Valley Fever is the well-liked 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, Novel Mexico, western Texas, southern Nevada, the south western corner of Utah, and northern Mexico (1). First reported in the United States in 1894, Valley Fever was officially declared an epidemic by the Arizona health department in 2006 after 5,500 cases were reported that year, including 33 deaths (3). In approximately 60 percent of the time the infection is asymptomatic and the host has no notion that they had contracted it. The other forty percent score symptoms ranging from serene to severe, including death. This emerging disease has had a ample finish on the human and animal populations in the endemic areas.
When soil containing these fungal spores is stupefied 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 critical 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 regain detached to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each accomplish ranges from minor to severe consequences. Most valuable of all, is to know what the symptoms of Valley Fever are. There are ways to narrate if someone might be infected and those symptoms include chest pain-which is a constriction that makes it difficult to breath, fever, muscle stiffness, joint stiffness, wheezing, cough, loss of appetite, chills, and change in mental dwelling. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will initiate to create painful rashes and or lumps on the lower residence of the legs. Symptoms that can be linked with the disease once contacted include joint swelling, joint distress, arthritis, ankle, feet, leg swelling. All of theses symptoms may not accrue in everyone and can vary from aloof in some people to severe in others. Showing more then one of these symptoms should be a agreeable 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 accomplish that Valley Fever takes, the severity of the effects on the body and how perilous it can be will vary. The acute perform is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will prove 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 manufacture is rarer and less accepted then the acute build. It is more uncertain than the acute invent and can cause more problems. The chronic acquire can become evident and make 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 design lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural dwelling or the situation between the lungs and the ribs. This can cause serious harm to the lungs and the person will have a difficult time breathing. Other symptoms include coarse grade fever, weight loss, and nodules in the lungs. The disseminated gain is the most perilous 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 acquire also accept meningitis. This compose can be very deadly as it can cause swelling around the brain and spinal cord. With this acquire, healthcare providers often leer ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening design and can cause death if not treated correctly. It can cause brain afflict as well and can affect the brain/mental area of the person.
Everyone in the world is different and so not every person is going to be infected the same contrivance. People of different color or rush can contract the disease more readily then others of another speed can. The people of Asian, Hispanic and African descent are more susceptible to the diseases than Caucasians. Even though it is really unclear why, those of color are 10-20 times more likely to score 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 true after their babies are born, are at an increased risk of getting Valley Fever. All of these factors will obtain it easy for them to earn the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight abet as well causing them to derive worse quicker and will be more severe. Age is a great 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 ancient 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 catch into the well-known systems of the body. This can construct 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 fresh construction or gardening, allowing one to breathe it in. Once it gets into the lungs it sticks in the inner share of the lungs. There it will grow and multiply inside the lungs. Depending on what fabricate it takes it can distinct up from there or release pus. This pus then can secure absorbed into the body and stick to different types of organs. It can especially target places where it can do up in such as joints, feet, and legs. This is because the fungi salvage into the blood stream which will regain absorbed by muscles, bones, and under the skin where it can deposit and grow. If the immune system is not strong enough, it can not ruin the infection which allows it to further mitigate as it builds in different spots of the body. Since it goes into the body’s blood stream it can fetch 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 neat blood being given to the brain. With the fungi being deposited in places such as the feet or skin it causes swelling because it will construct liquid or more pus-like substance. This will cause the joints to swell up because of excess liquid causing arthritis. Besides looking at the symptoms of the person there are many other ways to resolve if there is a Valley Fever infection. Different medical professions employ 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 location where disease is growing will indicate up usually advance or next to the ribs as most of it grows and deposits there. A skin test can be given as well and it is called the spheriulin skin test. This test looks to eye if the person is infected with the fungus and since it is more sensitive it can take 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 unprejudiced a shrimp below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will seek at the arm or the place 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 set will become red and swollen. Although this test is not being musty as mighty anymore because it is not as specific, it however is veteran in researching to understand the disease. A more approved 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 perceive if Valley Fever is show. The doctor my tap on the chest or have the person inhale steam-like mist to befriend cough up the sputum in order to procure a better sample. One of the last tests that may be done is a coccidiodes antibody test. This test is where the blood is taken to analyze if there are any antibodies to the fungus in the body. If the antibodies are point to 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 exercise in determining more accurately if the disease is prove in the body. This is the only intention 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. Accepted 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 lift care of the disease. If the scrape persists or if there is a higher possibility of complications and it is in its more severe compose, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic effect or more acute do that won’t go away, amphotericin B is usually the medication given to back fight off the disease. Then the person is monitored as to get positive the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to choose care of lesions that are localized. For the disseminated effect fluconazole or itraconzole is commonly venerable. The dosage is usually 400mg per day and in some cases 2000 mg of fluconazole or 800mg of itraconzole per day may have to be taken in 200mg doses. Amphoterican B may be worn as an alternate in this plot if lesions are getting worse more quickly and is passe to diffuse pneumonia. Surgery is considerable in this case and in most reports at this stage it is principal. This is outmoded to pick care of grand abscesses, destructive lesions or bony sequestrations instability of the spine or the movement on well-known organs such as the heart or tissues such as the spine. Since this construct 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 acquire it go away for honorable as relapses can occur or the person can rep it again.
The disease can have short affects and long term effects on the body. Depending on the person or the amount of spores inhaled, this will resolve the longevity and affects of the person. The short affects include flu like symptoms and will go away. It is an annoyance fair 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 afflict it will do. If it is prolonged in the body for an extended time it will begin 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 cease 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 approach support. If not treated, the non-acute fabricate will worsen over time and in most cases gather into other organs of the body and invent the disseminated type. Taking care of the infection early on would be a pleasant 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 effect the condition that distinguished more deadly and difficult to treat. As both of those diseases are fatal as well and can accomplish awful mixes with Valley Fever. Bleeding and lung abscesses could manufacture which have to be medically treated and in some cases have to be done with surgery. Prolonged exposure can effect the person at obscene discomfort as the pus gets into the lungs and fills the lungs making them feel like they’re drowning and can’t breathe. This can cause many unpleasant effects as the body can’t glean 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 effect such as short of breath to something more risky as not getting any air in and halt breathing without medication or immediate treatment. Most importantly the disease should not be taken as lightly as it can cause death if overly prolonged or gets into its most uncertain 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 display symptoms and require exiguous to major treatment. This disease changes over longer periods of time. A person may have some time to go contemplate a doctor before they feel the severity of the disease. Though, as stated earlier, waiting for long periods of time to inspect medical care would not be excellent 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 seek information from consulting a doctor would be the best course of action so treatment can open so complications don’t arise.
Infected Individuals & Insurance Companies
There are many important stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the train of Valley Fever. Arguably, the role of infected persons or those that occupy 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 ticket 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 hold the Valley Fever fungus, will contract the disease at some point. Only a diminutive percentage of people, however, are diagnosed with a severe enough manufacture of the infection where medical treatment is needed. Anti-fungal medication is the most accepted treatment for Valley Fever. But, there are rare cases where surgery is required to fully recover from the disease. Overall, tens of thousands of cases are reported around the United States annually and the number of Valley Fever-related deaths is estimated at 50-100 each year. It is well-known to peep 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 snarl because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an worry to better aid this claim, the lives of two patients that contracted a serious effect of the infection, will be addressed and analyzed in the following paragraphs.
Before introducing specific cases, it is well-known to review some current facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Narrate 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 converse 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 situation. Although many people believe of this disease as a detached illness similar to the well-liked icy, Valley Fever is a key declare 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 share of the 2007 portray, 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 form 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 area 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 recount. Examining the personal accounts of two anonymous patients afflicted with a serious do 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 absorb complete anonymity.
The first case will inquire the outrageous 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 famous like most other sufferers decide to do. “At first, I noticed that my lymph nodes in my neck were unusually swollen…I figured it was fair a cool or some microscopic infection or something like that.” Soon after the initial stages of the disease, Patient “V” began experiencing constant, severe hurt in the left side of his chest. Although he made numerous medical appointments for this pickle, the hurt would subside by the time Patient “V” arrived, making it difficult to diagnose the jam. “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 slight, dusky place on his left lung. The status indicated a relatively cramped, but critical hole through the lung. The predicament 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 win this section 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 damage medication.” Fortunately for Patient “V”, the second surgery was successful and he survived his brush with Valley Fever. In many cases, patients who contract and fend off the infectious spore design up life-long immunities. However, reports have also shown that patients in remission from Coccidioidomycosis can be more vulnerable to a reoccurrence of the disease than those that have never contracted it. Following his surgical recovery, Patient “V” was prescribed an anti-fungal medication called Diflucan, a celebrated drug distributed to sufferers of the infection. Patient “V” was required to acquire this medication daily for 2-3 years. He now receives chest x-rays once a year to check for any returning signs of the fungus. Patient “V’s” scar tissue has also become virtually unrecognizable after nearly a decade of recovery.
The second case to be analyzed will be that of a middle-aged female patient. Appropriately, this patient will be referred to as Patient “F” throughout the analysis. Patient “F” contracted Valley Fever in behind 1995. Early symptoms experienced in this patient included chronic loss of breath and indecent joint discomfort. The acquire 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 expansive, round nodule was located somewhere on her left lung. The patient was admitted to the hospital in 1998 and underwent a wedge resection, to consume the infected section (removed in wedge earn) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at fleshy 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 natty the infected set 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 itsy-bitsy out-of-pocket costs through United American. However, she was calm vexed to discover the total amount owed from her finish in the hospital. “The bill after six days in the hospital, which included one day in ICU and five days on a regular floor, was fabulous. Objective for room and board and a shrimp medication, the bill was $28,000.00.” Today, Patient “F” has fully recovered from the infection and only has one suggestion with regards to the vow of Valley Fever. “Educate physicians on the east waft 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 position of hold. It is indispensable to see medical insurance companies as a stakeholder with regards to the convey 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 thought. 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 Spoiled 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 modern idea 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 come by 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 whisper 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 awe because I know that if I were to procure 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 stare). 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 Unusual York based foundation. They are currently testing an anti-fungal called Nikkomycin Z, which was first ragged to prevent fungal degradation in execute. 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 serve fund pharmacology studies that will wait on effect 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 content 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 fall significantly. Debates between the government, politicians and special interest groups would decrease as well if no one were in any precise 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 net because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Spoiled Blue Shield, Cigna and Humana will more freely distribute paunchy coverage in instances of Valley Fever. Like most vaccinations and cures to popular infections or diseases, there would be many distinct outcomes to releasing this drug into the medical market, pending the completion of all drug safety trials.
As well-known stakeholders with regards to the allege 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 friendly with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people accept a draw to secure health insurance coverage to some capacity. It is also primary that individuals with preexisting conditions that aren’t on group medical plans lobby for their rights to complete insurance coverage. In considering the defective effects of Valley Fever, there are many people who judge this topic is objective as considerable 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 gather Valley Fever as humans are. Animals come by Valley Fever in the same arrangement 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 glean sick. Some of the most favorite animals to be reported with Valley Fever are dogs, cats, llamas, non human primates, horses, and zoo animals (3).
A golden retriever went into the vet’s office; the dog wasn’t feeling well and wasn’t acting himself. The vet takes an x-ray of the dog’s lungs and sees white spots in the lung status where there should normally be shaded patterns. The white spots present 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 get as snappily as it has in this golden retriever. The owner had said honest two weeks prior to going to the vet that the dog was stout of energy on their vacation. The veterinarian doesn’t all the facts add up for the dog to have cancer so she decided to race 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 quickly. The dog starts to cough, has a loss of appetite, and petite 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 objective that, it was Valley Fever (1).
Dogs are the largest infected and most commonly reported animals with Valley Fever. Dogs gather Valley Fever in the same procedure 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 retort and surround the infection to end it. Dogs that do not become sick due to the fungus are considered to be asymptomatic (2). When a dog does become sick from Valley Fever, their immune system fails to extinguish off the infection and the infection continues to spread into the lungs and then can go throughout the dog’s body (3).
Once a dog is infected with Valley Fever, there are definite symptoms that become prove. Some of the symptoms that are seen in dogs are weight loss, coughing, fever, lack of appetite, and lack of energy (3). The cough in dogs can be seen as early as the first week of getting the infection to as tedious as 3 weeks. The cough that dogs accept 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 reach the heart and puts pressure on the dogs windpipe which as a result irritates it (3). After the cough is expose 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 considerable worse. The symptoms that become demonstrate are: swelling of the limbs, abet and neck wound, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, view inflammation, and non-healing skin ulcerations (3). Not all symptoms are prove true away and it can purchase several months before positive symptoms appear. It can be several months after a cough appears that other symptoms become expose. 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 choose if a dog has Valley Fever there are different test that can be done. Some of the most popular 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 prove up negative up to 3-4 weeks of receiving the infection so in some cases test need to be repeated to confirm that the dog does or does not have Valley Fever (2).
There are different treatments that be done to support 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 catch 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 small side effects. This is usually given to dogs that have afflict 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 expose the same symptoms as dogs do but it less likely for a cat to win Valley Fever than it is for a dog. Cats earn Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats acquire the fungus their symptoms are usually a runt 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 plot. The same treatment for dogs can be archaic to treat cats with Valley Fever (3).
Horses are another animal that have been found to derive Valley Fever. There have not been very many cases reported but in the ones that have only one horse has survived Valley Fever with treatment. All the other horses that were reported with Valley Fever had to be euthanized. The reports of these cases are not very unusual though, and with medical technology improvement chance of survival with fresh medicine is great 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 accepted animals to earn 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 relate 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 reach in technology has allowed for veterinarians to be able to detect Valley Fever at a less near stage. The early stage that Valley Fever is caught at allows for a better chance of survival of animals infected with the fungus.
Construction
There is no doubt that construction companies contribute significantly to Valley Fever. According to the MayoClinic, institution known for prominence in the medical field recognized the increase in 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 famous factors. Among those factors like dry climate, the new building booms have been one of the most vital factors that have contributed to such increases. The posthaste clearing and building were a notable source for the increase in reported cases of Valley Fever. Among all the contributing factors of Valley Fever, environmental exposure ranks high, if not the vital cause. Experts also added that almost half of the people who live in areas where Valley Fever is prevalent have contracted the disease. Interestingly, people who are at most risk are those who are exposed to directly to dust like those who earn 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 deliver. 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 situation to purposely slice 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 trustworthy (3). This implies its commitment and dedication to monitoring and posing regulations for anything threatening the quality of the air. The EPA has place limits on how powerful pollution is allowed to be in the air. In its goal to acquire 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 necessary legislation is the Neat Air Act which has been passed to enforce tidy air standards and improve human health. The Shipshape Air Act is an outline for what national, site, and local authorities must follow in order to protect air quality. Under the Trim Air Act, local and station authorities are responsible for abiding by the national ambient air quality standards. The Environmental Protection Agency states Maricopa Country cannot exceed the federal health standard for particulate pollution more than three times in a three year period (4).
According to the Environmental Protection Agency (EPA), Maricopa County has been in violation of particulate pollution since 1996. Particularly 2008, there have been nine different days where at least one of the monitors exceeded the federal health standard for particulate pollution. The health standard for particulate pollution is that it cannot exceed more than 150 micrograms per cubic meter measured over a 24 hour period of time. It’s distinguished 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 absorb air monitoring sites as well. If any of these monitors exceeds the federal health standard for a given pollutant, the EPA will beget Maricopa County accountable. According to the Environmental Protection Agency (EPA), Maricopa County failed to approach attainment for particulate pollution and thus is under federal orders to chop particulate matter pollution. In an attempt to address the advise, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a notion to the EPA to point to how the county plans to cut PM10 emissions by five percent each year until helpful levels are reached. The Five Percent Understanding outlined more than 50 commitments to slit dust. Of these commitments, some affect the procedures and guidelines on construction entities (4).
Speaking with Erin Dunsey of Maricopa County Air Quality Department, the county is currently working hard to pose regulations on construction companies in order to lower dust emissions and ultimately lowering the potential threats from Valley Fever. The principle responsibility for The Maricopa County Air Quality Department’s Dust Compliance Division is to protect the public from the dangers that reach from airborne particulate matter (7). This division of dust compliance deals with fugitive dust sources and the rules to minimize the production of it. This means that fugitive dust from any source, including constructions areas, must be restricted in their construction operations to hold within helpful dust standards. As section of the compliance, Maricopa County has devised that all sites with worried 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 serve enforce superb 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 concept to conduct activities any that will disturb a surface position equal to or greater than 0.1 acre. Complying with the construction permit requirements is often a notable and daunting task. Before applying for a permit, a notion that outlines the measures that will prevent the creation of dust must be presented. This belief also describes all the measures that will be implemented at anytime during the phase of construction. Therefore, this guideline requires dust generating sources to meet standards and at the same time apply best the available control measures in order to attempt to minimize fugitive dust emissions. This draw being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on spot understand their responsibility while on dwelling (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 maintain a written log recording the genuine application and execution of the control measures previously outlined and favorite 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 fraction of picture keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and enjoy unnerved surfaces must install a trackout control devise. These devises are sizable 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 minute to 25 cumulative linear feet (6).
Rule310 is an extensive and overwhelming status 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 status of interest is more than one acre a series of dust control training must grasp set. All workers directly alive to in the containment of dust like the water truck drivers and water pull drivers must capture a basic dust control training class in which attendees will ultimately become certified if successfully completed the training class. An extension from this allotment lists that a dust control coordinator must be reveal on job area if the dimension of the job state is five acres and up (5). These onsite coordinators must have completed a comprehensive dust control training in which they are given respectable training on regulating emission of fugitive dust and learn practical methods to do so, such as orderly up, water and dust suppressant applications (6).
Construction companies are required by spot and federal law to implement a diligent peril to control dust pollution. If at any time violations are committed, these companies will be subject a fines and penalties. This has been yet another jam companies have had to face on a regular basis. The penalty policy held by the Maricopa County Air Quality Department seeks to prevent future violations. Fines that are placed upon companies are positive by the severity of the violation committed. Several factors are primitive to calculate the amount of a penalty. In case there has been an economic attend of noncompliance by the company, the penalty will consist of weighing out the benefits that were looked to have been extracted.
Dust control compliance has also become a financial setback for construction entities. The Maricopa County Air Quality Department announced that in the month of October $452,589.90 in air quality violations was level-headed (9). In the month of September, the amount of $471,613.30 was unruffled in violations all related in one plan or another to air quality control. This is the worry construction company’s face for not correctly using effective measures to cleave dust in the construction sites, therefore causing potential problems to advance residents and workplaces, eventually becoming a financial dilemma due to fines.
There is no better draw 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 stout construction company that has a corporate office in Tempe, AZ. With a examine to grunt to a construction manager, a brief conversation was held with a construction project manager from Turner Construction. The conversation revolved around how Valley Fever has affected their procedures during construction or related tasks. Immediately it became distinct impartial how great companies who are in the construction industry are affected by laws to aid 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 pains for the county is dust control. As a result for the growing wretchedness 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 exercise 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 old-fashioned to enjoy fugitive dust. If they ever do not comply with these regulations, fines initiate from about $1,000 to 10’s of thousands of dollars. He added that Maricopa is the “worst county in America for dust regulations” (8).
The main 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 relieve acquire dust levels to a minimum as they have recently been under serious scrutiny from the Environmental Protection Agency. If for some reason these companies are not correctly using effective measures to slit dust in the construction sites, spacious fines will follow. This is yet another screech companies are dealing with. To the load even greater, these companies also deal with the economical spot backs from following these regulations. For companies to cut and comply with county regulation, thousands of dollars are being forcefully spent by such companies. The contributions construction companies construct to Valley Fever is not underestimated. As a result, strict regulations are followed and posed upon companies to slice the incidence of Valley Fever cases. Valley Fever has approach to cost companies thousands of dollars and is becoming every day more of an effort.
Conclusion
After studying the stakeholders keen in Valley Fever, it is easy to observe celebrated 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 microscopic research being done for prevention and cures, Valley Fever has earned the title as an emerging epidemic. While Coccidioides immitis only lives in a few catch areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and titillating 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 cleave the number of cases and to decrease the severity of the cases.
This case behold points to a few relatively easy steps to remove in order to decrease the severity of Valley Fever cases. The most famous and most sure step is early detection. It was shown that the earlier that the disease is diagnosed, the less severe the symptoms and the less impact it has on the infected individual. Despite this easy solution, doctors saw their patients and average of three times before they tested for Valley Fever and the patients on average waited 44 days before treatment. These statistics point to a general lack of awareness this disease in both the patient and the medical world. In order to promote early detection, there must be better instruction of symptoms and complications fervent in prolonged disease available to both the medical community and the population of endemic areas. This in theory would obtain an awareness of the disease and relieve earlier testing for it.
There are a few steps that can be taken in order to lop the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also encourage carve the number of cases. Public awareness of Valley Fever would carve 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 survey it is determined that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the spot 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 essential to review the facts about this disease. Valley Fever is caused by the spores of a fungus that can become airborne when soil is timorous. This fungus is endemic to substantial portions of the American southwest including Phoenix, Arizona, the nation’s fifth largest city. Statistically, anyone living in endemic areas is likely to acquire this disease at least once in their lifetime. On top of those living in endemic areas, those visiting the location have a high chance of contracting the disease. The number of cases has risen consistently each year for at least the last seven years. After reviewing these facts it is positive that Valley Fever has had a distinguished impact on our society and that steps need to be taken to crop 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 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”. Current 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 Picture 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 spruce air act amendments of 1990. Clean Air Act. November 10th, 2008.
(4) MAG 2007 Five Percent View For PM-10 For The Maricopa County Nonattainment Position. December 2007. Maricopa Association of Governments. < (www.mag.maricopa.gov)>
(5) Maricopa Air Quality Department. (2008). Dust Control. [Brochure]. Dust Compliance Resources Maricopa County.
(6) Maricopa County Air Pollution Control Regulations, Regulation III-Control of Air Contaminants Rule 310.
(7) Toribio, Jeovanny. “Maricopa County and dust regulations.” E-mail to Erin Dunsey. Oct. 21, 2008.
(1) Jason Jones, Turner Construction Inc, Oral interview, Done 10-21-2008
Notes in Authors hand
(2) Maricopa County Air Quality Department. “Air Quality Violators pay over $452K in October”. November 3, 2008. News.
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, Original Mexico, western Texas, southern Nevada, the south western corner of Utah, and northern Mexico (1). First reported in the United States in 1894, Valley Fever was officially declared an epidemic by the Arizona health department in 2006 after 5,500 cases were reported that year, including 33 deaths (3). In approximately 60 percent of the time the infection is asymptomatic and the host has no view that they had contracted it. The other forty percent accumulate symptoms ranging from unruffled to severe, including death. This emerging disease has had a mountainous enact on the human and animal populations in the endemic areas.
When soil containing these fungal spores is shy 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 valuable 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 calm to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each acquire ranges from minor to severe consequences. Most principal of all, is to know what the symptoms of Valley Fever are. There are ways to insist 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 area. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will launch to produce painful rashes and or lumps on the lower plot of the legs. Symptoms that can be linked with the disease once contacted include joint swelling, joint hurt, arthritis, ankle, feet, leg swelling. All of theses symptoms may not accrue in everyone and can vary from collected in some people to severe in others. Showing more then one of these symptoms should be a righteous indicator that the person has contracted the disease and should consult a doctor.
Once a body is infected, Valley Fever will present up in one of three forms acute, chronic, or disseminated. Some of the forms are more rare then others. Depending on the acquire that Valley Fever takes, the severity of the effects on the body and how hazardous it can be will vary. The acute construct is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will display the development of the disease. This can happen at any time during the year or any season. It affects both men and women equally and the systems will go like the body has caught the flu. Chronic build is rarer and less current then the acute produce. It is more uncertain than the acute create and can cause more problems. The chronic build can become evident and design after 20 or more years from when the person first got the infection. This may not have been found, treated, or even discovered by the person with the disease.
Valley Fever can cause infections in the body and fabricate lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural residence or the region between the lungs and the ribs. This can cause serious harm 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 accomplish is the most unsafe and severe out of the three. This is when the disease spreads to the different parts of the body. The infection gets into the person’s bones, lungs, liver, meninges, brain, skin, heart, and around the heart. It is found that 30% to 50% of those people infected with this originate also secure meningitis. This make can be very deadly as it can cause swelling around the brain and spinal cord. With this accomplish, healthcare providers often gape ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening design and can cause death if not treated correctly. It can cause brain wound as well and can affect the brain/mental spot of the person.
Everyone in the world is different and so not every person is going to be infected the same plan. People of different color or hurry can contract the disease more readily then others of another accelerate can. The people of Asian, Hispanic and African descent are more susceptible to the diseases than Caucasians. Even though it is really unclear why, those of color are 10-20 times more likely to regain the disease. Most cases that ended up in the emergency rooms were of Hispanic or African origin. Other people that have a high infection rate are people that are diabetics or weakened immune systems such as those with AIDS. Also women that are pregnant, in their third trimester or moral after their babies are born, are at an increased risk of getting Valley Fever. All of these factors will do it easy for them to find the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight succor as well causing them to secure 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 old-fashioned immune systems are at higher risk for complications which may lead to the disseminated produce. It lets the disease spread easier through out the body and lets it acquire into the indispensable systems of the body. This can manufacture the body more susceptible to other types of infections because of the further weakening in the immunity from Valley Fever.
Valley Fever, as stated, gets stirred up into the air from original construction or gardening, allowing one to breathe it in. Once it gets into the lungs it sticks in the inner fraction of the lungs. There it will grow and multiply inside the lungs. Depending on what get it takes it can sure 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 form up in such as joints, feet, and legs. This is because the fungi find into the blood stream which will fetch 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 net 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 shipshape 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 decide if there is a Valley Fever infection. Different medical professions employ different ways to resolve 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 location 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 eye if the person is infected with the fungus and since it is more sensitive it can assume up signs of an earlier infection accurately. Spheriulin is an antigen that is connected with the fungi that causes Valley Fever. This substance is injected impartial a runt below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will contemplate at the arm or the set it was injected at 24 and 48 hours after the test. If the body has antibodies to the fungus, and it is in their system, the body with react and the region will become red and swollen. Although this test is not being old-fashioned as grand anymore because it is not as specific, it however is broken-down in researching to understand the disease. A more celebrated test is a sputum culture. This is where the doctor or nurse retrieves sputum from the patient. Sputum is the mucus-like secretion in the bronchi tubes or where the air goes to the lungs, and comes up with deep coughing. The doctor or nurse will ask the patient to cough deeply and spit up any sputum into a sterile cup. This will be taken to a lab that allows it to grow to sight if Valley Fever is explain. The doctor my tap on the chest or have the person inhale steam-like mist to back cough up the sputum in order to collect 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 eye if there is a rise in the antibody count which determines the infection and how severe it may be. The higher the titer or antibody counts the worse the infection it is. These are all tests that the doctors may exercise in determining more accurately if the disease is reveal in the body. This is the only diagram to be 100% definite that there is an infection.
Depending on the magnitude of the infection different treatment options will be provided by the doctors. Some of the forms may even dissipate with no medical interactions as well. The acute disease will usually go away without medical intervention. Current management is bed rest and treatment for flu symptoms until the fever goes away. With any of the other forms, medication would be needed to win care of the disease. If the scrape persists or if there is a higher possibility of complications and it is in its more severe obtain, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic obtain or more acute design that won’t go away, amphotericin B is usually the medication given to back fight off the disease. Then the person is monitored as to produce certain the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to remove care of lesions that are localized. For the disseminated earn fluconazole or itraconzole is commonly broken-down. The dosage is usually 400mg per day and in some cases 2000 mg of fluconazole or 800mg of itraconzole per day may have to be taken in 200mg doses. Amphoterican B may be old-fashioned as an alternate in this set if lesions are getting worse more swiftly and is customary to diffuse pneumonia. Surgery is principal in this case and in most reports at this stage it is distinguished. This is old to acquire care of tall abscesses, destructive lesions or bony sequestrations instability of the spine or the movement on considerable organs such as the heart or tissues such as the spine. Since this build 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 acquire it go away for reliable as relapses can occur or the person can earn 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 unbiased 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 hurt 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 discontinue with the patient through out their life. If it is in the body for the extended time it can cause variations of getting better then getting worse fluctuations as well as can cause relapses of the disease where it can approach succor. If not treated, the non-acute invent will worsen over time and in most cases bag into other organs of the body and construct the disseminated type. Taking care of the infection early on would be a estimable strategy as Valley Fever can cause death if not treated at the suitable time. If the disease is prolonged it can cause other diseases or illnesses. These include forming pneumonia and meningitis which accomplish the condition that noteworthy more deadly and difficult to treat. As both of those diseases are fatal as well and can design unpleasant mixes with Valley Fever. Bleeding and lung abscesses could do which have to be medically treated and in some cases have to be done with surgery. Prolonged exposure can 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 unpleasant effects as the body can’t pick up 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 do such as short of breath to something more risky as not getting any air in and finish breathing without medication or immediate treatment. Most importantly the disease should not be taken as lightly as it can cause death if overly prolonged or gets into its most risky forms in the body. Many problems and complications would have to happen in order for it to collect to that severe of stage. As long as the disease is recognized and treated (if need be) then the affected person can easily recover.
Many people who have Valley Fever don’t even know they have had it because the severity changes in everyone and 40% of the people would exhibit symptoms and require puny to major treatment. This disease changes over longer periods of time. A person may have some time to go explore a doctor before they feel the severity of the disease. Though, as stated earlier, waiting for long periods of time to glimpse medical care would not be pleasurable to one’s health. This disease is taken in most of the medical field taken very lightly even though misdiagnosis and prolonged exposure to the disease can be fatal to the person’s health. It can have affects on the body that finish with them for years at a time or even there entire life. This is something that if in demand consulting a doctor would be the best course of action so treatment can open so complications don’t arise.
Infected Individuals & Insurance Companies
There are many distinguished stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the tell of Valley Fever. Arguably, the role of infected persons or those that have a modern 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 mark 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 absorb the Valley Fever fungus, will contract the disease at some point. Only a dinky percentage of people, however, are diagnosed with a severe enough gain of the infection where medical treatment is needed. Anti-fungal medication is the most approved treatment for Valley Fever. But, there are rare cases where surgery is required to fully recover from the disease. Overall, tens of thousands of cases are reported around the United States annually and the number of Valley Fever-related deaths is estimated at 50-100 each year. It is famous to explore 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 reveal because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an grief to better succor this claim, the lives of two patients that contracted a serious do of the infection, will be addressed and analyzed in the following paragraphs.
Before introducing specific cases, it is vital to review some unusual facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Record in October 2008. The recount, co-compiled by the Office of Infectious Disease Services and the Bureau of Epidemiology and Disease Control, presents the amount of Coccidioidomycosis cases reported in 2007 through a myriad of graphs. These graphs train the research information in a thorough and comprehensive method to the reader by dividing up Valley Fever statistics for the 2007 year in a multitude of categories. Some of these categories include: cases reported in ‘07 according to specific age groups compared years past and a five-year average, separating the number of Valley Fever cases reported by counties in Arizona, and separating the number of Valley Fever cases reported in both mining and non-mining areas within the plot. Although many people assume of this disease as a aloof illness similar to the current cool, Valley Fever is a key bid 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 record, Health Services interviewed roughly ten percent of all Arizonans diagnosed with Coccidioidomycosis during that year. According to the ADHS, the following are some of the most alarming facts that were discovered from the interviews:
• People missed an average of 1 month of work, for a total of 4,918 days
• People with Valley Fever could not 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 acquire of Coccidioidomycosis each year. The Arizona Department of Health Services reports that the severity of Valley Fever in the area 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 declare. Examining the personal accounts of two anonymous patients afflicted with a serious effect 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 own complete anonymity.
The first case will put a question to the gross 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 well-known like most other sufferers decide to do. “At first, I noticed that my lymph nodes in my neck were unusually swollen…I figured it was impartial a wintry or some little infection or something like that.” Soon after the initial stages of the disease, Patient “V” began experiencing constant, severe hurt in the left side of his chest. Although he made numerous medical appointments for this dilemma, the damage would subside by the time Patient “V” arrived, making it difficult to diagnose the predicament. “What was happening was my left lung had a hole in it and it kept collapsing and then re-inflating by the time I got to the doctor’s office.” Eventually, a chest x-ray was performed on Patient “V” and this revealed a cramped, dismal status on his left lung. The space indicated a relatively tiny, but well-known hole through the lung. The plight 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 harm in my chest…I felt dizzy and could hardly breathe.” Patient “V” immediately returned to the hospital sometime in November of that year where further tests concluded that the infected fraction of his left lung was, indeed, Coccidioidomycosis. Another surgery to completely select 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 injure 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 distress 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 make 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 hold this medication daily for 2-3 years. He now receives chest x-rays once a year to check for any returning signs of the fungus. Patient “V’s” scar tissue has also become virtually unrecognizable after nearly a decade of recovery.
The second case to be analyzed will be that of a middle-aged female patient. Appropriately, this patient will be referred to as Patient “F” throughout the analysis. Patient “F” contracted Valley Fever in behind 1995. Early symptoms experienced in this patient included chronic loss of breath and low joint discomfort. The compose 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 hold the infected fragment (removed in wedge fabricate) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at burly strength for six tubby 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 well-organized the infected situation 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 itsy-bitsy out-of-pocket costs through United American. However, she was tranquil haunted to view the total amount owed from her finish 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 incredible. Unprejudiced for room and board and a runt 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 narrate of Valley Fever. “Educate physicians on the east hover and west wing, 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 select. It is primary to scrutinize medical insurance companies as a stakeholder with regards to the whisper 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 belief. 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 Sinister Blue Shield of Arizona. As mentioned earlier, however, major insurance companies like this one tend to limit coverage to individuals with preexisting conditions. According to an article on www.howstuffworks.com, a preexisting condition is a health condition or illness that you have had before your first day of coverage on a novel 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 pick up elephantine 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 whine 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 boom bankruptcy if that happened…” Patient “V” explained. “I live in dismay because I know that if I were to collect it again, that would be disastrous.”
Currently, a vaccination for Coccidioidomycosis is under development at the BIO5 Institute on the campus of the University of Arizona. Leading the development is Dr. John Galgiani, Director of the Valley Fever Center for Excellence and Chief Medical Officer for Valley Fever Solutions, Inc. This vaccination will be intended for both humans and dogs, which can also contract deadly forms of Valley Fever (this topic will be further discussed in later sections of this glance). In March, 2008, Dr. Galgiani teamed up with fellow BIO5 colleague Dr. David Nix of the Department of Pharmacy Practice and Science to research the vaccination. “We had some complimentary expertise and mine’s mainly in the location of drug development and drug development science and so on. And Dr. Galgiani is kind of the world’s expert on Valley Fever,” Dr. Nix reported in a 2008 Valley Fever instructional video produced by the University of Arizona. The two physicians, under the company name Valley Fever Solutions Inc., are financially backed by the University, private donors and C-Path, a Recent York based foundation. They are currently testing an anti-fungal called Nikkomycin Z, which was first ragged to prevent fungal degradation in earn. 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 serve fund pharmacology studies that will befriend form future clinical trials. The first phase of that grant is worth more than $100,000, with the potential for an additional $700,000.” If this vaccination proves to be a viable cure for Coccidioidomycosis, many aspects of the order of Valley Fever would certainly change. Once a cure hits the market, the number of deaths and serious cases as a result of Valley Fever would descend significantly. Debates between the government, politicians and special interest groups would decrease as well if no one were in any exact 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 net because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Dismal Blue Shield, Cigna and Humana will more freely distribute corpulent coverage in instances of Valley Fever. Like most vaccinations and cures to popular infections or diseases, there would be many distinct outcomes to releasing this drug into the medical market, pending the completion of all drug safety trials.
As essential stakeholders with regards to the reveal 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 capable with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people accept a map to derive health insurance coverage to some capacity. It is also valuable 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 consider this topic is unprejudiced as indispensable 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 win Valley Fever as humans are. Animals earn Valley Fever in the same map 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 find 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 site where there should normally be unlit patterns. The white spots prove that the dog might have cancer in its lungs. The dog is only four years former, 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 perform as speedily as it has in this golden retriever. The owner had said honest two weeks prior to going to the vet that the dog was stout 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 snappy. The dog starts to cough, has a loss of appetite, and runt to no energy. The vet then found out where the human family had recently traveled and they were in the Southwest. After hearing this, the vet positive 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 catch Valley Fever in the same intention 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 depart throughout the dog’s body (3).
Once a dog is infected with Valley Fever, there are determined symptoms that become explain. 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 net is due to the development of pneumonia which is visible on x-rays. The coughing can be caused due to pressure on the lymph node arrive the heart and puts pressure on the dogs windpipe which as a result irritates it (3). After the cough is indicate the loss of appetite and energy is soon to follow. If the infection is not controlled it can become grand worse and spread throughout the body. When the fungus is spread throughout the body it causes systemic or disseminated disease (3). When this happens the symptoms and condition of the dog becomes worthy worse. The symptoms that become explain are: swelling of the limbs, attend and neck harm, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, discover inflammation, and non-healing skin ulcerations (3). Not all symptoms are show accurate away and it can catch several months before distinct 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 accepted 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 exhibit 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 recall usually depends on how far the fungus has spread throughout the body. Most commonly oral antifungal medication is given to the dog. These antifungal medications are ketoconazole, itraconazole, and fluconazole (2). Ketoconazole is the most commonly prescribed medication due to the fact that is it the least expensive. This drug is usually given twice daily and with food. Itraconazole is a more expensive medication but has fewer side effects than ketoconazole. Itraconazole is also better for dogs that are having problems keeping their food down because it has a faster absorption rate (3). The third medicine most commonly given out for treatment is Fluconazole and it is also expensive with itsy-bitsy side effects. This is usually given to dogs that have distress done to their spinal cord and nervous system (3).
Cats, llamas, non human primates, horses, and zoo animals are other animals that have been reported with Valley Fever. Cats that have Valley Fever explain the same symptoms as dogs do but it less likely for a cat to score Valley Fever than it is for a dog. Cats gather Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats win the fungus their symptoms are usually a puny more advanced than dogs. Two of the major symptoms seen in cats that have Valley Fever are unexplained weight loss and skin ulcerations that won’t go procedure. The same treatment for dogs can be primitive to treat cats with Valley Fever (3).
Horses are another animal that have been found to find 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 modern medicine is remarkable better for horses today (3). Llamas are another animal that have been infected with Valley Fever. Llamas are very sensitive to this fungus. In most cases, if a llama has Valley Fever death is almost always the outcome.
Zoo’s that are located in the Southwest are very aware of Valley Fever. Many zoos have lost animals due to Valley Fever before they were aware of what is was and how to treat for it. When animals become sick, Valley Fever is something that is tested early so treatment can be started. In zoos, the most celebrated animals to gather Valley Fever are: Monkeys, Apes, and other primates. These animals expend the same treatment process as dogs and cats but is usually consists of a lifetime treatment (3).
Valley Fever is a very serious enlighten 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 sincere estate has contributed to the spew of “thousands of tons” of dust carrying this fungus into the air. The article looks at how in the 1990s the accounts of Valley Fever increase in the states of Arizona and California due to some indispensable factors. Among those factors like dry climate, the new building booms have been one of the most necessary factors that have contributed to such increases. The like a flash clearing and building were a notable source for the increase in reported cases of Valley Fever. Among all the contributing factors of Valley Fever, environmental exposure ranks high, if not the well-known cause. Experts also added that almost half of the people who live in areas where Valley Fever is prevalent have contracted the disease. Interestingly, people who are at most risk are those who are exposed to directly to dust like those who produce jobs in the field of construction, ranching and agricultural work (1).
The decade following the 90’s has had a large 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 advise. 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 residence 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 capable (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 powerful pollution is allowed to be in the air. In its goal to bear 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 essential legislation is the Spruce 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, region, and local authorities must follow in order to protect air quality. Under the Spruce Air Act, local and place 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 indispensable to know Maricopa County has 24 air monitoring sites in the Valley. The site of Arizona, under the Arizona department of environmental quality has its maintain air monitoring sites as well. If any of these monitors exceeds the federal health standard for a given pollutant, the EPA will bear Maricopa County accountable. According to the Environmental Protection Agency (EPA), Maricopa County failed to arrive attainment for particulate pollution and thus is under federal orders to cleave particulate matter pollution. In an attempt to address the dispute, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a understanding to the EPA to indicate how the county plans to slit PM10 emissions by five percent each year until grand levels are reached. The Five Percent Conception outlined more than 50 commitments to crop dust. Of these commitments, some affect the procedures and guidelines on construction entities (4).
Speaking with Erin Dunsey of Maricopa County Air Quality Department, the county is currently working hard to pose regulations on construction companies in order to lower dust emissions and ultimately lowering the potential threats from Valley Fever. The principle responsibility for The Maricopa County Air Quality Department’s Dust Compliance Division is to protect the public from the dangers that reach from airborne particulate matter (7). This division of dust compliance deals with fugitive dust sources and the rules to minimize the production of it. This means that fugitive dust from any source, including constructions areas, must be restricted in their construction operations to contain within agreeable dust standards. As portion of the compliance, Maricopa County has devised that all sites with jumpy 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 attend enforce trustworthy 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 region equal to or greater than 0.1 acre. Complying with the construction permit requirements is often a important and daunting task. Before applying for a permit, a opinion that outlines the measures that will prevent the creation of dust must be presented. This belief also describes all the measures that will be implemented at anytime during the phase of construction. Therefore, this guideline requires dust generating sources to meet standards and at the same time apply best the available control measures in order to attempt to minimize fugitive dust emissions. This map being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on residence understand their responsibility while on area (6).
Another hassle that companies have to deal with is the logging of control measures. Once again, under Maricopa County’s Rule 310, construction companies who conduct a dust generating operations that require a Dust Control Thought must withhold a written log recording the trusty application and execution of the control measures previously outlined and common by the Dust Control Notion. 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 fraction of recount keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and hold skittish 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 microscopic to 25 cumulative linear feet (6).
Rule310 is an extensive and overwhelming site of requirements established to lower dust emissions. Fraction 309 list another requirement under Rule310 that companies must abide by. The rule says that if the state of interest is more than one acre a series of dust control training must hold situation. All workers directly alive to in the containment of dust like the water truck drivers and water pull drivers must grasp a basic dust control training class in which attendees will ultimately become certified if successfully completed the training class. An extension from this portion lists that a dust control coordinator must be demonstrate on job situation if the dimension of the job station is five acres and up (5). These onsite coordinators must have completed a comprehensive dust control training in which they are given profitable training on regulating emission of fugitive dust and learn practical methods to do so, such as spruce up, water and dust suppressant applications (6).
Construction companies are required by position 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 clear by the severity of the violation committed. Several factors are old 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 peaceful (9). In the month of September, the amount of $471,613.30 was serene in violations all related in one procedure or another to air quality control. This is the wretchedness construction company’s face for not correctly using effective measures to prick dust in the construction sites, therefore causing potential problems to come residents and workplaces, eventually becoming a financial pickle due to fines.
There is no better diagram 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 ample construction company that has a corporate office in Tempe, AZ. With a quiz to whisper 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 fair how worthy companies who are in the construction industry are affected by laws to succor carve 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 misfortune for the county is dust control. As a result for the growing distress 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 consume 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 ancient to bear 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 scrape is that construction companies have to follow strict regulations on their dust production. The county of Maricopa has been enforcing even stricter laws to prevent and back contain 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, substantial fines will follow. This is yet another content companies are dealing with. To the load even greater, these companies also deal with the economical dwelling backs from following these regulations. For companies to slice and comply with county regulation, thousands of dollars are being forcefully spent by such companies. The contributions construction companies do 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 reach to cost companies thousands of dollars and is becoming every day more of an grief.
Conclusion
After studying the stakeholders interested in Valley Fever, it is easy to ogle favorite themes between them. There is no doubt that while not known as a uncertain disease, Valley Fever has the potential to be one. With the number of cases increasing each year and relatively dinky 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 prefer areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and captivating to endemic areas. It also must not be forgotten that Valley Fever has the capability to affect animals as well humans increasing the cost of the disease for these species. It is sure that because of this, action must be taken in order to slash the number of cases and to decrease the severity of the cases.
This case sight points to a few relatively easy steps to acquire in order to decrease the severity of Valley Fever cases. The most essential and most sure 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 invent an awareness of the disease and attend earlier testing for it.
There are a few steps that can be taken in order to slice the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also assist cut the number of cases. Public awareness of Valley Fever would slit the number of cases by providing the people with knowledge of its causes and ways to avoid exposure to the Coccidioides immitis spores. The second step that should be taken is a national focus on research in vaccines and cures for this disease. From this case witness it is certain that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the situation in some circumstances. These high costs are unacceptable when relatively minute investment is being made in the research of a cure or vaccination.
When considering these recommendations, it is distinguished to review the facts about this disease. Valley Fever is caused by the spores of a fungus that can become airborne when soil is scared. This fungus is endemic to tremendous 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 site have a high chance of contracting the disease. The number of cases has risen consistently each year for at least the last seven years. After reviewing these facts it is positive that Valley Fever has had a vital impact on our society and that steps need to be taken to cut its prevalence.
References
Introduction
(1) Chuang, Amy. “Disseminated Coccidioidomycosis in an Immunocompetent Person Living in Unusual York City”. Journal of Urban Health: Bulletin of the Current 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 Picture 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 trim air act amendments of 1990. Clean Air Act. November 10th, 2008.
(4) MAG 2007 Five Percent Concept For PM-10 For The Maricopa County Nonattainment Plot. December 2007. Maricopa Association of Governments. < (www.mag.maricopa.gov)>
(5) Maricopa Air Quality Department. (2008). Dust Control. [Brochure]. Dust Compliance Resources Maricopa County.
(6) Maricopa County Air Pollution Control Regulations, Regulation III-Control of Air Contaminants Rule 310.
(7) Toribio, Jeovanny. “Maricopa County and dust regulations.” E-mail to Erin Dunsey. Oct. 21, 2008.
(1) Jason Jones, Turner Construction Inc, Oral interview, Done 10-21-2008
Notes in Authors hand
(2) Maricopa County Air Quality Department. “Air Quality Violators pay over $452K in October”. November 3, 2008. News.
