H5N1

US: New diagnostic tool for valley fever

Via MedicalXpress.com: Dangers of desert dust: New diagnostic tool for valley fever.

On July 5, 2011, a massive wall of dust, ("haboob," in Arabic), blanketed Phoenix, Arizona, creating an awesome spectacle, (or stubborn nuisance, depending on your perspective). Dust storms are a common occurrence in the arid desert environments of the American Southwest. 

But windborne dust can be a serious health risk, lofting spores of a sometimes-lethal fungus known as Coccidioides. The resulting ailment, known as coccidioidomycosis or valley fever, has been perplexing researchers since it was first described in 1892. It is currently on an alarming ascent in the United States. 

Dr. Stephen Albert Johnston, Krupa Navalkar and their colleagues at Arizona State University's Biodesign Institute have been investigating Valley Fever. Navalkar is the lead author of a new study describing a promising strategy known as immunosignaturing, which can provide clinicians with an accurate identification of valley fever, a potentially serious affliction that is often misdiagnosed. 

"The incidence of this disease is seemingly low due to non-sensitive diagnostic assays," Navalkar says. As Johnston further notes, "immunosignatures could easily change those false assumptions if made available in the clinical setting." 

Navalkar is a researcher in Biodesign's Center for Innovations in Medicine, under the direction of Stephen Albert Johnston, who is also a co-author of the new study. 

The group's findings appear in the current issue of the journal ASM Clinical and Vaccine Immunology.

US: Valley fever fears rise after Arizona dust storm

Via azfamily.com: Valley fever fears rise after dust storm. Click through for the full report and a video clip. Excerpt:

PHOENIX -- Now that the dust has settled, it's stirring up new health concerns. 

Hundreds of people gathering for a family-friendly fireworks show on July 3 in Ahwatukee may have exposed themselves to more than a little holiday fun when a massive dust storm rolled through. 

After being caught out in the storm and breathing in all that dust, a lot of people are now worrying about valley fever. 

"It's a fungus that's in the dirt, the soil, the air, so it's, in essence, around us all the time," said Dr. Rick Swearingen, the medical director at Dignity Health's Ahwatukee Urgent Care. "But certainly see clusterings of it this time of the year when we have the monsoons." 

In an interview with 3TV, Swearingen said that after Thursday's storm and more in the forecast, he expects to see an uptick in patients seeking care in the coming weeks. 

Valley fever, he said, takes about one to three weeks to become present. 

"The main symptoms are fever, a dry cough, at times a rash," he said. In essence, he said, most people have flu-like symptoms. 

Last year, there were several thousand cases of the disease in Maricopa County alone. However, Swearingen told 3TV it's nothing to panic over. 

"The vast majority of people never have any symptoms; they never knew they had valley fever," he said. 

There are certain groups, though, like the elderly or those with immune-system deficiencies that are more susceptible to severe symptoms and complications. 

"There can be worse problems. Those are the ones we hear about in the news, where people had meningitis and bone infections -- all kinds of crazy things from valley fever -- but thankfully that's in the minority," he said. 

For the most part, people who have lived in Arizona for any length of time have built up an immunity to the disease. Swearingen says people who have recently moved here are more likely to come down with it.

US: LA Zoo works to help gorilla with valley fever

Via The Los Angeles Times: Healthcare for apes: L.A. Zoo works to help gorilla with valley fever. Excerpt:

Veterinarian Cindy Stadler carefully pushed a 2-foot-long plastic breathing tube down the 360-pound gorilla’s throat after he’d been sedated in preparation for a medical exam Thursday at the Los Angeles Zoo. 

It was the first checkup of the year for Jabari, a 16-year-old western lowland gorilla recovering from a severe case of valley fever. 

“The good news is that Jabari has finally turned the corner and is doing very well,” said Curtis Eng, chief veterinarian at the zoo, as staffers tightened a tourniquet and shaved a patch of hair off the gorilla’s massive right arm in order to draw blood samples. Jabari was sprawled on the concrete floor, his heartbeat steady. 

The staff set to work, adjusting the flow of anesthesia while keeping a close eye on the digital heart monitor. 

Putting any animal under anesthesia can be a risky proposition, yet Jabari has endured dozens of such procedures since he became the first great ape at the zoo to contract valley fever. 

In late 2011, Jabari developed symptoms consistent with a bad cold: persistent cough, fever, runny nose, loss of appetite and lethargy. When he didn’t respond to antibiotics, extensive testing revealed he was suffering from fungal pneumonia brought on by coccidioidomycosis, or valley fever. 

Because gorillas share 98.5% of their genes with humans, they are susceptible to many of the same pathogens. And they often are treated with the same drugs.

But Jabari was especially uncooperative and refused any oral medication. Zookeepers tried hiding it in bananas, papayas, oranges, and leafy vegetables. 

“We even tried hiding it in oatmeal, mashed potatoes and cooked pasta doused in soy sauce and salad dressing,” said Candace Sclimenti, senior animal keeper of the ape section. “No luck.” 

It wasn’t long before Jabari was having serious trouble breathing. He lost a fifth of his body weight. 

After consulting with veterinarians across the country and physicians who treat humans with the disease, zookeepers placed Jabari on a medication that needed to be administered intravenously after he was sedated. 

“Jabari was immobilized 25 times over a period of about two months in 2012 to get him to start feeling better,” Eng said. 

Several months ago Jabari was put on posaconazole, a potent and expensive medication that he washes down with grape juice. He may end up taking it for the rest of his life, at a cost of roughly $17,000 a month.

US: Valley fever research may get funding boost

Via the Visalia Times-Delta: Valley fever research may get funding boost. Excerpt:

A bipartisan task force made up of lawmakers across the Southwest, including Representative Devin Nunes, scored a victory in Washington this week in its quest to add the fungus that causes Valley fever to a list of pathogens the government has a heightened interest in combating. 

Signed into law in 2012, the Generating Antibiotic Incentives Now, or GAIN Act, created incentives for pharmaceutical companies to develop antibiotics to treat new and emerging drug-resistant bugs. The incentives in this act will now extend to researchers studying valley fever. 

Valley fever, also called coccidioidomycosis, is an infection caused by the fungus Coccidioides, which is common in the soil of the southwestern United States, especially in the San Joaquin Valley. 

Over the last several years, the Tulare County health department reports there has been an average of about 200 cases per year. 

Many people infected by the fungus suffer passing flu-like symptoms, but in less than five percent of local cases, the fever is fatal, County Health Officer Karen Haught said. 

Tulare dairyman Joseph Bakker, 35, has been battling the fever for about a month. It began with headaches. But the headaches, followed by a nasty cough, just wouldn't stop. 

Bakker visited a clinic nearly two weeks into his illness that gave him some antibiotics. When the pills failed to help, a blood test was done that determined he was infected with valley fever. 

After receiving the diagnosis, he was referred by other dairymen who've had the fever to a physician who they say has a good track record fighting the fever. Bakker's now two weeks into his treatment. 

"I can't say I feel better, but I feel like I'm on the right path now," he said. 

Still, work is difficult. He's worked sparingly the last three weeks. The fever, he said, saps his energy. 

"I'm exhausted," he said. 

Rep. Kevin McCarthy, R-Bakersfield, co-chairs the Congressional Valley Fever Task Force, which has been trying to raise awareness of valley fever and funnel more public money into research for a vaccine and cure. 

On Wednesday, McCarthy and co-chair U.S. Rep. David Schweikert, R-Scottsdale, Ariz., released a joint statement about the inclusion of the fungus on the list. 

"The decision by the Food and Drug Administration to add the underlying fungi species responsible for valley fever to the list of qualifying pathogens is a big win for our constituents suffering from this disease," it read. "FDA's actions will help with developing an effective treatment and vaccine for this disease."

US: A Valley fever death in New Mexico

Via the Carlsbad Current-Argus: Valley fever claims life of Carlsbad man. Excerpt:

A Carlsbad man is dead after a recent battle with valley fever. 

The fever is relatively rare for New Mexico, and deaths even more so, according to a state health official. It's more commonly found in areas of Arizona and California. 

Cases of the fever are now on the rise, largely in Arizona and California, the Health Department said. There have been 336 cases of valley fever in New Mexico reported since 2006. None of those have resulted in deaths, according to the health department. Four cases have been reported so far this year. 

Paul Jeffery Moore, 60, died on May 19. The Current-Argus was unable to talk with Moore's family members about the circumstances of his death, but according to a spokeswoman at the Office of the Medical Examiner, in Albuquerque, the manner of Moore's death was natural. The cause was "sepsis due to coccidioides immitis pneumonia." 

What that means in plain English, according to the Centers for Disease Control, is that valley fever is an infection caused by the fungus Coccidioides. The fungus lives in the soil in the southwestern United States and parts of Mexico and Central and South America. The fungus was also recently found in south-central Washington.

"A climate crisis is also a health crisis"

Via The New York Times, a letter to the editor: ‘A Climate Crisis Is Also a Health Crisis’.

To the Editor: 

Climate change effects extend far beyond the very real and urgent crisis faced by California communities that are running out of water (“Climate Issues Moved to Fore in California by Governor,” news article, May 20). 

Millions of Californians now rely on groundwater contaminated by agricultural runoff and industrial chemicals. Drought-related dust and wildfires intensify asthma, respiratory diseases and Valley Fever. Less agricultural production means poorer nutrition, fewer jobs and higher food prices for the entire country. 

A climate crisis is also a health crisis, and we must first direct solutions and resources to our most vulnerable and already affected communities. 

Yes, we need electric cars and reduced carbon emissions, but we need more than just a tweak to the systems put in place when California was home to less than 12 million people and was at least one degree cooler. 

We must begin to incorporate adaptation and mitigation strategies into every decision we make — agricultural, environmental, energy, public health and economic. If we want to save lives and the planet, we have to think of climate change as more than a climate issue. 

LINDA RUDOLPH Oakland, Calif., May 20, 2014 

The writer, a pediatrician and specialist in emergency medicine, is director of the Center for Climate Change and Health at the Public Health Institute.

CIDRAP: News scan for May 22

CIDRAP has published News Scan for May 22, 2014 | H7N9 cases in China; H5N1 death in Indonesia; Valley fever in Washington state; WHA hepatitis resolution. Excerpt:

A 2-year-old boy died of H5N1 avian flu in Indonesia last month, the WHO said in an update posted yesterday. 

The boy, from Central Java, first had symptoms on Apr 10, was hospitalized Apr 13, and died Apr 20, the WHO said in its most recent "Influenza at the Human-Animal Interface" report, dated May 5. "In the weeks before disease onset of the child, some backyard chickens died around the house," the report said. 

The boy's death represents the first case of H5N1 this year in Indonesia, a country that has seen as many as 55 confirmed cases in a year (in 2006), but last year reported only 3. 

In the report, the WHO placed the global number of lab-confirmed H5N1 cases since 2003 at 665, 392 of which have been fatal. That number represents 15 new cases and 6 newly reported deaths since the agency last updated its case count, on Jan 24. 

The 15 cases not included in the WHO's Jan 24 count reflect 9 in Cambodia, 3 in Egypt, and 1 each in Canada, Vietnam, and China, according to previous news reports. In addition, Hong Kong officials on Feb 25 reported an H5 infection in a child in mainland China but did not issue a follow-up report about the specific strain.

US: Experts don't believe dust storms increase Valley fever cases

Via Tucson News Now: Experts don't believe dust storms increase Valley Fever cases. Click through for the full report and a video news clip. Excerpt:

As always, high winds increase dust in the air and that makes some people wonder if those wind storms are creating more cases of Valley Fever.    

Valley Fever is a disease caused when we inhale a fungus that lives in the desert soil. Almost all Valley Fever cases in this country are in the Southwest. About 60% are in three Arizona counties: Pima, Pinal and Maricopa. 

When the soil is stirred up by something, like construction, the fungus can go airborne. That's how we can end up inhaling it. 

However, researchers say dust and wind aren't all there is to Valley Fever, and just because we're having windy, dusty days doesn't mean we'll see a spike in cases.      

"Individual dust storms generally don't seem to be a big factor in Valley Fever cases because we don't see big spikes in Valley Fever right afterwards, and because the kind of soil that gets stirred up in a dust storm tends to be the sort of loose top soil you get from river bottoms or from construction sites--not usually the kinds of places that Valley Fever's hanging out," says University of Arizona Climate and Health researcher, Dr. Andrew Comrie. 

He says Valley Fever usually appears during the drier months of the year. 

Comrie says it's not only Valley Fever we should be concerned about when the dust storms hit because it's also unhealthy to breathe dust. 

 Only a small number of people get sick enough to require treatment with anti-fungal drugs. 

Most people who do get Valley Fever will not even know it or will have mild symptoms their own bodies can handle. 

"Most patients that come to seek clinical attention come because of symptoms of pneumonia. Of those patients, the minority of them actually have Valley Fever as a primary cause of the pneumonia. And, interestingly, the majority of them do not need to be treated. However, it is very important to identify those patients because perhaps half of them don't need to be treated and the other half may need to be treated," says Tucson Medical Center Internist and Pulmonologist Dr. Ives de Chazal. 

Dr. de Chazal says, in very rare cases, the disease can spread to other parts of the body and cause death.   

He says there are certain people who are more susceptible to Valley Fever. They include those with a weakened immune system, pregnant women, people with uncontrolled diabetes. 

The University of Arizona Valley Fever Center for Excellence also lists African Americans and Asians. The website says "The reasons why some racial groups are at higher risk are not completely understood but may have to do with genetics." 

"Classically, a patient that will present with pneumonia will present with fever, chills, respiratory symptoms, such as cough.  But also some other systemic symptoms--maybe more subtle.  Fatigue, night sweats, joint aches, skin rash perhaps.  Those are the classic presentations of Valley Fever," Dr. de Chazal says.

US: Doctoral candidate presents research on racial disparities in Valley fever

Via the Merced Sun-Star: Doctoral candidate presents research on racial disparities in Valley fever. But it really sounds like class disparities. Excerpt:

Latino and black men are more likely to acquire and die from Valley fever than other groups, research shows, but very little is known about why that occurs. 

According to Sarah Rios, a doctoral candidate in the sociology department at the University of California, Santa Barbara, a possible explanation as to why these groups are especially vulnerable could be because of the environments they are exposed to. 

During a lecture at UC Merced on Wednesday, Rios presented research that examines how race, gender and geography shape the environmental health risk of Valley fever for certain nonwhite groups in the Central Valley. The lecture is part of a Valley Fever Seminar Series hosted by UC Merced’s Health Sciences Research Institute. Valley fever is a fungal infection of the lungs. 

Rios, who comes from a family of farmworkers in the Salinas-Watsonville area, completed her undergraduate studies at Fresno State. After college, Rios joined the United Farm Workers, where she started developing the foundation for her work. 

Rios currently collects interviews from Valley fever patients in Kern County, where there is a large population of farmworkers. Because Valley fever is prevalent in areas where dirt and soil are disturbed, farmworkers are at greater risk. Rios recruits subjects mostly at health fairs, swap meets and bus stations in Bakersfield, Wasco and Taft. 

These patients, who are in large part Spanish speakers, share with Rios their experiences in dealing with the disease as well as their access to health care. 

Rios noted that because a large number of these people are undocumented, they do not have access to proper medical care. 

“Most of the affected people have worked in the fields,” Rios said. “They become sick, but they never know if it’s Valley fever, pesticide poisoning or exhaustion, because some of the symptoms are very similar. And without visiting a doctor, there’s no way to know for sure.” 

“I’ve heard cases of people who work until they collapse,” she continued. “Their knees just give out.” It is not until these workers are taken to a hospital that they learn about the possibility of Valley fever, Rios explained. 

Although there is still no cure for Valley fever, antifungal medications can be used to treat more severe cases. However, Rios said, the costs of these medications are too high for most farmworkers. 

“Medicine is very expensive. While speaking with these people, I’ve found that many feel the financial burden that they are placing on their families is not worth it,” she said. “As horrible as it might sound, some people feel it’s easier to just die.”

US: Valley fever found in Washington state

Via MyNorthwest.com: For the first time, fatal fungus found in Washington state. 

A fungus that can launch a fatal illness has been found for the first time in the soil of Washington. 

Officials for Washington State University say the fungus can cause valley fever, an illness that presents symptoms ranging from flu- to pneumonia-like. 

Valley fever occurs when the soil-dwelling fungus becomes airborne, releasing spores that get lodged in the lungs of humans and certain animals, especially dogs. 

The fungus is normally found in semiarid parts of the Southwest. 

Three unrelated cases were diagnosed in Eastern Washington in 2010-11. 

Scientists for Washington State say that soil samples taken recently from the vicinity tested positive for the fungus, proving it can survive here. 

All three people who got sick in Eastern Washington survived. 

According to WSU, in the fungus' most severe form, spores break from the lungs and cycle through the bloodstream, setting up infections that destroy bones, cause skin abscesses and inflame the brain. 

The Centers for Disease Control estimates it kills 160 people a year. 

WSU Regents Professor Emeritus Jack D. Rogers, an international expert on fungi, said the appearance of valley fever is not a one-time fluke. 

"Do I think it just showed up and made three people sick? No," Rogers said. "I think it has probably been in the soil for some time."