Valley Fever

Phoenix clinic seeking to combat Valley fever.
The disease is hard to diagnose, and it's on the rise in Arizona. But now, there's some new hope for people battling Valley fever.
The Valley Fever Center opened this summer at St. Joseph's Hospital and Medical Center in Phoenix as a partnership between the hospital and the University of Arizona's Phoenix medical school.
Valley fever is caused by breathing in spores of a fungus called Coccidioides immitis. Symptoms can include pneumonia, chest pains, fever, difficulty breathing, rashes, weight loss and night sweats.
The fungus is endemic to the Southwest, including California's San Joaquin Valley - for which the disease is named - southern Arizona and Sonora, Mexico.
There were 16,436 reported cases of Valley fever last year in Arizona, which made up 60% of all U.S. cases and marked a 37% increase compared with 2010. More than 80% of the state's cases are from the Phoenix area, according to Dr. John Galgiani, the center's director.
While the immune system can generally fight off the disease, the pneumonia can sometimes run for months. In about 400 cases a year, the disease spreads beyond the lungs, where it can become a bone infection or meningitis - a swelling of the membranes surrounding the brain and spinal cord. Although rare, the disease can be fatal.
Valley fever is difficult to diagnose because symptoms can mimic the flu or a cold, a different type of pneumonia, or there can be no symptoms.
Additionally, blood tests can give a false negative during early stages of infection, and sometimes the tests never come back positive. Because of this, Galgiani estimates that there are at least twice as many cases than what are reported.
Clarisse Tsang, acting program manager for infectious-disease epidemiology at the state Department of Health Services, said Valley fever cases peak from May to July and again from October to December.
Determining when infection occurs is nearly impossible, because it usually takes seven to 28 days before symptoms appear, another one to four weeks before the patient sees a doctor, and two or three visits before the patient is tested,
The increase of reported cases could be caused by several factors, such as more people moving to the Phoenix metropolitan area, dust storms, construction and better diagnoses. But, in the end, it's because the spore is all around us, Tsang said.
"You don't need a dust storm. You could go walking in the dirt and Valley fever could spread," she said.
Galgiani said the clinic is the first comprehensive effort to help patients and doctors combat a disease that especially affects Arizonans.
The center at St. Joseph's is an outgrowth of the Valley Fever Center for Excellence that Galgiani established at UA in 1996. That center functioned mainly as a consultation and research facility, while the new one at St. Joseph's will also treat patients.
Through the center's association with the Valley Fever Alliance of Arizona Clinicians, a group of more than 100 specialists and general practitioners with experience in the disease, it refers patients to experienced doctors.
Although 95% of those doctors work in the "Valley fever corridor" of Maricopa, Pinal and Pima counties, Galgiani hopes to eventually involve hundreds of doctors statewide.
The goal is for a patient in Flagstaff or Yuma to consult with the center but see a local doctor without having to make a trek to Phoenix, he said. The center also will coordinate patients' electronic records.
"It's a center without walls, as well as a place you can visit," Galgiani said.
Dr. Priya Radhakrishnan, director of internal medicine at St. Joseph's, said the new center is about educating the public and physicians alike to catch the disease earlier.
"We really feel like it's a tip of the iceberg; we only see the sickest of the sickest," Radhakrishnan said.