UA Expertise on Valley Fever (Coccidioidomycosis)

(A haboob, or dust storm, blowing into Ahwatukee, near Phoenix, as seen from the top of South Mountain, looking south on July 23, 2011. Notice the size of homes in the foreground.)

Valley fever, also known as coccidioidomycosis or cocci, is primarily a lung disease that is common in the Southwest United States and northwestern Mexico. It is caused by the fungus Coccidioides, which grows in soils in areas with low rainfall, high summer temperatures and moderate winter temperatures. The fungal spores become airborne when the soil is disturbed by winds, construction, farming and other activities.

Valley fever is more likely to occur during certain seasons. In Arizona, the highest prevalence of infections occurs from June through July and from October through November. In California, the risk of infection is highest from June through November.

In susceptible people, such as those who are immunocompromised, and animals, infection occurs when a spore is inhaled. Within the lung, the spore changes into a larger, multicellular structure called a spherule. The spherule grows and bursts, releasing endospores, which, in turn, develop into spherules. Symptoms of Valley fever generally occur within three weeks of exposure. It is not a contagious disease – meaning it is not passed from person to person. Related infections are rare.

In susceptible people, such as those who are immunocompromised, and animals, infection occurs when a spore is inhaled. Within the lung, the spore changes into a larger, multicellular structure called a spherule. The spherule grows and bursts, releasing endospores, which, in turn, develop into spherules. Symptoms of Valley fever generally occur within three weeks of exposure. It is not a contagious disease – meaning it is not passed from person to person. Related infections are rare.

Many domestic and native animals are susceptible to the disease, including dogs, cats, horses, cattle, sheep, burros, coyotes, rodents, bats and snakes.

University of Arizona Valley Fever Center for Excellence

The Arizona Board of Regents established the UA Valley Fever Center for Excellence in 1996 for the benefit of the entire state. Based at the UA Health Sciences campus—which includes the UA College of Medicine – Tucson, College of Pharmacy, College of Nursing and Mel and Enid Zuckerman College of Public Health—the center has developed a research base that includes the state’s three universities, and an information program for the scientific community and the general public. Its work encompasses public awareness, clinical guidelines and training, and research into rapid detection methods for the disease as well as development of a vaccine for both animals and humans. Much of the center’s research is conducted at the UA BIO5 Institute.

Valley Fever in People

Valley Fever derives its name from its discovery in the San Joaquin Valley of California, where it was also referred to as "San Joaquin Valley Fever" or "Desert Rheumatism."

The medical name for Valley Fever is coccidioidomycosis (often shortened to "cocci" caused by the fungus Coccidioides spp. (C. immitis, C. posadasii).

It is not contagious. For most, symptoms—if any—are mild, including fatigue, fever, headaches, rash, night sweats, weight loss, joint or muscle aches. For some people, the disease may spread to the skin, joints, bone or, in the most severe cases, the brain.

The disease usually affects the lungs and can cause pneumonia.

It is found in the southern deserts of Arizona (including Maricopa, Pima and Pinal counties), the central valley and southern portions of Califonia (including Fresno, Kern, and Kings counties), the southern tip of Nevada, southern Utah, southern New Mexico, western Texas (especially along the Rio Grande), and the northern and Pacific coastal areas of Mexico. Recently, a pocket of Coccidioides has been identified in Washington State. Some areas have been identified in Central and South America as well.

For more information, visit http://vfce.arizona.edu/valley-fever-people

Valley Fever in Dogs

Because of their susceptibility and popularity as human companions, dogs comprise the majority of animal cases of Valley Fever. Owners spend hundreds to thousands of dollars each year, especially in Arizona, diagnosing, treating, and following up care for their dogs with Valley Fever. It is estimated that valley fever costs all Arizona dog owners at least $60 million per year.

For more information, visit http://vfce.arizona.edu/valley-fever-dogs

University of Arizona Experts on Valley Fever

Researchers

UA College of Medicine – Tucson

John Galgiani, MD
UA Professor of Medicine, Division of Infectious Diseases
Director, UA Valley Fever Center for Excellence
Member, BIO5 Institute
UA main campus, Tucson, AZ

Dr. Galgiani has been working with Valley Fever (Coccidioidomycosis) for three decades. As center founder and director his passion is research in the treatment of Valley Fever. This involves studies to improve detection of the fungus in the environment, to increase the sensitivity of diagnostic tests for patients, and to develop a vaccine to prevent the disease in both humans and animals. He also has served as lead author for the Infectious Diseases Society of America “Clinical Practice Guideline for the Treatment of Coccidioidomycosis” in 2005 and 2016. He sees patients at the Valley Fever Clinic at Banner – University Medical Center Tucson.

Neil Ampel, MD
UA Professor of Medicine, Division of Infectious Diseases
Staff Physician, Southern Arizona VA Health Care System

Dr. Ampel, co-author with Dr. Galgiani on the IDSA Clinical Practice Guideline for the Treatment of Coccidioidomycosis, has been a UA faculty member since 1985. His research interests include the cellular immune response in human coccidioidomycosis as well as other aspects of this disease, including its epidemiology. He also has had an ongoing interest in HIV infection both in its clinical management and association with opportunistic fungal infections.

Sean Elliott, MD
UA Professor, Clinical Pediatrics, Division of Pediatric Infectious Disease
Medical Director, Infection Prevention, Banner – University Medical Center Tucson and South

Dr. Elliott’s research interest in coccidioidomycosis lies in understanding and preventing the disease in pediatric patients. His other areas of interest include toxin-mediated diseases, bladder dysfunction and urinary tract infections, and graduate medical education efficacy.

Jeffrey Frelinger, PhD
UA Professor of Immunobiology
Member, UA Cancer Center and UA Center on Aging

The Frelinger Lab has been interested for some years in immune responses to the lung pathogens, influenza virus and Francisella tularensis. At the UA, it has begun collaborations on the role of T cell responses in Coccidioides infections and development of an effective vaccine.

Kenneth Knox, MD
Chief, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine
Member, UAHS Asthma and Airway Diseases Research Center and UA BIO5 Institute

Part of Dr. Knox’s research has been focused on various clinical and translational projects dealing with coccidioidomycosis including use of bronchoalveolar lavage to study lung mucosal responses to Coccidioides. A co-principal investigator for a clinical trial to test Valley Fever rapid detection methods in Arizona through an NIH grant to Duke University Human Vaccine Institute, he has also been working on examination of radiographic manifestations of coccidioidomycosis and how antifungal prophylaxis affects lung transplant recipients.

Dominick Sudano, MD
UA Assistant Professor of Medicine, Division of Rheumatology

Dr. Sudano’s research findings, “Management of Asymptomatic Coccidioidomycosis in Patients with Rheumatic Disease,” look at the impact of Valley Fever on patients also taking biologics used in treating some forms of arthritis. The study suggests it may be safe to continue treatment in patients with asymptomatic coccidioidomycosis (Valley Fever). He sees patients at the Rheumatology Physician Offices and Infusion Clinic at Banner – UMC South.

 

Valley Fever Center for Excellence

Lisa Shubitz, DVM
Research Scientist, Valley Fever Center for Excellence

A veterinarian and leading expert on Valley Fever in animals, Dr. Shubitz has focused her research on developing a vaccine for Valley Fever, studying the epidemiology of the disease in canines, the ecological distribution of the fungus in Southern Arizona and interactions between the host (both animal and human) and the fungus that causes Valley Fever using animal models.

 

UA College of Social & Behavioral Sciences

Andrew Comrie, PhD
UA Professor of Climatology, School of Geography and Development
UA Senior Vice President for Academic Affairs and Provost
UA Associate Vice President for Research & Dean of the Graduate College

Dr. Comrie has been studying climatic impacts on the spread of coccidioidomycosis in the desert of Southern Arizona. His other interests include regional and local climate variability, air quality, climate-health relationships, mapping, spatial modeling and interpolation and the effects of climate change on human health.

 

UA College of Pharmacy

David Nix, PharmD
UA Professor, Department of Pharmacy Practice & Science

Dr. Nix has played a key role in design and implementation of the Nikkomycin Z clinical trials at the UA Valley Fever Center for Excellence. He teaches infectious disease topics in multiple courses and precepts students and residents on related rotations. His other research interests include treatment of bacterial infections, antibacterial resistance and antimicrobial stewardship.

 

UA College of Agriculture and Life Sciences

Marc Orbach, PhD
UA Professor of Plant Pathology and Microbiology, School of Plant Sciences< /br> Director, Keating Select Agent BSL3 Laboratory

Dr. Orbach’s focus is studying the ecological niche of the fungus that causes Valley Fever and analysis of global gene expression in Coccidioides posadasii during both saprobic and parasitic growth. In his analysis, he has been using a technique called Serial Analysis of Gene Expression (SAGE) to produce an RNA snapshot of the fungal spores. His research interests also include molecular genetics of fungal pathogenicity in animals and plants. He also is involved in animal testing of a vaccine for Valley Fever, for which a breakthrough article was published in August 2016 by the journal Infection and Immunity.

 

Clinicians

Tucson:

John Galgiani, MD

Director, UA Valley Fever Center for Excellence
Infectious Diseases
Banner University Medical Center
1501 N. Campbell Avenue
Tucson, AZ 85724

For appointments: 520-694-8888

 

Joshua Malo, MD

Pulmonary and Critical Care Medicine
Banner – University Medical Center Tucson
1501 N. Campbell Ave., Tucson, AZ 85724

For appointments: 520-694-4000

 

Steven Oscherwitz, MD

Southern Arizona Infectious Disease Specialists
5230 E. Farness Drive, Suite 100
Tucson, AZ 85712

For appointments: 520-318-9681

 

Tirdad Zangeneh, DO

Infectious Diseases
Banner – University Medical Center Tucson
1501 N. Campbell Ave., Tucson, AZ 85724

For appointments: 520-626-6887

 

Sean Elliott, MD

Pediatric Infectious Diseases
Banner – University Medical Center Tucson
1501 N. Campbell Ave., Tucson, AZ 85724

For appointments: 520-694-KIDS

 

Ziad Shehab, MD

Pediatric Infectious Diseases
Banner – University Medical Group
535 N. Wilmot Road, Tucson, AZ 85711

For appointments: 520-694-KIDS

 

Phoenix:

Ronald Servi, DO

Pulmonary Medicine
Banner MD Anderson Cancer Center
2946 E. Banner Gateway Dr., Gilbert, AZ 85234

For appointments: 480-256-6444

 

Janis Blair, MD

Infectious Diseases
Mayo Clinic Arizona
5777 E. Mayo Blvd., Phoenix, AZ 85054

For appointments: 480-342-0115

[NOTE: Keynote speaker at 2016 Farness Lecture/UA Dept. of Medicine]

 

Wesley Shealey, MD

Infectious Diseases
Dignity Health / St. Joseph’s Hospital and Medical Center
500 W. Thomas Road, Phoenix, AZ 85013

For appointments: 602-406-2323


For a printable list of these physicians, consult the VFAAC Doctors Directory of the Valley Fever Alliance of Arizona Clinicians.

Multimedia

Additional video and image resources are available—in addition to those below—at the Valley Fever Center for Excellence website.

Other Resources

U.S. Centers for Disease Control and  Prevention

National Institute for Occupational Safety and Health

U.S. Geological Society

Arizona Department of Health Services

California Department of Public Health

University of California, Davis, Department of Medical Microbiology and Immunobiology

USC Annenberg Center for Health Journalism – "Just One Breath"

Kern County Department of Public Health Services

Fresno County Public Health

Los Angeles County Department of Public Health

Washington State Department of Health

MedScape

WebMD

MedicineNet

Patient Advocacy

Arizona Victims of Valley Fever

ScaryAir | Valley Fever | Get the Facts: www.scaryair.org

ScaryAir.org was developed by the Valley Fever Center for Excellence at the University of Arizona to educate Arizona residents about Valley Fever.

Valley Fever Americas Foundation

Valley Fever Survivor

Valley Fever in Pets

“Valley Fever in Dogs” | VCA Animal Hospitals

“Fungal Infection (Coccidioidomycosis) in Dogs” | PetMD

“Symptoms of Valley Fever in Dogs” | The Bark

Articles on Valley Fever

“How the Government Put Tens of Thousands of People at Risk of a Deadly Disease” | January/February 2015 | Mother Jones

“The Mysterious Fungus Infecting the American Southwest” | Aug. 8, 2014 | Atlantic Monthly

“The 'Silent Epidemic' of Valley Fever in the Southwest U.S.” | April 1, 2014 | Discover Magazine

“DEATH DUST – The valley-fever menace” | Jan. 20, 2014 | The New Yorker

“Valley Fever – An Incurable Illness in the Dust” | July 16, 2013 | BBC News

“A Disease Without a Cure Spreads Quietly in the West” | July 4, 2013 | New York Times

— New York Times Health Guide – Valley Fever

UA Valley Fever Experts in the News

https://uanews.arizona.edu/ua-in-the-news/valley-fever

https://uanews.arizona.edu/news/valley-fever

Media Contact

Doug Carroll
UA University Relations, Communications
520-621-9017
dougcarroll@email.arizona.edu