CoccidioidomycosisKayla Davis

Northern Arizona University

Introduction Alias: Valley Fever or San Joaquin Fever Non-infectious fungal infection

Cannot be passed from person to person, animal to animal, or animal to person

Caused by Coccidioides posadasii and Coccidioides immitis (Buhrow, 2013)

Commonly dispersed into the air by any means that disrupts soil (Angus, Schmidt, Dockrell & Grant, 2011)

Farming Construction Earthquakes Large gusts of wind

Ecology Endemic to arid desert regions of: SW United States

Arizona California New Mexico Texas

Mexico Central America South America (Buhrow, 2013)

Figure 1: Geographic distribution of coccidioidomycosis in the Americas.Reprinted from R. Laniado-Laborin. (2007a).

Predisposing FactorsIncreased susceptibility to disseminated disease Being elderly Immunosuppressed Pregnant

Especially the third trimester (Gago et al., 2014)

Certain races African American Hispanic Filipino (Choleva, 2010)

Disease Process Once the spore is inhaled, incubation is 1-3 weeks (Coccidioidomycosis, 2010).

60% OF PEOPLE REMAIN ASYMPTOMATIC

1-4 weeks after exposure 40% of people will present symptoms (Buhrow, 2013).

Mild cases: Flu-like symptoms which include Fever, rash, cough, headache, chest pain, night sweats, and myalgias (Buhrow, 2013).

Valley fever is restricted to respiratory system (90%) 10% will develop pulmonary lesions (Coccidioidomycosis, 2010)

<1% of cases fungus disseminates to other systems (commonly the brain) Change in mental status, respiratory distress, bone or joint pain (Tsang et al., 2010)

Stage of Recovery, Disability, or death

95% of mild cases recover without intervention (Change et al., 2008)

Antifungal medication given to reduce intensity of infection

Untreated disseminated disease will expire Surgery may be required Lifetime treatment may be necessary to prevent reinfection

There is no vaccination or cure for coccidioidomycosis

Figure 2: The life cycles of valley fever. (Buhrow,2013)

Data and Measures Used

Tools• National Electronic Telecommunication System for

Surveillance• U.S. Census Bureau

Measures• retrospective cohort studies• case-control studies• statistical analysis     (Chang et al., 2008)

Incidence Rate Worldwide VALLEY FEVER IS UNIQUE IN A WAY THAT INCIDENCE AND PREVALENCE CAN

BE EXTREMELY HARD TO MEASURE BECAUSE MANY SYMPTOMS ARE COMMONLY MISDIAGNOSED. Many cases in Latin America are misdiagnosed as Tuberculosis “prevalence rates in Latin America are either fragmented or simply not

available” (Laniado-Laborin, 2007a)

IT IS ONLY REPORTABLE IN ARIZONA AND CALIFORNIA BASED ON GLOBAL RESEARCH.

Incidence Rate Worldwide United States-1998-2011

111,717 cases were reported to the CDC from 28 states and the District of Columbia 66% Arizona 31% California 1% other endemic states <1% non endemic states (Tsang, Tabnak, Vugia, Chillder, & Park, 2013)

• Mexico• No prevalence studies have been conducted since 1960

• Central America• Most current studies over 40 years ago

• 21% of children in Guatemala tested positive• 25% of children tested positive in Honduras (Laniado-Laborin, 2007a)

• South America• Endemic areas include Argentina, Brazil, Paraguay, Bolivia, Colombia

• Little known about these countries due to lack of research

Mortality rate worldwide 3.089 coccidioidomycosis related deaths in U.S.(1998-2008)

Crude mortality rate of 0.58 per 1 million person-years (Huang, Bristow, Shafir, & Sorvillo, 2012)

Mortality rates outside the United States were unavailable

Patterns of DiseaseIn the United States

United States Notifiable disease 1995-2010

Arizona and California only states that report these infections after 2010

Endemic states were only taken into account Arizona California Nevada New Mexico Texas *not reportable

Utah

National rates rose from 12,868 cases in 2009 increased to 16,664 cases in 2010 (Tsang et al., 2013)

National prevalence rate in 2011 was 22,401. National incidence rate of 42.6 per 100,000

people (Tsang et al., 2013)

Figure 3: Geographic distribution in the Southwestern United States. (“U of A”, n.d.)

Arizona

Arizona has the highest prevalence rate in the country.

12,920 cases in 2012 22% decrease from 2011 (“Valley

Fever”, 2013)

Figure 4: Reported cases of valley fever per 100,000 population, Arizona 1990 – 2012. Reprinted from Valley Fever 2012 Annual Report.(2013). Retrieved from http://www.azdhs.gov/phs/oids/epi/valley-fever/reports-publications.htm

Gender Historically males are more prone than women

In Arizona, recently, this is not the case 2009: 55% of cases were women (Tsang et al., 2013)

2012: 58% of cases were women (“Valley Fever”, 2013)

California incidence rates 2000-2007: 7.6/100,000 men vs. 4.0/100,000 women 2011: 20.5/100,000 men vs. 9.7/100,000

These variations may be due to higher-risk factors associated with men Occupation, smoking habits, sex hormones

Race/Ethnicity In Arizona only 18.7% of reported cases identified race

Unable to calculate incidence rates based off this (“Valley Fever”, 2013)

Hospitalization rates for African Americans were 12 times higher than Causasians and 20.8 times higher than Hispanics in Arizona (Seitz, Prevots, & Holland, 2012).

1940 study Found African Americans had dissemination rates 8-10 times higher than

Caucasians in California (Brown et al., 2013)

Age Elderly are the most susceptible age group

2011 40-59 years of age: 56.0 per 100,000 people 60-79 years of age: 69.1 per 100,000 people 80+ years of age: 63.6 per 100,000 people Unites States averaged an incident rate of 43.2 per 100,000 people (Tsang et al., 2013)

345 cases were identified during 1999-2008 Median age was 75.7 years old (Baddley et al.,2011)

Arizona has the highest incidence of cases among those over the age of 65 2,752 cases 65+ years old in 2012

Geographic Location California (per 100,000 people)

2010: 9.0 (Hector et al., 2011)

BY COUNTY (2001-2009; per 100,000 people)

Kern: 144.0 Kings: 68.0 Tulare: 37 Fresno: 33 Madera: 15 San Luis Obispo: 31 (Hector et al., 2011)

Figure 7: Coccidioidomycosis incidence rates, California, 2001-2009. (Hector et al., 2011)

Figure 6: Coccidioidomycosis county-specific incidence rate ranges, California, 2001-2009. (Hector et al., 2011)

Geographic Location Arizona (per 100,000 people)

2010: 182.0 2011: 247.7 (Tsang et al., 2013) 2012: 198.8 (“Valley Fever”, 2013)

BY COUNTY (2009; per 100,000 people): Maricopa: 204.0 Pinal: 155.0 Pima: 130.0 (Hector et al., 2011)

The remaining endemic states (Combined incidence rate; per 100,000 people)

-Nevada, Utah, and New Mexico- 2010: 2.1 2011: 3.1

Figure 5: Cases per 100,000 population by county, 2012. . Reprinted from Valley Fever 2012 Annual Report.(2013). Retrieved from http://www.azdhs.gov/phs/oids/epi/valley-fever/reports-publications.htm

Patterns of DiseaseIn Latin America

References Laniado-Laborín, R. (2007).[Image file]. Expanding understanding of epidemiology of

coccidioidomycosis in the western hemisphere. Annals of the New York Academy of Sciences, 1111, 19-34. http://dx.doi.org/10.1196/annals.1406.004

“Life Cycles.” (n.d.) [Image file]. Retrieved from http://diseasespictures.com/wp-content/uploads/2012/10/Valley-fever-4.jpg

“U of A.” (n.d.). [Image file]. Retrieved from https://www.vfce.arizona.edu/Images/SkinTest.jpg

Valley Fever 2012 Annual Report. (2013). Retrieved from http://www.azdhs.gov/phs/oids/epi/valley-fever/reports-publications.htm