Study: Valley Fever a Common Cause of Community-Acquired Pneumonia

[Guest guest]

May 10, 2006]

TMCnet - USA

Study: Valley Fever a Common Cause of Community-Acquired Pneumonia

http://www.tmcnet.com/usubmit/2006/05/10/1646299.htm

TUCSON, Ariz., May 10 (AScribe Newswire) -- Arizona state

statistics show that reported cases of valley fever are at record

levels. As of the end of April, 2,305 cases of the infection were

reported in Arizona, four times the five-year average for the

January-April time period and more than 85 percent of the state's

five-year average of 2,732 cases per year.

An online report published in advance of the June 2006 print edition

of Emerging Infectious Diseases, a scientific publication of the

Centers for Disease Control and Prevention, suggests that these high

numbers may represent only the tip of the iceberg.

Valdivia, MD, and her colleagues at the Valley Fever Center for

Excellence at The University of Arizona College of Medicine and

Southern Arizona VA Health Care System (SAVAHCS) report that valley

fever, or coccidioidomycosis (cocci), is responsible for

approximately one of every three patients who are treated for what

their doctors think is a community-acquired pneumonia. Most of these

patients are treated with antibiotics, as if they had a bacterial

infection, even though valley fever is caused by a fungus and does

not respond to drugs directed at bacteria.

How frequently valley fever actually causes a medically important

illness has long been a source of uncertainty based upon previously

available information, says N. Galgiani, MD, director of the

Valley Fever Center for Excellence and a member of Dr. Valdivia's

research team.On one hand, cases of valley fever reported in Arizona

in recent years have numbered less than 4,000 infections annually.

But other epidemiologic estimates have suggested that this is only

one-tenth of the actual number. Dr. Valdivia's report is the first

prospective study looking at this question, and her results support

an estimate of about 30,000 patients with valley fever who seek

medical care per year, whether or not their physicians make the

correct diagnosis.

Dr. Valdivia, who is in private practice in Tucson, says, We expect

this study to bring new awareness of the prevalence of cocci to

people in the primary care field, where patients are being screened.

The study was conducted at three Tucson sites the Urgent Care Center

at University Medical Center and two medical offices of Arizona

Community Physicians.

Mark , MD, clinical assistant professor in the UA Department

of Emergency Medicine, medical director of the Urgent Care Center

and a member of Dr. Valdivia's research team, comments, Most

clinicians in this area know about valley fever, but a study never

had been done to see how common it really is. It's a grossly

underdiagnosed disease, and doctors need to think about it early,

not late.

Lindberg, MD, also a member of the research team, is an

assistant professor in the UA Department of Emergency Medicine and

clinical director of the Urgent Care Center. She has a longtime

interest in valley fever, and has written about and lectured on the

disease. This study, she says, confirmed my belief that there's a

lot of valley fever out there; I always look for it.

Dr. Valdivia's study also has major implications for tourists and

other recent visitors to the Phoenix-Tucson region, says Dr.

Galgiani. He explains that for individuals who develop a pneumonia

within a month of returning home from a visit to Southern Arizona,

the likelihood that the pneumonia is caused by the valley fever

fungus is equally high - basically a one-in-three chance.

Current professional recommendations for managing pneumonia include

seeking a travel history only in patients who do not respond to

conventional antibiotics, he says. This report provides evidence

that it might be preferable for physicians to seek a travel history

when the pneumonia is first detected.

Valley fever is caused by a fungus that lives in the soil of certain

areas in the Southwest, Mexico and other regions of the western

hemisphere. In Arizona, the most intensely endemic regions are

Maricopa, Pinal and Pima counties. Most infections cause respiratory

symptoms such as cough, chest pain, and shortness of breath. Other

frequent symptoms include muscle and joint pain, skin rashes, weight

loss and unusually intense fatigue. These symptoms can last from

weeks to many months but usually go away whether or not drug therapy

is given. A small proportion of infections leads to much more

serious complications, including progressively severe pneumonia. The

fungus also may travel through the blood stream from the lungs to

other parts of the body such as the skin, the bones or the brain.

For these complications treatment usually is needed. Currently

available treatments do not cure the infection but assist the immune

system to control the growth of the fungus, which results in

reduction or elimination of the symptoms while the patient continues

treatment. Recurrence of symptoms is common if treatment is stopped.

The University of Arizona is developing a new drug, nikkomycin Z,

which has the potential for eliminating the fungus from infected

tissue and thereby curing the infection. The Valley Fever Center for

Excellence currently is seeking funds to continue clinical trials of

nikkomycin Z, but even if the fund-raising efforts are successful,

the drug is unlikely to be available for general use for another

five to seven years.

In addition to Drs. Galgiani, and Lindberg, Dr. Valdivia's

research team includes Neil M. Ampel, MD, professor of medicine and

staff physician, Section of Infectious Diseases, Southern Arizona

Veterans Administration Health Care System; T'Prien Stoffer, a

medical student at The University of Arizona College of Medicine;

and Fagan, MD, and Lieberman, MD, of Arizona

Community Physicians.

The full text of the study, Coccidioidomycosis as a Common Cause of

Community-acquired Pneumonia, is available at

http://www.cdc.gov/ncidod/EID/vol12no06/06-0028.htm .

For more information about valley fever, please visit

http://www.vfce.arizona.edu

- - - -

CONTACT: Janet Stark, University of Arizona, 520-626-7551