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Re: Valley Fever - Personal Experience?

Dennis --

The blood test (of which I have a copy) includes a specific screen for coccidioides. Along with the elevated blood count, it indicates Valley Fever. As you know this is a geographically based disease, and incidences are higher in Maricopa County AZ than about anywhere else in the country. A doctor who has been seeing patients in this county has more actual experience with treatment of Valley Fever than most specialists anywhere else.

My brother has been in medical pracice in Chattanooga and northwestern New Mexico for over thirty years. He says they never see it in his area, but sent a three-page disease profile which tells me more than I need to know. For example,

1) "In Arizona, reported cases of coccidioidomycosis increased from 21 cases per 100,000 in 1997 to 91 cases per 100,000 in 2006."
2) "Approximately 60 percent of all United States coccidioidal infections occur within Maricopa, Pinal, and Pima counties of Arizona."
3) "Coccidioides spp grow as mold a few inches below the surface of the desert soil. With dry conditions, the mycelia become very fragile, are easily fractured by even slight air turbulence into single-cell spores (arthroconidia) approximately 3 to 5 microns in size, and can remain suspended for prolonged periods of time in the air."
4) "Infection is virtually always acquired by inhalation of a single arthroconidium. Within the lung, an arthroconidium changes from a barrel-shaped cell to a spherical structure and then greatly enlarges, sometimes becoming 70 µm or more in diameter. Enlarging spherules produce internal septations and within each of the resulting subcompartments, individual cells (endospores) evolve. After several days, mature spherules rupture, releasing endospores into the infected tissue; each endospore is potentially capable of producing another spherule." Nice, huh?
5) "When illness is clinically significant, a subacute process known as Valley Fever with respiratory and systemic complaints is typical, often lasting for weeks to months. In the great majority of such infections, resolution occurs without specific antifungal therapy." Hopefully my case falls within the great majority.
6) "Peripheral thin-walled pulmonary cavities or nodules are detected in 4 to 8 percent of all patients." Looks like I'm in that group.
7) "Fungal cultures are usually requested only in hospitalized patients or in those with more extensive disease." I would certainly like this avoid hospitlization.
8) "Any positive serologic result is very likely to be clinically relevant. Most patients lose serologic reactivity within months of an infection unless residual lesions are evident or infection is active." I may have another blood test in a couple of weeks to measure progress.,
9) Regarding the skin test, "Skin testing — Reagents for skin testing are not currently available and the utility of this modality is limited in patients with severe infection due to anergy. Skin testing is more useful for epidemiologic studies, since dermal reactivity remains present for life." This is based on an article in www.uptodate.com, a clinical information service that has thousands of topics such as this one, designed to give immediate answers to clinical questions.
10) The possible role of treatment was evaluated in an observational study of 105 patients with primary pulmonary coccidioidomycosis who were seen at a university-affiliated Veterans Administration clinic. Based upon severity of illness as assessed by the attending staff, 54 patients were treated and 51 were not. Treatment was more likely to be initiated in patients with elevated symptom scores. There was no difference between the groups with respect to overall rates of improvement. Among the untreated patients, none were subsequently found to have complications.

However, among 38 of the treated patients, eight had relapse or progression of their coccidioidal infection following discontinuation of therapy; the duration of treatment among these patients ranged from one to 24 months. A possible reason for these findings is that patients with more severe illness are more likely to develop relapse. These findings provide no support for treating patients with mild symptoms of primary coccidioidomycosis, but emphasize the importance of close and prolonged follow-up for patients with severe illness requiring treatment."
11) "An amphotericin B preparation should be considered only in the most severe cases of coccidioidal pneumonia due to its toxicity and problems with administration." That's essentially what I was told today.
12) Other treatments available "If a decision to begin treatment is made, reasonable doses would be up to 400 mg/day for ketoconazole, 400 mg/day for fluconazole, or 200 mg twice daily for itraconazole. Fluconazole has fewer drug interactions, while itraconazole has less of a drying effect on skin and mucus membranes. Both fluconazole and itraconazole have a lower incidence of gastrointestinal side effects compared with ketoconazole. Ketoconazole has also been associated with decreased testosterone synthesis and gynecomastia."

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Valley Fever - Personal Experience?
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Dennis,
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