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DATE: 5/16/2006
Health Alert: Valley Fever at Outbreak Levels in Arizona

Scottsdale, Ariz. - The Arizona Medical Board is posting this important Health Alert from the Arizona Department of Health Services. In recent years Arizona has seen a steady increase in reported cases of Valley Fever (coccidioidomycosis). This trend has been amplified by an outbreak of Valley Fever in Arizona over the past several months. From January through April 2006, the Arizona Department of Health Services (ADHS) has received 2,307 case reports. This is three times the five-year average for these months and 85% of the overall annual average for Arizona.

It is likely that case reporting greatly under estimates the extent of Valley Fever. A recently published study done by the Valley Fever Center for Excellence demonstrated that up to 29% of ambulatory patients with community acquired pneumonia (CAP) had Valley Fever (Valdivia, et al, 2006). The study also showed that there are no clinical signs to distinguish Valley Fever cases from ordinary CAP cases and only serologic tests on each patient enrolled established the diagnosis. Additional studies by CDC and ADHS have demonstrated that very low proportions (2-13%) of ambulatory patients with CAP are ever tested for Coccidioides (Doug Chang, CDC, 2006).

Taken together, these three observations (an increase in reported cases; a high frequency of Valley Fever in CAP; and a low percentage of CAP ever tested) clearly indicate the need for a more focused diagnostic approach to CAP cases. ADHS strongly recommends that laboratory testing for Valley Fever (coccidioidomycosis) (serologic or mycologic) be done routinely in Arizona patients with community acquired pneumonia.

Benefits of routine testing

� Accurate diagnosis provides patients with concrete information about their illness.

� Reduces the need for additional expensive and invasive diagnostic tests such as bronchoscopy.

� Avoids the use of unnecessary antibacterial drugs.

� Help the earlier diagnosis of infrequent but serious complications of valley fever when the infection spreads from the lungs through the blood stream to other parts of the body.

Treatment Options for Valley Fever (Coccidioidomycosis) The management of primary coccidioidal infections is an unsettled issue. While it is clear that some patients will benefit from anti fungal medications it is not known if anti fungal medication is necessary in all patients. Guidelines for managing patients with Valley Fever can be found at the Infectious Diseases Society of America and the Valley Fever Center for Excellence, or contact ADHS at (602) 364-4562 or your local health department for more information.