Valley Fever is the current 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, Modern 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 opinion that they had contracted it. The other forty percent find symptoms ranging from collected to severe, including death. This emerging disease has had a vast conclude on the human and animal populations in the endemic areas.
When soil containing these fungal spores is jumpy 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 vital 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 accumulate level-headed to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each originate ranges from minor to severe consequences. Most primary of all, is to know what the symptoms of Valley Fever are. There are ways to affirm 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 situation. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will originate to make painful rashes and or lumps on the lower dwelling of the legs. Symptoms that can be linked with the disease once contacted include joint swelling, joint wound, arthritis, ankle, feet, leg swelling. All of theses symptoms may not accrue in everyone and can vary from calm in some people to severe in others. Showing more then one of these symptoms should be a estimable indicator that the person has contracted the disease and should consult a doctor.
Once a body is infected, Valley Fever will explain up in one of three forms acute, chronic, or disseminated. Some of the forms are more rare then others. Depending on the create that Valley Fever takes, the severity of the effects on the body and how uncertain it can be will vary. The acute get is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will reveal the development of the disease. This can happen at any time during the year or any season. It affects both men and women equally and the systems will disappear like the body has caught the flu. Chronic build is rarer and less well-liked then the acute execute. It is more perilous than the acute effect and can cause more problems. The chronic acquire can become evident and do 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 perform lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural residence or the location 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 execute 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 effect also regain meningitis. This perform can be very deadly as it can cause swelling around the brain and spinal cord. With this produce, healthcare providers often scrutinize ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening compose and can cause death if not treated correctly. It can cause brain wound as well and can affect the brain/mental position of the person.
Everyone in the world is different and so not every person is going to be infected the same diagram. People of different color or speed can contract the disease more readily then others of another urge 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 win 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 moral after their babies are born, are at an increased risk of getting Valley Fever. All of these factors will build it easy for them to pick up the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight aid as well causing them to win worse quicker and will be more severe. Age is a broad 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 find into the valuable systems of the body. This can form 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 novel construction or gardening, allowing one to breathe it in. Once it gets into the lungs it sticks in the inner piece of the lungs. There it will grow and multiply inside the lungs. Depending on what get it takes it can certain up from there or release pus. This pus then can bag absorbed into the body and stick to different types of organs. It can especially target places where it can effect up in such as joints, feet, and legs. This is because the fungi catch into the blood stream which will procure 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 end 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 glean 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-organized 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 obtain 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 decide if there is a Valley Fever infection. Different medical professions utilize 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 spot where disease is growing will explain up usually approach 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 spy if the person is infected with the fungus and since it is more sensitive it can hold up signs of an earlier infection accurately. Spheriulin is an antigen that is connected with the fungi that causes Valley Fever. This substance is injected fair a dinky below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will sight at the arm or the situation 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 dwelling will become red and swollen. Although this test is not being broken-down as distinguished anymore because it is not as specific, it however is passe 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 spy 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 gather 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 show 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 examine if there is a rise in the antibody count which determines the infection and how severe it may be. The higher the titer or antibody counts the worse the infection it is. These are all tests that the doctors may expend in determining more accurately if the disease is reveal in the body. This is the only scheme to be 100% distinct 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. Approved 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 select care of the disease. If the predicament persists or if there is a higher possibility of complications and it is in its more severe develop, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic do or more acute execute that won’t go away, amphotericin B is usually the medication given to support fight off the disease. Then the person is monitored as to obtain determined the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to retract care of lesions that are localized. For the disseminated originate 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 ancient as an alternate in this station if lesions are getting worse more snappily and is feeble to diffuse pneumonia. Surgery is critical in this case and in most reports at this stage it is significant. This is old to steal care of vast 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 acquire 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 construct it go away for kindly as relapses can occur or the person can accumulate it again.
The disease can have short affects and long term effects on the body. Depending on the person or the amount of spores inhaled, this will choose the longevity and affects of the person. The short affects include flu like symptoms and will go away. It is an annoyance objective like any time someone gets sick and the person can go on with their life with no hurt. These people probably have higher immune systems. However, the longer the disease stays around in the body the more distress it will do. If it is prolonged in the body for an extended time it will open having more harsh affects on the body. The infection can spread to the bones in the body and cause deterioration or holes in the bones. This will halt with the patient through out their life. If it is in the body for the extended time it can cause variations of getting better then getting worse fluctuations as well as can cause relapses of the disease where it can reach support. If not treated, the non-acute originate will worsen over time and in most cases accumulate into other organs of the body and effect the disseminated type. Taking care of the infection early on would be a gracious 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 get the condition that mighty more deadly and difficult to treat. As both of those diseases are fatal as well and can make terrible mixes with Valley Fever. Bleeding and lung abscesses could compose 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 dreadful effects as the body can’t score enough oxygen into the body. People that already have respiratory problems such as asthma can be compromised and hinder the lungs from working efficiently. This can cause a more acute design such as short of breath to something more unsafe as not getting any air in and terminate breathing without medication or immediate treatment. Most importantly the disease should not be taken as lightly as it can cause death if overly prolonged or gets into its most perilous forms in the body. Many problems and complications would have to happen in order for it to regain 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 slight 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 search for medical care would not be noble 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 quit with them for years at a time or even there entire life. This is something that if in expect 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 vital stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the jabber of Valley Fever. Arguably, the role of infected persons or those that absorb a unusual vulnerability to the disease is top priority on the decision-maker’s list. Each year, thousands of people are diagnosed with Coccidioidomycosis in Arizona alone. In a 2007 article, the Washington Post wrote that Valley Fever cases diagnosed in 2006 were up fifty-six percent from a year earlier. This prompted Arizona health officials to sign the disease at, “epidemic proportions,” as thousands of other cases likely went undocumented. It has also been reported that anyone who has spent enough time in Arizona, or any other fraction of the Southwestern United States where soils believe the Valley Fever fungus, will contract the disease at some point. Only a cramped percentage of people, however, are diagnosed with a severe enough beget 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 distinguished to survey individuals currently struggling with the disease as well as those who have recovered from a serious acquire of Coccidioidomycosis as a stakeholder with regards to this whisper because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an misfortune to better benefit this claim, the lives of two patients that contracted a serious earn of the infection, will be addressed and analyzed in the following paragraphs.
Before introducing specific cases, it is necessary to review some new facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Represent in October 2008. The represent, 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 notify the research information in a thorough and comprehensive map 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 site. Although many people reflect of this disease as a smooth illness similar to the current frosty, Valley Fever is a key snarl amongst Arizona residents as well as both local and national governments. In 2008, the Arizona Department of Health Services received funds for Valley Fever prevention and control from a legislative appropriations committee. The Center for Disease Control and Prevention (CDC) also awarded the department funds for continued research. As portion of the 2007 picture, 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 beget 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 make of Coccidioidomycosis each year. The Arizona Department of Health Services reports that the severity of Valley Fever in the dwelling 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 screech. Examining the personal accounts of two anonymous patients afflicted with a serious create 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 the horrible effects of Coccidioidomycosis on a male patient of early adulthood age. This individual will be referred to as Patient “V” throughout this paragraph. Patient “V” began his ordeal with Valley Fever in the summer months of 2001. A younger man in the final years of adolescence, Patient “V” experienced generic, flu-like symptoms, which he disregarded as nothing significant like most other sufferers resolve to do. “At first, I noticed that my lymph nodes in my neck were unusually swollen…I figured it was fair a frosty or some exiguous 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 jam, the damage would subside by the time Patient “V” arrived, making it difficult to diagnose the spot. “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 exiguous, dusky region on his left lung. The place indicated a relatively cramped, but indispensable hole through the lung. The jam 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 damage 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 capture this allotment 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 wound 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 afflict medication.” Fortunately for Patient “V”, the second surgery was successful and he survived his brush with Valley Fever. In many cases, patients who contract and fend off the infectious spore perform up life-long immunities. However, reports have also shown that patients in remission from Coccidioidomycosis can be more vulnerable to a reoccurrence of the disease than those that have never contracted it. Following his surgical recovery, Patient “V” was prescribed an anti-fungal medication called Diflucan, a favorite drug distributed to sufferers of the infection. Patient “V” was required to capture this medication daily for 2-3 years. He now receives chest x-rays once a year to check for any returning signs of the fungus. Patient “V’s” scar tissue has also become virtually unrecognizable after nearly a decade of recovery.
The second case to be analyzed will be that of a middle-aged female patient. Appropriately, this patient will be referred to as Patient “F” throughout the analysis. Patient “F” contracted Valley Fever in slow 1995. Early symptoms experienced in this patient included chronic loss of breath and shameful joint discomfort. The create of Coccidioidomycosis contracted by Patient “F” was not diagnosed correctly until 2 ½ years after symptoms began. Before visiting a pulmonologist, Patient “F” was given a chest x-ray, where a grand, round nodule was located somewhere on her left lung. The patient was admitted to the hospital in 1998 and underwent a wedge resection, to purchase the infected allotment (removed in wedge execute) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at beefy strength for six elephantine months; and then half the dosage for another six months. The patient continued to have fevers following the surgery. She also had an excess amount of fluid in her lung. Patient “F” returned for a second surgery to further orderly the infected plot 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 detached horrified to seek the total amount owed from her end 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 improbable. Honest for room and board and a microscopic 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 order of Valley Fever. “Educate physicians on the east flee and west sail, 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 status of buy. It is critical to witness medical insurance companies as a stakeholder with regards to the screech 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 concept. 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 Defective Blue Shield of Arizona. As mentioned earlier, however, major insurance companies like this one tend to limit coverage to individuals with preexisting conditions. According to an article on www.howstuffworks.com, a preexisting condition is a health condition or illness that you have had before your first day of coverage on a unique concept with an insurance company. Typically under group coverage, such as that offered by a corporation under an employee’s benefits, a person with a preexisting condition can acquire plump 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 state 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 issue bankruptcy if that happened…” Patient “V” explained. “I live in alarm because I know that if I were to accumulate 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 gape). 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 station 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 Novel York based foundation. They are currently testing an anti-fungal called Nikkomycin Z, which was first veteran to prevent fungal degradation in make. 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 befriend compose 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 assure 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 plunge significantly. Debates between the government, politicians and special interest groups would decrease as well if no one were in any dependable 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 procure because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Inappropriate Blue Shield, Cigna and Humana will more freely distribute pudgy coverage in instances of Valley Fever. Like most vaccinations and cures to celebrated 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 significant stakeholders with regards to the hiss 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 estimable with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people fetch a draw to come by health insurance coverage to some capacity. It is also significant that individuals with preexisting conditions that aren’t on group medical plans lobby for their rights to complete insurance coverage. In considering the disagreeable effects of Valley Fever, there are many people who believe this topic is unprejudiced as necessary 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 find Valley Fever as humans are. Animals net Valley Fever in the same blueprint as humans do, by breathing the fungus. It has been found that more and more animals are being reported of becoming ill due to this fungus. It has been found the 30-40% of animals who breathe in the fungus come by sick. Some of the most current 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 sad patterns. The white spots exhibit that the dog might have cancer in its lungs. The dog is only four years passe, 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 quickly as it has in this golden retriever. The owner had said fair 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 hasten a few more test before she starting treatment for lung cancer. The dog’s health over the course of time starts to go downhill and very like a flash. The dog starts to cough, has a loss of appetite, and small to no energy. The vet then found out where the human family had recently traveled and they were in the Southwest. After hearing this, the vet distinct that it must be a fungal disease and it was impartial that, it was Valley Fever (1).
Dogs are the largest infected and most commonly reported animals with Valley Fever. Dogs net Valley Fever in the same plot 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 slay 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 ruin off the infection and the infection continues to spread into the lungs and then can recede throughout the dog’s body (3).
Once a dog is infected with Valley Fever, there are distinct symptoms that become expose. 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 tedious as 3 weeks. The cough that dogs win 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 note 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 remarkable worse. The symptoms that become show are: swelling of the limbs, support and neck damage, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, glimpse inflammation, and non-healing skin ulcerations (3). Not all symptoms are prove upright away and it can win several months before obvious symptoms appear. It can be several months after a cough appears that other symptoms become exhibit. There is typically an order that the fungus spreads throughout the dog’s body. The first organ to be effected is lung, and then the infection usually spreads into the bone, than eyes, heart, testicles, brain, spinal cord, and finally abdominal organs (2).
To decide if a dog has Valley Fever there are different test that can be done. Some of the most favorite test done to decide 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 present 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 choose 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 injure done to their spinal cord and nervous system (3).
Cats, llamas, non human primates, horses, and zoo animals are other animals that have been reported with Valley Fever. Cats that have Valley Fever prove the same symptoms as dogs do but it less likely for a cat to collect Valley Fever than it is for a dog. Cats net Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats acquire the fungus their symptoms are usually a petite more advanced than dogs. Two of the major symptoms seen in cats that have Valley Fever are unexplained weight loss and skin ulcerations that won’t go arrangement. The same treatment for dogs can be primitive to treat cats with Valley Fever (3).
Horses are another animal that have been found to salvage 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 unique though, and with medical technology improvement chance of survival with unusual medicine is remarkable better for horses today (3). Llamas are another animal that have been infected with Valley Fever. Llamas are very sensitive to this fungus. In most cases, if a llama has Valley Fever death is almost always the outcome.
Zoo’s that are located in the Southwest are very aware of Valley Fever. Many zoos have lost animals due to Valley Fever before they were aware of what is was and how to treat for it. When animals become sick, Valley Fever is something that is tested early so treatment can be started. In zoos, the most well-liked animals to obtain Valley Fever are: Monkeys, Apes, and other primates. These animals spend the same treatment process as dogs and cats but is usually consists of a lifetime treatment (3).
Valley Fever is a very serious disclose 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 approach in technology has allowed for veterinarians to be able to detect Valley Fever at a less approach stage. The early stage that Valley Fever is caught at allows for a better chance of survival of animals infected with the fungus.
Construction
There is no doubt that construction companies contribute significantly to Valley Fever. According to the MayoClinic, institution known for prominence in the medical field recognized the increase in right estate has contributed to the spew of “thousands of tons” of dust carrying this fungus into the air. The article looks at how in the 1990s the accounts of Valley Fever increase in the states of Arizona and California due to some principal factors. Among those factors like dry climate, the unique building booms have been one of the most primary factors that have contributed to such increases. The fleet clearing and building were a well-known 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 essential 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 beget jobs in the field of construction, ranching and agricultural work (1).
The decade following the 90’s has had a mountainous 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 snort. 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 dwelling to purposely cleave 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 genuine (3). This implies its commitment and dedication to monitoring and posing regulations for anything threatening the quality of the air. The EPA has position limits on how distinguished pollution is allowed to be in the air. In its goal to contain 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 valuable legislation is the Super Air Act which has been passed to enforce well-kept air standards and improve human health. The Dapper Air Act is an outline for what national, status, and local authorities must follow in order to protect air quality. Under the Tidy Air Act, local and situation authorities are responsible for abiding by the national ambient air quality standards. The Environmental Protection Agency states Maricopa Country cannot exceed the federal health standard for particulate pollution more than three times in a three year period (4).
According to the Environmental Protection Agency (EPA), Maricopa County has been in violation of particulate pollution since 1996. Particularly 2008, there have been nine different days where at least one of the monitors exceeded the federal health standard for particulate pollution. The health standard for particulate pollution is that it cannot exceed more than 150 micrograms per cubic meter measured over a 24 hour period of time. It’s notable to know Maricopa County has 24 air monitoring sites in the Valley. The spot of Arizona, under the Arizona department of environmental quality has its occupy air monitoring sites as well. If any of these monitors exceeds the federal health standard for a given pollutant, the EPA will absorb 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 cut particulate matter pollution. In an attempt to address the vow, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a notion to the EPA to indicate how the county plans to lop PM10 emissions by five percent each year until apt levels are reached. The Five Percent Notion outlined more than 50 commitments to lop 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 gain within qualified dust standards. As fragment of the compliance, Maricopa County has devised that all sites with timid 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 profitable 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 plot equal to or greater than 0.1 acre. Complying with the construction permit requirements is often a distinguished 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 understanding 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 contrivance being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on place understand their responsibility while on spot (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 View must hold a written log recording the real application and execution of the control measures previously outlined and accepted by the Dust Control Concept. This is a daily detailed recordkeeping which records what actions are being conducted in dust-generating operations in what may include daily inspections for crusted or damp soil. Another allotment of describe keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and believe haunted surfaces must install a trackout control devise. These devises are mountainous 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 little to 25 cumulative linear feet (6).
Rule310 is an extensive and overwhelming place 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 residence of interest is more than one acre a series of dust control training must win dwelling. All workers directly eager in the containment of dust like the water truck drivers and water pull drivers must buy a basic dust control training class in which attendees will ultimately become certified if successfully completed the training class. An extension from this part lists that a dust control coordinator must be demonstrate on job station 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 suitable training on regulating emission of fugitive dust and learn practical methods to do so, such as smart up, water and dust suppressant applications (6).
Construction companies are required by region and federal law to implement a diligent concern 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 scrape companies have had to face on a regular basis. The penalty policy held by the Maricopa County Air Quality Department seeks to prevent future violations. Fines that are placed upon companies are definite by the severity of the violation committed. Several factors are faded to calculate the amount of a penalty. In case there has been an economic back 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 detached (9). In the month of September, the amount of $471,613.30 was mild in violations all related in one procedure or another to air quality control. This is the disaster construction company’s face for not correctly using effective measures to cut dust in the construction sites, therefore causing potential problems to come residents and workplaces, eventually becoming a financial spot due to fines.
There is no better procedure 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 expect to allege 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 definite unprejudiced how distinguished companies who are in the construction industry are affected by laws to befriend slit 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 peril for the county is dust control. As a result for the growing grief 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 spend 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 customary to possess 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 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 attend bear 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, titanic fines will follow. This is yet another assert companies are dealing with. To the load even greater, these companies also deal with the economical situation backs from following these regulations. For companies to carve and comply with county regulation, thousands of dollars are being forcefully spent by such companies. The contributions construction companies earn 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 eager in Valley Fever, it is easy to witness favorite 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 petite 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 capture areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and involving 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 slice the number of cases and to decrease the severity of the cases.
This case leer points to a few relatively easy steps to steal in order to decrease the severity of Valley Fever cases. The most distinguished 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 get an awareness of the disease and befriend earlier testing for it.
There are a few steps that can be taken in order to sever the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also abet carve the number of cases. Public awareness of Valley Fever would gash the number of cases by providing the people with knowledge of its causes and ways to avoid exposure to the Coccidioides immitis spores. The second step that should be taken is a national focus on research in vaccines and cures for this disease. From this case peek it is distinct that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the site in some circumstances. These high costs are unacceptable when relatively dinky 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 terrorized. This fungus is endemic to gigantic portions of the American southwest including Phoenix, Arizona, the nation’s fifth largest city. Statistically, anyone living in endemic areas is likely to glean this disease at least once in their lifetime. On top of those living in endemic areas, those visiting the place 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 carve its prevalence.
References
Introduction
(1) Chuang, Amy. “Disseminated Coccidioidomycosis in an Immunocompetent Person Living in Recent York City”. Journal of Urban Health: Bulletin of the Unique York Academy of Medicine, Vol. 82, No. 2, doi:10.1093/jurban/jti057
(2) Comrie, Andrew C. “Climate factors influencing coccidioidomycosis seasonality and outbreaks. Environmental Health Perspectives. June 2005 http://findarticles.com/p/articles/mi_m0CYP/is_/ai_n14816419
(3) DiSalvo, Dr. Arthur. Mycology – Chapter Six Dimorphic Fungi. 21 Nov. 2008 http://pathmicro.med.sc.edu/mycology/mycology-6.htm
(4) McKinley, Jesse. “Valley Fever hits epidemic numbers from Texas to Northern California”. Fresh York Times. 30 Dec. 2007 http://www.sfgate.com/cgi bin/article.cgi? f=/c/a/2007/12/30/MN12U6OGF.DTL&feed=rss.news
(5) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .
Medical Industry
(1) “Coccidioidomycosis..” NGC – National Guideline Clearinghouse . 1 Nov. 2005. 2 Nov. 2008
(2) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .
(3) “Valley Fever – Valley Fever Connections.” Valley Fever – Valley Fever Connections. 22 Nov. 2008 .
(4) “Valley fever – MayoClinic.com.” Mayo Clinic medical information and tools for healthy living – MayoClinic.com. 15 Mar. 2008. 22 Nov. 2008 .
(5) Interview Roni Cummings, Quality risk management: Notes in hand
Infected Individuals & Insurance Companies
(1) Arizona Department of Health Services. (2008). Valley Fever Annual Record 2007 (1st ed.). Phoenix, AZ: Arizona Department of Health Services, Division of Public Health Services.
(2) Interview with Anonymous Patient #1: Patient “V”. (Personal Communication, November 15, 2008).
(3) Interview with Anonymous Patient #2: Patient “F”. (Personal Communication, November 17, 2008).
(4) The Associated Press (2007, January 11). Ariz. Valley Fever Cases Soared in 2006. The Washington Post. All Pages.
(5) Unknown Author. (2008, October 29). Arizona Company Seeks Valley Fever Cure. BIO5 Institute News Archives. All Pages.
(6) Arizona Department of Health Services Webmaster. (2008, November 3). Infectious Disease Epidemiology. Retrieved November 15, 2008, from http://azdhs.gov/phs/oids/epi/disease /cocci/index.htm
(7) Author Unknown. (Last modified October 30, 2008). How Pre-Existing Conditions Work. Retrieved November 15, 2008, from http://health.howstuffworks.com/pre-existing-condition.htm
(8) BIO5 Institute at the University of Arizona. (2008). BIO5 Institute Home Page. Retrieved November 15, 2008, from http://bio5.arizona.edu/index.php
(9) Pfizer Inc. (Unknown Date). Pfizer Products. Retrieved November 15, 2008, from http://www.pfizer.com/products/rx/rx_product_diflucan.jsp
(10) Roerig, Division of Pfizer. (Last revised March 2008). Diflucan (LAB-0099-10.0). Retrieved November 15, 2008, from http://media.pfizer.com/files/products/uspi_diflucan.pdf
(11) The Mayo Clinic. (2006, March 17). Diseases and Conditions Valley Fever. CNN.com & MayoClinic.com. Retrieved from http://azdhs.gov/phs/oids/epi/disease/cocci/index.htm
(12) The University of Arizona. (Video Production). (2008, March 8). Innovation Day at UA 2008, UA @ the Leading Edge [Episode 1]. Development of the Valley Fever Vaccine. Video retrieved from http://www.youtube.com/watch? v=kgT0hFo49G4
(13) Valley Fever Center for Excellence at the University of Arizona. (2003). Valley Fever Center for Excellence: Coccidioidomycosis. Retrieved November 15, 2008, from http://www.vfce.ar izona.edu/
Infected Animals
(1) Mitchell, Chris. Blastomycosis, Cryptococcosis, Coccidioidomycosis (Valley Fever), Histoplasmosis, Disease and more. Animal Shelter Org. 2004. November 4, 2008.
(2) Valley Fever (Coccidiodomycosis). Mar Vista Animal Medical Center. 2006. November 5, 2008. http://www.marvistavet.com/index.html
(3) Valley Fever in Dogs. Valley Fever Center for Excellence. 2008. October 18, 2008.
Construction
(1) “Valley Fever” 1998-2008 Mayo Foundation for Medical Education and Research. Outbreak grips Arizona. March 17, 2006
(2) Benjamin J. Park, Keith Sigel, Victorio Vaz, Ken Komatsu, Cheryl McRill, Maureen Phelan, Timothy Colman, Andrew C. Comrie, David W. Warnock, John N. Galgiani, and Rana A. Hajjeh. “An Epidemic of Coccidioidomycosis in Arizona”, 1998-2001. The Journal of Infectious Diseases, 2005. 1 June.
(3) U.S Environmental Protection Agency. The orderly air act amendments of 1990. Clean Air Act. November 10th, 2008.
(4) MAG 2007 Five Percent Conception For PM-10 For The Maricopa County Nonattainment Region. 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 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, Unique 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 view that they had contracted it. The other forty percent glean symptoms ranging from detached to severe, including death. This emerging disease has had a spacious execute on the human and animal populations in the endemic areas.
When soil containing these fungal spores is fearful they become airborne and can be inhaled by humans and animals. This disturbance can be caused by anything from humans digging and animals playing in the soil to dust storms and earthquakes. Immunocompromised patients, young children, the elderly and members of several ethnic minorities have a higher risk of contracting Valley Fever (4). Although these groups have a higher level of risk, coccidioidomycosis has been known to affect a wide range of individuals from prison inmates and archaeologists, to drug sniffing dogs along the Mexican border. In unusual years, cases in prisoners at a California Central Valley correctional have reached as high as 1 inmate in every 10 tested (4).
The necessary 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 rep serene to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each manufacture ranges from minor to severe consequences. Most critical of all, is to know what the symptoms of Valley Fever are. There are ways to shriek 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 set. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will initiate to beget painful rashes and or lumps on the lower status 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 calm in some people to severe in others. Showing more then one of these symptoms should be a marvelous indicator that the person has contracted the disease and should consult a doctor.
Once a body is infected, Valley Fever will note up in one of three forms acute, chronic, or disseminated. Some of the forms are more rare then others. Depending on the make that Valley Fever takes, the severity of the effects on the body and how unsafe 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 expose the development of the disease. This can happen at any time during the year or any season. It affects both men and women equally and the systems will move like the body has caught the flu. Chronic produce is rarer and less current then the acute develop. It is more hazardous than the acute manufacture and can cause more problems. The chronic build can become evident and construct 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 compose lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural place or the residence between the lungs and the ribs. This can cause serious afflict to the lungs and the person will have a difficult time breathing. Other symptoms include grievous grade fever, weight loss, and nodules in the lungs. The disseminated make is the most uncertain and severe out of the three. This is when the disease spreads to the different parts of the body. The infection gets into the person’s bones, lungs, liver, meninges, brain, skin, heart, and around the heart. It is found that 30% to 50% of those people infected with this perform also secure meningitis. This build can be very deadly as it can cause swelling around the brain and spinal cord. With this acquire, healthcare providers often watch ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening fabricate and can cause death if not treated correctly. It can cause brain pain as well and can affect the brain/mental position 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 hurry can contract the disease more readily then others of another rush 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 gain 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 design it easy for them to come by the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight support as well causing them to derive worse quicker and will be more severe. Age is a ample 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 worn immune systems are at higher risk for complications which may lead to the disseminated invent. It lets the disease spread easier through out the body and lets it rep into the necessary systems of the body. This can gain 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 section of the lungs. There it will grow and multiply inside the lungs. Depending on what accomplish it takes it can distinct up from there or release pus. This pus then can derive absorbed into the body and stick to different types of organs. It can especially target places where it can perform up in such as joints, feet, and legs. This is because the fungi fetch into the blood stream which will bag absorbed by muscles, bones, and under the skin where it can deposit and grow. If the immune system is not strong enough, it can not slay the infection which allows it to further mitigate as it builds in different spots of the body. Since it goes into the body’s blood stream it can come by 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 super 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 perform 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 expend different ways to settle the infection in the body and depending on the degree of the disease.
A chest x-ray can be taken to figure out if one is infected. In the x-ray the doctor would be looking for light areas in the lungs that are poorly defined or patch areas. The area where disease is growing will demonstrate 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 scrutinize if the person is infected with the fungus and since it is more sensitive it can purchase 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 unbiased a shrimp below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will inspect at the arm or the position 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 dwelling will become red and swollen. Although this test is not being obsolete as mighty anymore because it is not as specific, it however is aged in researching to understand the disease. A more current test is a sputum culture. This is where the doctor or nurse retrieves sputum from the patient. Sputum is the mucus-like secretion in the bronchi tubes or where the air goes to the lungs, and comes up with deep coughing. The doctor or nurse will ask the patient to cough deeply and spit up any sputum into a sterile cup. This will be taken to a lab that allows it to grow to recognize if Valley Fever is reveal. The doctor my tap on the chest or have the person inhale steam-like mist to befriend cough up the sputum in order to net 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 indicate it can mean that there is an ongoing infection or a prior one. The test and blood may be taken a couple of weeks after to behold if there is a rise in the antibody count which determines the infection and how severe it may be. The higher the titer or antibody counts the worse the infection it is. These are all tests that the doctors may employ in determining more accurately if the disease is explain in the body. This is the only method to be 100% distinct that there is an infection.
Depending on the magnitude of the infection different treatment options will be provided by the doctors. Some of the forms may even dissipate with no medical interactions as well. The acute disease will usually go away without medical intervention. Favorite management is bed rest and treatment for flu symptoms until the fever goes away. With any of the other forms, medication would be needed to win care of the disease. If the dilemma persists or if there is a higher possibility of complications and it is in its more severe acquire, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic originate or more acute construct that won’t go away, amphotericin B is usually the medication given to aid fight off the disease. Then the person is monitored as to beget certain the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to capture care of lesions that are localized. For the disseminated produce fluconazole or itraconzole is commonly feeble. 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 faded as an alternate in this dwelling if lesions are getting worse more snappily and is old to diffuse pneumonia. Surgery is famous in this case and in most reports at this stage it is primary. This is musty to engage care of sizable abscesses, destructive lesions or bony sequestrations instability of the spine or the movement on primary 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 form it go away for marvelous as relapses can occur or the person can secure it again.
The disease can have short affects and long term effects on the body. Depending on the person or the amount of spores inhaled, this will settle the longevity and affects of the person. The short affects include flu like symptoms and will go away. It is an annoyance objective like any time someone gets sick and the person can go on with their life with no injure. These people probably have higher immune systems. However, the longer the disease stays around in the body the more distress it will do. If it is prolonged in the body for an extended time it will commence 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 end 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 attend. If not treated, the non-acute develop will worsen over time and in most cases win into other organs of the body and accomplish the disseminated type. Taking care of the infection early on would be a suited strategy as Valley Fever can cause death if not treated at the just time. If the disease is prolonged it can cause other diseases or illnesses. These include forming pneumonia and meningitis which originate the condition that worthy more deadly and difficult to treat. As both of those diseases are fatal as well and can earn poor mixes with Valley Fever. Bleeding and lung abscesses could acquire which have to be medically treated and in some cases have to be done with surgery. Prolonged exposure can save the person at vulgar 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 terrible 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 beget such as short of breath to something more risky as not getting any air in and close breathing without medication or immediate treatment. Most importantly the disease should not be taken as lightly as it can cause death if overly prolonged or gets into its most perilous forms in the body. Many problems and complications would have to happen in order for it to acquire 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 itsy-bitsy to major treatment. This disease changes over longer periods of time. A person may have some time to go inspect a doctor before they feel the severity of the disease. Though, as stated earlier, waiting for long periods of time to gawk medical care would not be genuine to one’s health. This disease is taken in most of the medical field taken very lightly even though misdiagnosis and prolonged exposure to the disease can be fatal to the person’s health. It can have affects on the body that finish with them for years at a time or even there entire life. This is something that if in expect consulting a doctor would be the best course of action so treatment can start so complications don’t arise.
Infected Individuals & Insurance Companies
There are many principal stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the mumble of Valley Fever. Arguably, the role of infected persons or those that contain a new vulnerability to the disease is top priority on the decision-maker’s list. Each year, thousands of people are diagnosed with Coccidioidomycosis in Arizona alone. In a 2007 article, the Washington Post wrote that Valley Fever cases diagnosed in 2006 were up fifty-six percent from a year earlier. This prompted Arizona health officials to trace 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 portion of the Southwestern United States where soils have the Valley Fever fungus, will contract the disease at some point. Only a runt percentage of people, however, are diagnosed with a severe enough design of the infection where medical treatment is needed. Anti-fungal medication is the most celebrated 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 necessary to peek individuals currently struggling with the disease as well as those who have recovered from a serious manufacture of Coccidioidomycosis as a stakeholder with regards to this stutter because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an wretchedness to better assist this claim, the lives of two patients that contracted a serious accomplish of the infection, will be addressed and analyzed in the following paragraphs.
Before introducing specific cases, it is necessary to review some fresh facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Represent in October 2008. The describe, 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 articulate the research information in a thorough and comprehensive device to the reader by dividing up Valley Fever statistics for the 2007 year in a multitude of categories. Some of these categories include: cases reported in ‘07 according to specific age groups compared years past and a five-year average, separating the number of Valley Fever cases reported by counties in Arizona, and separating the number of Valley Fever cases reported in both mining and non-mining areas within the location. Although many people assume of this disease as a aloof illness similar to the current cool, Valley Fever is a key narrate 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 fragment of the 2007 represent, 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 execute 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 compose of Coccidioidomycosis each year. The Arizona Department of Health Services reports that the severity of Valley Fever in the spot 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 order. Examining the personal accounts of two anonymous patients afflicted with a serious execute of Coccidioidomycosis can bring further clarity to this claim. Any and all personal information for the following accounts has either been fictionalized, changed or generalized to possess complete anonymity.
The first case will question the despicable effects of Coccidioidomycosis on a male patient of early adulthood age. This individual will be referred to as Patient “V” throughout this paragraph. Patient “V” began his ordeal with Valley Fever in the summer months of 2001. A younger man in the final years of adolescence, Patient “V” experienced generic, flu-like symptoms, which he disregarded as nothing indispensable like most other sufferers settle to do. “At first, I noticed that my lymph nodes in my neck were unusually swollen…I figured it was fair a chilly or some exiguous infection or something like that.” Soon after the initial stages of the disease, Patient “V” began experiencing constant, severe damage in the left side of his chest. Although he made numerous medical appointments for this spot, the damage would subside by the time Patient “V” arrived, making it difficult to diagnose the scrape. “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 exiguous, unlit position on his left lung. The place indicated a relatively diminutive, but well-known hole through the lung. The jam required corrective surgery and Patient “V” was admitted to one of Arizona’s hospitals in August, 2001. Surgeons sewed up the hole in Patient “V’s” left lung and released him after a day of recovery. Within weeks following the surgery, Patient “V” experienced a relapse of his earlier symptoms. “…I was playing Volleyball one night and in an instant, there was this intense injure in my chest…I felt dizzy and could hardly breathe.” Patient “V” immediately returned to the hospital sometime in November of that year where further tests concluded that the infected fragment of his left lung was, indeed, Coccidioidomycosis. Another surgery to completely pick this fraction 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 hurt 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 hurt medication.” Fortunately for Patient “V”, the second surgery was successful and he survived his brush with Valley Fever. In many cases, patients who contract and fend off the infectious spore perform up life-long immunities. However, reports have also shown that patients in remission from Coccidioidomycosis can be more vulnerable to a reoccurrence of the disease than those that have never contracted it. Following his surgical recovery, Patient “V” was prescribed an anti-fungal medication called Diflucan, a current drug distributed to sufferers of the infection. Patient “V” was required to remove 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 slack 1995. Early symptoms experienced in this patient included chronic loss of breath and rude 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 gargantuan, round nodule was located somewhere on her left lung. The patient was admitted to the hospital in 1998 and underwent a wedge resection, to seize the infected fragment (removed in wedge earn) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at tubby strength for six stout 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 shipshape the infected state 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 mild timid to study the total amount owed from her quit 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 amazing. Fair for room and board and a cramped 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 snarl 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 state of win. It is considerable to leer medical insurance companies as a stakeholder with regards to the instruct of Valley Fever as well. Because there is no cure or vaccination for the infection, insurance companies limit the amount of coverage to persons with preexisting conditions. If a cure were to be developed and released into the market, insurance companies would most likely include Valley Fever coverage into any understanding. Unfortunately, without medical insurance, the overall amount of money needed to recover from a serious infection like Valley Fever is simply insurmountable for the majority of Americans. Even with sufficient medical insurance, however, people who have had Valley Fever in the past are typically not covered for a relapse of the infection. Patient “V” currently receives individual health insurance under a PPO from Blue Base 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 current belief 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 pudgy coverage, but will have to wait anywhere from nine months to a year before it kicks in. This period is enforced by insurance companies to insure that a patient is not constantly having relapses of the same condition. However, a person with a preexisting condition will rarely receive private health coverage that includes their condition. This is referred to as the preexisting conditions exclusion. Our attempts to contact major medical insurance companies or medical insurance agents for further clarity on this shriek 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 screech bankruptcy if that happened…” Patient “V” explained. “I live in fright because I know that if I were to fetch 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 spy). 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 status 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 Current York based foundation. They are currently testing an anti-fungal called Nikkomycin Z, which was first ancient to prevent fungal degradation in accomplish. 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 aid fund pharmacology studies that will abet acquire 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 exclaim of Valley Fever would certainly change. Once a cure hits the market, the number of deaths and serious cases as a result of Valley Fever would topple significantly. Debates between the government, politicians and special interest groups would decrease as well if no one were in any right 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 obtain because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Nasty Blue Shield, Cigna and Humana will more freely distribute rotund coverage in instances of Valley Fever. Like most vaccinations and cures to current 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 principal stakeholders with regards to the pronounce of Valley Fever, both infected persons and medical insurance companies would be greatly affected if an executive decision were to be made, or possibly a vaccination released into the market. While the future looks satisfactory with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people come by a blueprint to collect health insurance coverage to some capacity. It is also considerable that individuals with preexisting conditions that aren’t on group medical plans lobby for their rights to complete insurance coverage. In considering the bad effects of Valley Fever, there are many people who mediate this topic is impartial as essential 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 acquire Valley Fever as humans are. Animals accept Valley Fever in the same blueprint as humans do, by breathing the fungus. It has been found that more and more animals are being reported of becoming ill due to this fungus. It has been found the 30-40% of animals who breathe in the fungus secure 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 shaded patterns. The white spots note that the dog might have cancer in its lungs. The dog is only four years aged, 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 invent as hasty as it has in this golden retriever. The owner had said objective two weeks prior to going to the vet that the dog was fat 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 speedy. The dog starts to cough, has a loss of appetite, and minute 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 obvious that it must be a fungal disease and it was fair that, it was Valley Fever (1).
Dogs are the largest infected and most commonly reported animals with Valley Fever. Dogs gain Valley Fever in the same design that humans do and in the same regions as humans do. The fungus is spread through spores which dogs can easily inhale. Once the fungus is inhaled, the spores grow into spherules which enlarge and eventually burst into hundreds of endospores (3). This causes the spreading of the infection into the lungs. A dog’s immune system should acknowledge and surround the infection to 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 raze off the infection and the infection continues to spread into the lungs and then can recede throughout the dog’s body (3).
Once a dog is infected with Valley Fever, there are distinct symptoms that become expose. 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 unhurried as 3 weeks. The cough that dogs earn 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 come the heart and puts pressure on the dogs windpipe which as a result irritates it (3). After the cough is show the loss of appetite and energy is soon to follow. If the infection is not controlled it can become noteworthy 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 distinguished worse. The symptoms that become reveal are: swelling of the limbs, wait on and neck wound, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, spy inflammation, and non-healing skin ulcerations (3). Not all symptoms are display suitable away and it can retract several months before obvious symptoms appear. It can be several months after a cough appears that other symptoms become indicate. 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 popular test done to choose if a dog has been infected is blood tests, chest x-rays, bone and joint x-rays, and Valley Fever blood test (3). Test results may present 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 abet 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 choose 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 puny side effects. This is usually given to dogs that have wound 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 indicate the same symptoms as dogs do but it less likely for a cat to score Valley Fever than it is for a dog. Cats bag Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats gain the fungus their symptoms are usually a microscopic 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 method. The same treatment for dogs can be old to treat cats with Valley Fever (3).
Horses are another animal that have been found to earn 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 current though, and with medical technology improvement chance of survival with fresh medicine is distinguished better for horses today (3). Llamas are another animal that have been infected with Valley Fever. Llamas are very sensitive to this fungus. In most cases, if a llama has Valley Fever death is almost always the outcome.
Zoo’s that are located in the Southwest are very aware of Valley Fever. Many zoos have lost animals due to Valley Fever before they were aware of what is was and how to treat for it. When animals become sick, Valley Fever is something that is tested early so treatment can be started. In zoos, the most celebrated animals to obtain Valley Fever are: Monkeys, Apes, and other primates. These animals spend the same treatment process as dogs and cats but is usually consists of a lifetime treatment (3).
Valley Fever is a very serious direct that is rising in animals. Currently there are no preventatives for Valley Fever. The treatments for Valley Fever for animals has become better and better over time. The near in technology has allowed for veterinarians to be able to detect Valley Fever at a less 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 genuine 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 primary factors. Among those factors like dry climate, the unusual building booms have been one of the most valuable factors that have contributed to such increases. The mercurial clearing and building were a considerable 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 critical 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 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 grunt. 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 lop the amount of dust construction companies contribute to the environment.
The Environmental Protection Agency (EPA) is an agency of the federal government of the United States who is in charge of protecting human health by maintaining the natural environment fine (3). This implies its commitment and dedication to monitoring and posing regulations for anything threatening the quality of the air. The EPA has location limits on how great pollution is allowed to be in the air. In its goal to absorb 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 indispensable legislation is the Smart Air Act which has been passed to enforce super air standards and improve human health. The Shapely Air Act is an outline for what national, plot, and local authorities must follow in order to protect air quality. Under the Natty Air Act, local and space 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 residence of Arizona, under the Arizona department of environmental quality has its beget air monitoring sites as well. If any of these monitors exceeds the federal health standard for a given pollutant, the EPA will have 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 slash particulate matter pollution. In an attempt to address the verbalize, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a understanding to the EPA to reveal how the county plans to carve PM10 emissions by five percent each year until helpful levels are reached. The Five Percent View outlined more than 50 commitments to cut dust. Of these commitments, some affect the procedures and guidelines on construction entities (4).
Speaking with Erin Dunsey of Maricopa County Air Quality Department, the county is currently working hard to pose regulations on construction companies in order to lower dust emissions and ultimately lowering the potential threats from Valley Fever. The principle responsibility for The Maricopa County Air Quality Department’s Dust Compliance Division is to protect the public from the dangers that advance from airborne particulate matter (7). This division of dust compliance deals with fugitive dust sources and the rules to minimize the production of it. This means that fugitive dust from any source, including constructions areas, must be restricted in their construction operations to fill within reliable dust standards. As piece of the compliance, Maricopa County has devised that all sites with timorous 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 abet enforce noble 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 understanding to conduct activities any that will disturb a surface spot equal to or greater than 0.1 acre. Complying with the construction permit requirements is often a essential and daunting task. Before applying for a permit, a conception that outlines the measures that will prevent the creation of dust must be presented. This conception also describes all the measures that will be implemented at anytime during the phase of construction. Therefore, this guideline requires dust generating sources to meet standards and at the same time apply best the available control measures in order to attempt to minimize fugitive dust emissions. This scheme being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on dwelling understand their responsibility while on plot (6).
Another hassle that companies have to deal with is the logging of control measures. Once again, under Maricopa County’s Rule 310, construction companies who conduct a dust generating operations that require a Dust Control Idea must sustain a written log recording the accurate application and execution of the control measures previously outlined and popular by the Dust Control Conception. 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 portion of narrate keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and maintain frightened surfaces must install a trackout control devise. These devises are colossal 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 dwelling of requirements established to lower dust emissions. Share 309 list another requirement under Rule310 that companies must abide by. The rule says that if the plot of interest is more than one acre a series of dust control training must steal situation. All workers directly keen in the containment of dust like the water truck drivers and water pull drivers must seize a basic dust control training class in which attendees will ultimately become certified if successfully completed the training class. An extension from this fraction lists that a dust control coordinator must be demonstrate on job position if the dimension of the job spot is five acres and up (5). These onsite coordinators must have completed a comprehensive dust control training in which they are given excellent 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 situation and federal law to implement a diligent misfortune 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 spot 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 obvious by the severity of the violation committed. Several factors are old-fashioned to calculate the amount of a penalty. In case there has been an economic encourage 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 quiet (9). In the month of September, the amount of $471,613.30 was mild in violations all related in one method or another to air quality control. This is the danger construction company’s face for not correctly using effective measures to prick dust in the construction sites, therefore causing potential problems to reach residents and workplaces, eventually becoming a financial scrape due to fines.
There is no better plot 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 substantial construction company that has a corporate office in Tempe, AZ. With a question to disclose 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 positive honest how distinguished companies who are in the construction industry are affected by laws to wait on cut 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 danger for the county is dust control. As a result for the growing pain 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 conventional to beget fugitive dust. If they ever do not comply with these regulations, fines inaugurate 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 quandary 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 succor fill 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 cut dust in the construction sites, colossal fines will follow. This is yet another insist companies are dealing with. To the load even greater, these companies also deal with the economical status backs from following these regulations. For companies to chop and comply with county regulation, thousands of dollars are being forcefully spent by such companies. The contributions construction companies accomplish to Valley Fever is not underestimated. As a result, strict regulations are followed and posed upon companies to slash the incidence of Valley Fever cases. Valley Fever has advance to cost companies thousands of dollars and is becoming every day more of an disaster.
Conclusion
After studying the stakeholders alive to in Valley Fever, it is easy to explore accepted 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 exiguous 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 assume areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and enchanting 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 positive that because of this, action must be taken in order to slice the number of cases and to decrease the severity of the cases.
This case peep points to a few relatively easy steps to retract 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 alive to in prolonged disease available to both the medical community and the population of endemic areas. This in theory would fabricate an awareness of the disease and relieve earlier testing for it.
There are a few steps that can be taken in order to chop the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also benefit gash the number of cases. Public awareness of Valley Fever would slash 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 gape it is clear that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the location in some circumstances. These high costs are unacceptable when relatively miniature investment is being made in the research of a cure or vaccination.
When considering these recommendations, it is indispensable to review the facts about this disease. Valley Fever is caused by the spores of a fungus that can become airborne when soil is fearful. This fungus is endemic to expansive portions of the American southwest including Phoenix, Arizona, the nation’s fifth largest city. Statistically, anyone living in endemic areas is likely to catch this disease at least once in their lifetime. On top of those living in endemic areas, those visiting the 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 determined that Valley Fever has had a important impact on our society and that steps need to be taken to gash its prevalence.
References
Introduction
(1) Chuang, Amy. “Disseminated Coccidioidomycosis in an Immunocompetent Person Living in Fresh 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”. Original 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 well-kept air act amendments of 1990. Clean Air Act. November 10th, 2008.
(4) MAG 2007 Five Percent Idea For PM-10 For The Maricopa County Nonattainment Status. 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.
