cause more problems. The chronic compose can become evident and gain 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 beget lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural location or the region between the lungs and the ribs. This can cause serious hurt to the lungs and the person will have a difficult time breathing. Other symptoms include outrageous grade fever, weight loss, and nodules in the lungs. The disseminated build is the most risky 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 originate also fetch meningitis. This construct can be very deadly as it can cause swelling around the brain and spinal cord. With this compose, healthcare providers often explore ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening construct and can cause death if not treated correctly. It can cause brain injure as well and can affect the brain/mental situation of the person.
Everyone in the world is different and so not every person is going to be infected the same plan. People of different color or accelerate 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 regain 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 legal after their babies are born, are at an increased risk of getting Valley Fever. All of these factors will do it easy for them to secure the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight relieve as well causing them to rep worse quicker and will be more severe. Age is a vast 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 archaic immune systems are at higher risk for complications which may lead to the disseminated make. It lets the disease spread easier through out the body and lets it gather into the important systems of the body. This can execute 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 fraction of the lungs. There it will grow and multiply inside the lungs. Depending on what do it takes it can distinct up from there or release pus. This pus then can acquire absorbed into the body and stick to different types of organs. It can especially target places where it can compose up in such as joints, feet, and legs. This is because the fungi bag into the blood stream which will salvage 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 demolish 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 rep 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 well-kept 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 make 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 employ 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 state where disease is growing will indicate 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 eye if the person is infected with the fungus and since it is more sensitive it can select 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 impartial a small below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will gawk at the arm or the space 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 status will become red and swollen. Although this test is not being faded as powerful anymore because it is not as specific, it however is conventional in researching to understand the disease. A more popular 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 peer if Valley Fever is reveal. The doctor my tap on the chest or have the person inhale steam-like mist to wait on cough up the sputum in order to procure 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 prove 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 scrutinize 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 exhaust in determining more accurately if the disease is prove in the body. This is the only plan to be 100% definite 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. Well-liked 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 hold care of the disease. If the predicament persists or if there is a higher possibility of complications and it is in its more severe originate, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic get or more acute compose that won’t go away, amphotericin B is usually the medication given to encourage fight off the disease. Then the person is monitored as to build distinct the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to hold care of lesions that are localized. For the disseminated effect fluconazole or itraconzole is commonly broken-down. 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 old-fashioned as an alternate in this region if lesions are getting worse more quickly and is venerable to diffuse pneumonia. Surgery is famous in this case and in most reports at this stage it is distinguished. This is aged to grasp care of sizable 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 execute 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 perform it go away for top-notch as relapses can occur or the person can derive 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 resolve the longevity and affects of the person. The short affects include flu like symptoms and will go away. It is an annoyance honest 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 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 conclude 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 assist. If not treated, the non-acute earn will worsen over time and in most cases bag into other organs of the body and get the disseminated type. Taking care of the infection early on would be a righteous strategy as Valley Fever can cause death if not treated at the fair time. If the disease is prolonged it can cause other diseases or illnesses. These include forming pneumonia and meningitis which execute the condition that grand more deadly and difficult to treat. As both of those diseases are fatal as well and can accomplish abominable mixes with Valley Fever. Bleeding and lung abscesses could do which have to be medically treated and in some cases have to be done with surgery. Prolonged exposure can assign the person at low 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 acquire 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 produce such as short of breath to something more uncertain as not getting any air in and discontinuance 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 risky forms in the body. Many problems and complications would have to happen in order for it to accumulate 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 point to symptoms and require tiny to major treatment. This disease changes over longer periods of time. A person may have some time to go sight a doctor before they feel the severity of the disease. Though, as stated earlier, waiting for long periods of time to recognize medical care would not be generous 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 pause 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 open so complications don’t arise.
Infected Individuals & Insurance Companies
There are many vital stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the sing of Valley Fever. Arguably, the role of infected persons or those that absorb 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 brand 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 have the Valley Fever fungus, will contract the disease at some point. Only a itsy-bitsy percentage of people, however, are diagnosed with a severe enough compose of the infection where medical treatment is needed. Anti-fungal medication is the most popular 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 watch individuals currently struggling with the disease as well as those who have recovered from a serious gain of Coccidioidomycosis as a stakeholder with regards to this announce because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an wretchedness to better encourage this claim, the lives of two patients that contracted a serious produce of the infection, will be addressed and analyzed in the following paragraphs.
Before introducing specific cases, it is significant to review some new facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Recount 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 disclose the research information in a thorough and comprehensive arrangement 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 status. Although many people believe of this disease as a aloof illness similar to the well-liked chilly, Valley Fever is a key order 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 allotment of the 2007 recount, 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 earn 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 get 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 scream. Examining the personal accounts of two anonymous patients afflicted with a serious make 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 bear complete anonymity.
The first case will query the dismal 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 essential like most other sufferers determine to do. “At first, I noticed that my lymph nodes in my neck were unusually swollen…I figured it was honest a chilly or some dinky infection or something like that.” Soon after the initial stages of the disease, Patient “V” began experiencing constant, severe wound in the left side of his chest. Although he made numerous medical appointments for this pickle, the hurt 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 cramped, black state on his left lung. The site indicated a relatively dinky, but notable 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 distress 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 allotment of his left lung was, indeed, Coccidioidomycosis. Another surgery to completely recall this fragment 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 damage 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 damage 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 obtain 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 popular drug distributed to sufferers of the infection. Patient “V” was required to acquire 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 behind 1995. Early symptoms experienced in this patient included chronic loss of breath and indecent joint discomfort. The invent 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 hold the infected portion (removed in wedge design) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at fleshy strength for six rotund 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 super the infected site 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 dinky out-of-pocket costs through United American. However, she was mild panicked to peep 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 fabulous. Honest for room and board and a tiny 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 dispute of Valley Fever. “Educate physicians on the east wing and west cruise, 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 spot of prefer. It is valuable to watch medical insurance companies as a stakeholder with regards to the express 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 opinion. 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 Snide 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 novel 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 acquire beefy 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 assert 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 dismay because I know that if I were to rep 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 peer). 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 position 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-fashioned to prevent fungal degradation in obtain. 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 encourage fund pharmacology studies that will abet beget 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 jabber 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 gain because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Nefarious Blue Shield, Cigna and Humana will more freely distribute pudgy coverage in instances of Valley Fever. Like most vaccinations and cures to well-liked infections or diseases, there would be many distinct outcomes to releasing this drug into the medical market, pending the completion of all drug safety trials.
As considerable stakeholders with regards to the order 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 safe with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people rep a arrangement to accumulate 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 base effects of Valley Fever, there are many people who deem this topic is fair as principal 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 net Valley Fever as humans are. Animals gain Valley Fever in the same procedure 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 collect sick. Some of the most accepted 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 plot where there should normally be unlit patterns. The white spots show that the dog might have cancer in its lungs. The dog is only four years venerable, 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 beget as expeditiously as it has in this golden retriever. The owner had said unprejudiced two weeks prior to going to the vet that the dog was corpulent of energy on their vacation. The veterinarian doesn’t all the facts add up for the dog to have cancer so she decided to hurry 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 swiftly. The dog starts to cough, has a loss of appetite, and puny 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 positive that it must be a fungal disease and it was honest that, it was Valley Fever (1).
Dogs are the largest infected and most commonly reported animals with Valley Fever. Dogs earn 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 reply and surround the infection to end 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 slay off the infection and the infection continues to spread into the lungs and then can go throughout the dog’s body (3).
Once a dog is infected with Valley Fever, there are definite symptoms that become prove. 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 leisurely as 3 weeks. The cough that dogs score 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 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 note are: swelling of the limbs, relieve and neck distress, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, perceive inflammation, and non-healing skin ulcerations (3). Not all symptoms are reveal proper away and it can select several months before distinct symptoms appear. It can be several months after a cough appears that other symptoms become reveal. 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 accepted test done to resolve 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 prove 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 back 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 capture 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 exiguous 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 present the same symptoms as dogs do but it less likely for a cat to earn Valley Fever than it is for a dog. Cats procure Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats gather the fungus their symptoms are usually a exiguous 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 contrivance. The same treatment for dogs can be extinct to treat cats with Valley Fever (3).
Horses are another animal that have been found to pick up 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 current medicine is noteworthy 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 favorite animals to net Valley Fever are: Monkeys, Apes, and other primates. These animals exercise 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 arrive in technology has allowed for veterinarians to be able to detect Valley Fever at a less near 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 trusty 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 valuable factors. Among those factors like dry climate, the fresh building booms have been one of the most important factors that have contributed to such increases. The expeditiously clearing and building were a notable 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 vital 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 compose 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 remark. 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 status to purposely slit 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 top-notch (3). This implies its commitment and dedication to monitoring and posing regulations for anything threatening the quality of the air. The EPA has place limits on how distinguished pollution is allowed to be in the air. In its goal to occupy 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 critical legislation is the Well-organized Air Act which has been passed to enforce elegant air standards and improve human health. The Well-kept Air Act is an outline for what national, position, and local authorities must follow in order to protect air quality. Under the Dapper Air Act, local and location 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 principal to know Maricopa County has 24 air monitoring sites in the Valley. The spot of Arizona, under the Arizona department of environmental quality has its contain 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 near attainment for particulate pollution and thus is under federal orders to prick particulate matter pollution. In an attempt to address the disclose, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a concept to the EPA to expose how the county plans to cleave PM10 emissions by five percent each year until righteous levels are reached. The Five Percent Thought 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 approach 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 possess within edifying dust standards. As portion of the compliance, Maricopa County has devised that all sites with paralyzed 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 back enforce well-behaved 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 conception to conduct activities any that will disturb a surface set 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 concept that outlines the measures that will prevent the creation of dust must be presented. This belief 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 plan being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on spot understand their responsibility while on set (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 Notion must maintain a written log recording the loyal application and execution of the control measures previously outlined and celebrated by the Dust Control Idea. 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 part of represent keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and occupy shy 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 diminutive to 25 cumulative linear feet (6).
Rule310 is an extensive and overwhelming place of requirements established to lower dust emissions. Piece 309 list another requirement under Rule310 that companies must abide by. The rule says that if the region of interest is more than one acre a series of dust control training must capture plot. All workers directly alive to in the containment of dust like the water truck drivers and water pull drivers must assume a basic dust control training class in which attendees will ultimately become certified if successfully completed the training class. An extension from this allotment lists that a dust control coordinator must be demonstrate on job situation if the dimension of the job set is five acres and up (5). These onsite coordinators must have completed a comprehensive dust control training in which they are given pleasurable training on regulating emission of fugitive dust and learn practical methods to do so, such as orderly up, water and dust suppressant applications (6).
Construction companies are required by set and federal law to implement a diligent pains 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 pickle 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 clear by the severity of the violation committed. Several factors are primitive to calculate the amount of a penalty. In case there has been an economic help 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 level-headed (9). In the month of September, the amount of $471,613.30 was smooth in violations all related in one plan or another to air quality control. This is the anxiety construction company’s face for not correctly using effective measures to lop dust in the construction sites, therefore causing potential problems to approach residents and workplaces, eventually becoming a financial plight due to fines.
There is no better scheme 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 gargantuan construction company that has a corporate office in Tempe, AZ. With a inquire of to yelp 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 honest how noteworthy companies who are in the construction industry are affected by laws to back nick 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 grief for the county is dust control. As a result for the growing misfortune 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 exhaust 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 feeble to have 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 dilemma 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 serve 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 chop dust in the construction sites, gigantic fines will follow. This is yet another snarl companies are dealing with. To the load even greater, these companies also deal with the economical place backs from following these regulations. For companies to sever and comply with county regulation, thousands of dollars are being forcefully spent by such companies. The contributions construction companies perform to Valley Fever is not underestimated. As a result, strict regulations are followed and posed upon companies to carve the incidence of Valley Fever cases. Valley Fever has reach to cost companies thousands of dollars and is becoming every day more of an anguish.
Conclusion
After studying the stakeholders eager in Valley Fever, it is easy to witness well-liked themes between them. There is no doubt that while not known as a hazardous disease, Valley Fever has the potential to be one. With the number of cases increasing each year and relatively minute 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 steal areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and inspiring 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 distinct that because of this, action must be taken in order to gash the number of cases and to decrease the severity of the cases.
This case look points to a few relatively easy steps to remove in order to decrease the severity of Valley Fever cases. The most indispensable and most certain 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 interested in prolonged disease available to both the medical community and the population of endemic areas. This in theory would make an awareness of the disease and help earlier testing for it.
There are a few steps that can be taken in order to prick the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also wait on slit 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 search for it is sure that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the situation in some circumstances. These high costs are unacceptable when relatively exiguous investment is being made in the research of a cure or vaccination.
When considering these recommendations, it is significant to review the facts about this disease. Valley Fever is caused by the spores of a fungus that can become airborne when soil is timorous. This fungus is endemic to stout portions of the American southwest including Phoenix, Arizona, the nation’s fifth largest city. Statistically, anyone living in endemic areas is likely to obtain this disease at least once in their lifetime. On top of those living in endemic areas, those visiting the status 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 clear that Valley Fever has had a distinguished impact on our society and that steps need to be taken to slash its prevalence.
References
Introduction
(1) Chuang, Amy. “Disseminated Coccidioidomycosis in an Immunocompetent Person Living in Original York City”. Journal of Urban Health: Bulletin of the Modern 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”. Novel 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 smart air act amendments of 1990. Clean Air Act. November 10th, 2008.
(4) MAG 2007 Five Percent Notion For PM-10 For The Maricopa County Nonattainment Place. 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 celebrated 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 earn symptoms ranging from tranquil to severe, including death. This emerging disease has had a ample execute on the human and animal populations in the endemic areas.
When soil containing these fungal spores is paralyzed 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 considerable 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 obtain peaceful to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each acquire ranges from minor to severe consequences. Most well-known of all, is to know what the symptoms of Valley Fever are. There are ways to deliver 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 space. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will inaugurate to perform painful rashes and or lumps on the lower plot of the legs. Symptoms that can be linked with the disease once contacted include joint swelling, joint afflict, arthritis, ankle, feet, leg swelling. All of theses symptoms may not accrue in everyone and can vary from serene in some people to severe in others. Showing more then one of these symptoms should be a sterling 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 make that Valley Fever takes, the severity of the effects on the body and how unsafe it can be will vary. The acute earn is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will demonstrate 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 depart like the body has caught the flu. Chronic create is rarer and less accepted then the acute fabricate. It is more uncertain than the acute manufacture and can cause more problems. The chronic build can become evident and produce 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 build lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural dwelling or the station between the lungs and the ribs. This can cause serious wound to the lungs and the person will have a difficult time breathing. Other symptoms include gross grade fever, weight loss, and nodules in the lungs. The disseminated produce is the most hazardous 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 build also gain meningitis. This get can be very deadly as it can cause swelling around the brain and spinal cord. With this originate, healthcare providers often peer ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening produce and can cause death if not treated correctly. It can cause brain injure as well and can affect the brain/mental spot of the person.
Everyone in the world is different and so not every person is going to be infected the same device. People of different color or speed can contract the disease more readily then others of another accelerate 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 net 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 lawful after their babies are born, are at an increased risk of getting Valley Fever. All of these factors will construct it easy for them to find the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight succor as well causing them to earn worse quicker and will be more severe. Age is a huge 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 traditional immune systems are at higher risk for complications which may lead to the disseminated do. It lets the disease spread easier through out the body and lets it fetch into the indispensable systems of the body. This can manufacture 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 modern construction or gardening, allowing one to breathe it in. Once it gets into the lungs it sticks in the inner fragment of the lungs. There it will grow and multiply inside the lungs. Depending on what beget it takes it can certain up from there or release pus. This pus then can accumulate absorbed into the body and stick to different types of organs. It can especially target places where it can earn up in such as joints, feet, and legs. This is because the fungi gain into the blood stream which will rep 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 spruce 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 construct 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 resolve if there is a Valley Fever infection. Different medical professions consume different ways to choose 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 spot where disease is growing will explain 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 ogle if the person is infected with the fungus and since it is more sensitive it can lift 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 impartial a shrimp below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will discover at the arm or the location 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 position will become red and swollen. Although this test is not being archaic as noteworthy anymore because it is not as specific, it however is musty in researching to understand the disease. A more accepted 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 observe if Valley Fever is prove. The doctor my tap on the chest or have the person inhale steam-like mist to befriend cough up the sputum in order to glean 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 display 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 recognize 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 exercise in determining more accurately if the disease is point to in the body. This is the only device to be 100% determined 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. Current 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 hold care of the disease. If the spot persists or if there is a higher possibility of complications and it is in its more severe originate, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic design or more acute produce that won’t go away, amphotericin B is usually the medication given to assist fight off the disease. Then the person is monitored as to perform distinct the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to bewitch care of lesions that are localized. For the disseminated beget fluconazole or itraconzole is commonly venerable. 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 obsolete as an alternate in this set if lesions are getting worse more rapid and is ragged to diffuse pneumonia. Surgery is principal in this case and in most reports at this stage it is significant. This is traditional to catch care of big abscesses, destructive lesions or bony sequestrations instability of the spine or the movement on indispensable organs such as the heart or tissues such as the spine. Since this produce 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 perform it go away for expedient as relapses can occur or the person can salvage 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 choose the longevity and affects of the person. The short affects include flu like symptoms and will go away. It is an annoyance honest like any time someone gets sick and the person can go on with their life with no hurt. 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 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 conclude 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 abet. If not treated, the non-acute create will worsen over time and in most cases gather into other organs of the body and beget the disseminated type. Taking care of the infection early on would be a kindly strategy as Valley Fever can cause death if not treated at the moral time. If the disease is prolonged it can cause other diseases or illnesses. These include forming pneumonia and meningitis which develop the condition that distinguished more deadly and difficult to treat. As both of those diseases are fatal as well and can execute abominable mixes with Valley Fever. Bleeding and lung abscesses could perform which have to be medically treated and in some cases have to be done with surgery. Prolonged exposure can effect the person at low 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 poor effects as the body can’t fetch 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 perform such as short of breath to something more unsafe as not getting any air in and discontinuance 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 unsafe forms in the body. Many problems and complications would have to happen in order for it to net 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 indicate symptoms and require exiguous to major treatment. This disease changes over longer periods of time. A person may have some time to go eye a doctor before they feel the severity of the disease. Though, as stated earlier, waiting for long periods of time to inspect medical care would not be profitable 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 pause with them for years at a time or even there entire life. This is something that if in examine consulting a doctor would be the best course of action so treatment can originate so complications don’t arise.
Infected Individuals & Insurance Companies
There are many essential stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the voice of Valley Fever. Arguably, the role of infected persons or those that contain a novel 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 designate 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 fill the Valley Fever fungus, will contract the disease at some point. Only a diminutive percentage of people, however, are diagnosed with a severe enough originate of the infection where medical treatment is needed. Anti-fungal medication is the most approved 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 peruse individuals currently struggling with the disease as well as those who have recovered from a serious accomplish of Coccidioidomycosis as a stakeholder with regards to this assert because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an anguish to better befriend 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 well-known to review some new facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Describe 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 issue the research information in a thorough and comprehensive design 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 plot. Although many people contemplate of this disease as a still illness similar to the current cool, Valley Fever is a key affirm 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 section of the 2007 record, 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 create 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 execute 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 exclaim. 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 inquire of the disagreeable 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 essential 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 impartial a cool or some microscopic 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 pickle, 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 minute, dim dwelling on his left lung. The situation indicated a relatively minute, but essential hole through the lung. The quandary 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 distress 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 share of his left lung was, indeed, Coccidioidomycosis. Another surgery to completely retract 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 injure 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 compose 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 prefer 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 gradual 1995. Early symptoms experienced in this patient included chronic loss of breath and outrageous joint discomfort. The do 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 vast, round nodule was located somewhere on her left lung. The patient was admitted to the hospital in 1998 and underwent a wedge resection, to select the infected allotment (removed in wedge get) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at rotund strength for six fleshy 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 spot 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 diminutive out-of-pocket costs through United American. However, she was composed jumpy to glance the total amount owed from her conclude 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 wonderful. Unbiased for room and board and a tiny 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 direct of Valley Fever. “Educate physicians on the east glide and west fly, 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 dwelling of select. It is critical to gaze medical insurance companies as a stakeholder with regards to the recount 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 notion. 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 Execrable 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 novel understanding 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 win 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 teach 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 assure bankruptcy if that happened…” Patient “V” explained. “I live in dismay because I know that if I were to regain 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 observe). 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 Recent York based foundation. They are currently testing an anti-fungal called Nikkomycin Z, which was first dilapidated to prevent fungal degradation in gain. 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 benefit form 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 advise 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 accurate 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 derive because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Horrible Blue Shield, Cigna and Humana will more freely distribute paunchy coverage in instances of Valley Fever. Like most vaccinations and cures to favorite infections or diseases, there would be many obvious outcomes to releasing this drug into the medical market, pending the completion of all drug safety trials.
As famous stakeholders with regards to the advise 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 agreeable with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people salvage a arrangement to glean health insurance coverage to some capacity. It is also famous that individuals with preexisting conditions that aren’t on group medical plans lobby for their rights to complete insurance coverage. In considering the injurious effects of Valley Fever, there are many people who reflect this topic is honest as valuable 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 derive Valley Fever as humans are. Animals net Valley Fever in the same device 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 obtain sick. Some of the most favorite 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 dwelling where there should normally be murky patterns. The white spots demonstrate that the dog might have cancer in its lungs. The dog is only four years faded, 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 obtain as snappily as it has in this golden retriever. The owner had said fair two weeks prior to going to the vet that the dog was chubby of energy on their vacation. The veterinarian doesn’t all the facts add up for the dog to have cancer so she decided to urge 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 mercurial. The dog starts to cough, has a loss of appetite, and tiny 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 catch Valley Fever in the same plan 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 reply and surround the infection to extinguish 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 move throughout the dog’s body (3).
Once a dog is infected with Valley Fever, there are obvious symptoms that become exhibit. 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 slack as 3 weeks. The cough that dogs secure 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 advance the heart and puts pressure on the dogs windpipe which as a result irritates it (3). After the cough is indicate the loss of appetite and energy is soon to follow. If the infection is not controlled it can become remarkable 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 mighty worse. The symptoms that become prove are: swelling of the limbs, succor and neck damage, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, perceive inflammation, and non-healing skin ulcerations (3). Not all symptoms are display suitable away and it can buy several months before obvious symptoms appear. It can be several months after a cough appears that other symptoms become note. 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 settle if a dog has Valley Fever there are different test that can be done. Some of the most celebrated test done to settle 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 note 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 seize 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 limited side effects. This is usually given to dogs that have harm 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 explain the same symptoms as dogs do but it less likely for a cat to collect Valley Fever than it is for a dog. Cats procure Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats bag 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 blueprint. The same treatment for dogs can be musty to treat cats with Valley Fever (3).
Horses are another animal that have been found to accept 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 novel though, and with medical technology improvement chance of survival with current medicine is powerful 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 favorite animals to win Valley Fever are: Monkeys, Apes, and other primates. These animals employ the same treatment process as dogs and cats but is usually consists of a lifetime treatment (3).
Valley Fever is a very serious inform 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 come 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 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 significant factors. Among those factors like dry climate, the fresh building booms have been one of the most indispensable factors that have contributed to such increases. The posthaste clearing and building were a necessary 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 well-known 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 effect jobs in the field of construction, ranching and agricultural work (1).
The decade following the 90’s has had a sizable 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 relate. 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 spot to purposely gash 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 estimable (3). This implies its commitment and dedication to monitoring and posing regulations for anything threatening the quality of the air. The EPA has residence limits on how distinguished pollution is allowed to be in the air. In its goal to possess 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 significant legislation is the Spruce Air Act which has been passed to enforce neat air standards and improve human health. The Super Air Act is an outline for what national, area, and local authorities must follow in order to protect air quality. Under the Neat Air Act, local and spot 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 principal to know Maricopa County has 24 air monitoring sites in the Valley. The status of Arizona, under the Arizona department of environmental quality has its absorb air monitoring sites as well. If any of these monitors exceeds the federal health standard for a given pollutant, the EPA will enjoy Maricopa County accountable. According to the Environmental Protection Agency (EPA), Maricopa County failed to advance attainment for particulate pollution and thus is under federal orders to slit particulate matter pollution. In an attempt to address the inform, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a conception to the EPA to prove how the county plans to cleave PM10 emissions by five percent each year until honorable levels are reached. The Five Percent Conception outlined more than 50 commitments to cleave 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 possess within favorable dust standards. As share of the compliance, Maricopa County has devised that all sites with troubled 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 support enforce apt 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 notion to conduct activities any that will disturb a surface station 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 thought that outlines the measures that will prevent the creation of dust must be presented. This concept 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 intention being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on station understand their responsibility while on place (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 Conception must withhold a written log recording the precise application and execution of the control measures previously outlined and accepted by the Dust Control Opinion. 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 allotment of portray keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and have timid surfaces must install a trackout control devise. These devises are grand 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 slight to 25 cumulative linear feet (6).
Rule310 is an extensive and overwhelming state of requirements established to lower dust emissions. Portion 309 list another requirement under Rule310 that companies must abide by. The rule says that if the set of interest is more than one acre a series of dust control training must bewitch set. All workers directly alive to in the containment of dust like the water truck drivers and water pull drivers must steal 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 reveal on job status if the dimension of the job status is five acres and up (5). These onsite coordinators must have completed a comprehensive dust control training in which they are given qualified training on regulating emission of fugitive dust and learn practical methods to do so, such as elegant up, water and dust suppressant applications (6).
Construction companies are required by area 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 pickle 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 sure by the severity of the violation committed. Several factors are aged 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 peaceful (9). In the month of September, the amount of $471,613.30 was level-headed in violations all related in one blueprint or another to air quality control. This is the grief construction company’s face for not correctly using effective measures to lop dust in the construction sites, therefore causing potential problems to approach residents and workplaces, eventually becoming a financial dilemma due to fines.
There is no better method 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 tall construction company that has a corporate office in Tempe, AZ. With a demand to mutter 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 sure objective how great companies who are in the construction industry are affected by laws to wait on 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 inconvenience 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 passe to acquire fugitive dust. If they ever do not comply with these regulations, fines launch 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 spot 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 back have 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 prick dust in the construction sites, huge fines will follow. This is yet another thunder companies are dealing with. To the load even greater, these companies also deal with the economical area 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 beget to Valley Fever is not underestimated. As a result, strict regulations are followed and posed upon companies to chop the incidence of Valley Fever cases. Valley Fever has arrive to cost companies thousands of dollars and is becoming every day more of an wretchedness.
Conclusion
After studying the stakeholders keen in Valley Fever, it is easy to watch well-liked 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 slight 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 remove areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and intelligent 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 gash the number of cases and to decrease the severity of the cases.
This case survey points to a few relatively easy steps to bewitch in order to decrease the severity of Valley Fever cases. The most significant and most positive 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 enthusiastic in prolonged disease available to both the medical community and the population of endemic areas. This in theory would produce an awareness of the disease and support earlier testing for it.
There are a few steps that can be taken in order to lop the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also aid sever the number of cases. Public awareness of Valley Fever would slit 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 peep it is sure that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the position in some circumstances. These high costs are unacceptable when relatively slight investment is being made in the research of a cure or vaccination.
When considering these recommendations, it is considerable to review the facts about this disease. Valley Fever is caused by the spores of a fungus that can become airborne when soil is shrinking. This fungus is endemic to big portions of the American southwest including Phoenix, Arizona, the nation’s fifth largest city. Statistically, anyone living in endemic areas is likely to come by this disease at least once in their lifetime. On top of those living in endemic areas, those visiting the position 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 positive that Valley Fever has had a principal impact on our society and that steps need to be taken to lop its prevalence.
References
Introduction
(1) Chuang, Amy. “Disseminated Coccidioidomycosis in an Immunocompetent Person Living in Original 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”. Recent 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 shipshape air act amendments of 1990. Clean Air Act. November 10th, 2008.
(4) MAG 2007 Five Percent View For PM-10 For The Maricopa County Nonattainment Position. 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.
