Valley Fever is the well-liked name for the disease called coccidioidomycosis caused by the fungus Coccidioides immitis(2). This fungus grows in the San Joaquin Valley and south central California, Arizona, Original Mexico, western Texas, southern Nevada, the south western corner of Utah, and northern Mexico (1). First reported in the United States in 1894, Valley Fever was officially declared an epidemic by the Arizona health department in 2006 after 5,500 cases were reported that year, including 33 deaths (3). In approximately 60 percent of the time the infection is asymptomatic and the host has no view that they had contracted it. The other forty percent collect symptoms ranging from collected to severe, including death. This emerging disease has had a tremendous carry out on the human and animal populations in the endemic areas.

When soil containing these fungal spores is scared they become airborne and can be inhaled by humans and animals. This disturbance can be caused by anything from humans digging and animals playing in the soil to dust storms and earthquakes. Immunocompromised patients, young children, the elderly and members of several ethnic minorities have a higher risk of contracting Valley Fever (4). Although these groups have a higher level of risk, coccidioidomycosis has been known to affect a wide range of individuals from prison inmates and archaeologists, to drug sniffing dogs along the Mexican border. In fresh years, cases in prisoners at a California Central Valley correctional have reached as high as 1 inmate in every 10 tested (4).

The essential things to understand when learning about this disease are its cause, what is being done to prevent and cure it, its prevalence, and risk factors. This paper has been assembled to address these issues regarding Valley Fever. This paper focuses on four main stakeholders in this Valley Fever epidemic, the medical industry, infected individuals and insurance companies, infected animals and construction companies.

Medical Industry

Valley Fever is a respiratory disease caused by airborne fungi spores from Coccidioides immitis that enter and grow inside the lungs and cause infections. About 60% of the people do not realize that they have this disease because it can cause no recognizable symptoms and can only be positively identified by a skin test. The 40% of the remaining population can derive aloof to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each acquire ranges from minor to severe consequences. Most valuable of all, is to know what the symptoms of Valley Fever are. There are ways to affirm if someone might be infected and those symptoms include chest pain-which is a constriction that makes it difficult to breath, fever, muscle stiffness, joint stiffness, wheezing, cough, loss of appetite, chills, and change in mental space. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will originate to originate painful rashes and or lumps on the lower space of the legs. Symptoms that can be linked with the disease once contacted include joint swelling, joint damage, arthritis, ankle, feet, leg swelling. All of theses symptoms may not accrue in everyone and can vary from unruffled in some people to severe in others. Showing more then one of these symptoms should be a safe indicator that the person has contracted the disease and should consult a doctor.

Once a body is infected, Valley Fever will demonstrate up in one of three forms acute, chronic, or disseminated. Some of the forms are more rare then others. Depending on the accomplish that Valley Fever takes, the severity of the effects on the body and how hazardous it can be will vary. The acute produce is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will note the development of the disease. This can happen at any time during the year or any season. It affects both men and women equally and the systems will disappear like the body has caught the flu. Chronic make is rarer and less accepted then the acute create. It is more unsafe than the acute build and can cause more problems. The chronic compose can become evident and do after 20 or more years from when the person first got the infection. This may not have been found, treated, or even discovered by the person with the disease.

Valley Fever can cause infections in the body and make lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural place or the site between the lungs and the ribs. This can cause serious hurt to the lungs and the person will have a difficult time breathing. Other symptoms include gross grade fever, weight loss, and nodules in the lungs. The disseminated design is the most risky and severe out of the three. This is when the disease spreads to the different parts of the body. The infection gets into the person’s bones, lungs, liver, meninges, brain, skin, heart, and around the heart. It is found that 30% to 50% of those people infected with this create also derive meningitis. This invent can be very deadly as it can cause swelling around the brain and spinal cord. With this originate, healthcare providers often peruse ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening gain and can cause death if not treated correctly. It can cause brain afflict as well and can affect the brain/mental set of the person.

Everyone in the world is different and so not every person is going to be infected the same arrangement. People of different color or hasten can contract the disease more readily then others of another rush can. The people of Asian, Hispanic and African descent are more susceptible to the diseases than Caucasians. Even though it is really unclear why, those of color are 10-20 times more likely to regain the disease. Most cases that ended up in the emergency rooms were of Hispanic or African origin. Other people that have a high infection rate are people that are diabetics or weakened immune systems such as those with AIDS. Also women that are pregnant, in their third trimester or honest after their babies are born, are at an increased risk of getting Valley Fever. All of these factors will invent it easy for them to procure the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight support as well causing them to bag worse quicker and will be more severe. Age is a substantial factor as well seeing as older adults have a higher chance of developing Valley Fever then an younger age. This is because their immune systems are less active or have other medical conditions that lower their ability to fight off the infection. Individuals with archaic immune systems are at higher risk for complications which may lead to the disseminated gain. It lets the disease spread easier through out the body and lets it come by into the valuable systems of the body. This can create the body more susceptible to other types of infections because of the further weakening in the immunity from Valley Fever.

Valley Fever, as stated, gets stirred up into the air from original construction or gardening, allowing one to breathe it in. Once it gets into the lungs it sticks in the inner portion of the lungs. There it will grow and multiply inside the lungs. Depending on what beget it takes it can definite up from there or release pus. This pus then can find absorbed into the body and stick to different types of organs. It can especially target places where it can make up in such as joints, feet, and legs. This is because the fungi salvage into the blood stream which will collect absorbed by muscles, bones, and under the skin where it can deposit and grow. If the immune system is not strong enough, it can not raze the infection which allows it to further mitigate as it builds in different spots of the body. Since it goes into the body’s blood stream it can accumulate to where ever the blood is flowing. This includes vessels around brain and the spine. This will cause different reactions such as the person affected might lose some perception and awareness because of the lack of well-kept blood being given to the brain. With the fungi being deposited in places such as the feet or skin it causes swelling because it will execute liquid or more pus-like substance. This will cause the joints to swell up because of excess liquid causing arthritis. Besides looking at the symptoms of the person there are many other ways to resolve if there is a Valley Fever infection. Different medical professions employ different ways to choose the infection in the body and depending on the degree of the disease.

A chest x-ray can be taken to figure out if one is infected. In the x-ray the doctor would be looking for light areas in the lungs that are poorly defined or patch areas. The area where disease is growing will present up usually advance or next to the ribs as most of it grows and deposits there. A skin test can be given as well and it is called the spheriulin skin test. This test looks to glimpse if the person is infected with the fungus and since it is more sensitive it can acquire up signs of an earlier infection accurately. Spheriulin is an antigen that is connected with the fungi that causes Valley Fever. This substance is injected honest a runt below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will gaze at the arm or the residence it was injected at 24 and 48 hours after the test. If the body has antibodies to the fungus, and it is in their system, the body with react and the location will become red and swollen. Although this test is not being broken-down as great anymore because it is not as specific, it however is old-fashioned in researching to understand the disease. A more popular test is a sputum culture. This is where the doctor or nurse retrieves sputum from the patient. Sputum is the mucus-like secretion in the bronchi tubes or where the air goes to the lungs, and comes up with deep coughing. The doctor or nurse will ask the patient to cough deeply and spit up any sputum into a sterile cup. This will be taken to a lab that allows it to grow to discover if Valley Fever is indicate. The doctor my tap on the chest or have the person inhale steam-like mist to assist cough up the sputum in order to derive a better sample. One of the last tests that may be done is a coccidiodes antibody test. This test is where the blood is taken to analyze if there are any antibodies to the fungus in the body. If the antibodies are reveal it can mean that there is an ongoing infection or a prior one. The test and blood may be taken a couple of weeks after to peruse if there is a rise in the antibody count which determines the infection and how severe it may be. The higher the titer or antibody counts the worse the infection it is. These are all tests that the doctors may spend in determining more accurately if the disease is explain in the body. This is the only map to be 100% positive that there is an infection.

Depending on the magnitude of the infection different treatment options will be provided by the doctors. Some of the forms may even dissipate with no medical interactions as well. The acute disease will usually go away without medical intervention. Popular management is bed rest and treatment for flu symptoms until the fever goes away. With any of the other forms, medication would be needed to remove care of the disease. If the spot persists or if there is a higher possibility of complications and it is in its more severe construct, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic effect or more acute make that won’t go away, amphotericin B is usually the medication given to attend fight off the disease. Then the person is monitored as to create definite the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to retract care of lesions that are localized. For the disseminated compose fluconazole or itraconzole is commonly old. The dosage is usually 400mg per day and in some cases 2000 mg of fluconazole or 800mg of itraconzole per day may have to be taken in 200mg doses. Amphoterican B may be old as an alternate in this status if lesions are getting worse more speedily and is former to diffuse pneumonia. Surgery is vital in this case and in most reports at this stage it is well-known. This is obsolete to purchase care of sizable abscesses, destructive lesions or bony sequestrations instability of the spine or the movement on well-known organs such as the heart or tissues such as the spine. Since this design is the worst and in most of the time fatal more actions are required in recovery as compared to the more acute forms. Treatment of the disease does not perform it go away for grand as relapses can occur or the person can bag it again.

The disease can have short affects and long term effects on the body. Depending on the person or the amount of spores inhaled, this will decide the longevity and affects of the person. The short affects include flu like symptoms and will go away. It is an annoyance honest like any time someone gets sick and the person can go on with their life with no wound. These people probably have higher immune systems. However, the longer the disease stays around in the body the more injure it will do. If it is prolonged in the body for an extended time it will launch having more harsh affects on the body. The infection can spread to the bones in the body and cause deterioration or holes in the bones. This will pause with the patient through out their life. If it is in the body for the extended time it can cause variations of getting better then getting worse fluctuations as well as can cause relapses of the disease where it can near wait on. If not treated, the non-acute do will worsen over time and in most cases win into other organs of the body and get the disseminated type. Taking care of the infection early on would be a worthy strategy as Valley Fever can cause death if not treated at the just time. If the disease is prolonged it can cause other diseases or illnesses. These include forming pneumonia and meningitis which originate the condition that worthy more deadly and difficult to treat. As both of those diseases are fatal as well and can manufacture abominable mixes with Valley Fever. Bleeding and lung abscesses could develop which have to be medically treated and in some cases have to be done with surgery. Prolonged exposure can place the person at outrageous discomfort as the pus gets into the lungs and fills the lungs making them feel like they’re drowning and can’t breathe. This can cause many poor effects as the body can’t procure enough oxygen into the body. People that already have respiratory problems such as asthma can be compromised and hinder the lungs from working efficiently. This can cause a more acute build such as short of breath to something more hazardous as not getting any air in and halt breathing without medication or immediate treatment. Most importantly the disease should not be taken as lightly as it can cause death if overly prolonged or gets into its most risky forms in the body. Many problems and complications would have to happen in order for it to collect to that severe of stage. As long as the disease is recognized and treated (if need be) then the affected person can easily recover.

Many people who have Valley Fever don’t even know they have had it because the severity changes in everyone and 40% of the people would display symptoms and require limited to major treatment. This disease changes over longer periods of time. A person may have some time to go eye a doctor before they feel the severity of the disease. Though, as stated earlier, waiting for long periods of time to witness medical care would not be worthy to one’s health. This disease is taken in most of the medical field taken very lightly even though misdiagnosis and prolonged exposure to the disease can be fatal to the person’s health. It can have affects on the body that quit with them for years at a time or even there entire life. This is something that if in ask consulting a doctor would be the best course of action so treatment can originate so complications don’t arise.

Infected Individuals & Insurance Companies

There are many significant stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the direct of Valley Fever. Arguably, the role of infected persons or those that absorb a fresh vulnerability to the disease is top priority on the decision-maker’s list. Each year, thousands of people are diagnosed with Coccidioidomycosis in Arizona alone. In a 2007 article, the Washington Post wrote that Valley Fever cases diagnosed in 2006 were up fifty-six percent from a year earlier. This prompted Arizona health officials to designate the disease at, “epidemic proportions,” as thousands of other cases likely went undocumented. It has also been reported that anyone who has spent enough time in Arizona, or any other fragment of the Southwestern United States where soils acquire the Valley Fever fungus, will contract the disease at some point. Only a cramped percentage of people, however, are diagnosed with a severe enough execute of the infection where medical treatment is needed. Anti-fungal medication is the most celebrated treatment for Valley Fever. But, there are rare cases where surgery is required to fully recover from the disease. Overall, tens of thousands of cases are reported around the United States annually and the number of Valley Fever-related deaths is estimated at 50-100 each year. It is distinguished to gape individuals currently struggling with the disease as well as those who have recovered from a serious effect of Coccidioidomycosis as a stakeholder with regards to this affirm because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an misfortune to better encourage this claim, the lives of two patients that contracted a serious make of the infection, will be addressed and analyzed in the following paragraphs.

Before introducing specific cases, it is primary to review some novel facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Record in October 2008. The record, co-compiled by the Office of Infectious Disease Services and the Bureau of Epidemiology and Disease Control, presents the amount of Coccidioidomycosis cases reported in 2007 through a myriad of graphs. These graphs utter the research information in a thorough and comprehensive map to the reader by dividing up Valley Fever statistics for the 2007 year in a multitude of categories. Some of these categories include: cases reported in ‘07 according to specific age groups compared years past and a five-year average, separating the number of Valley Fever cases reported by counties in Arizona, and separating the number of Valley Fever cases reported in both mining and non-mining areas within the place. Although many people mediate of this disease as a aloof illness similar to the favorite wintry, Valley Fever is a key hiss amongst Arizona residents as well as both local and national governments. In 2008, the Arizona Department of Health Services received funds for Valley Fever prevention and control from a legislative appropriations committee. The Center for Disease Control and Prevention (CDC) also awarded the department funds for continued research. As fragment of the 2007 represent, Health Services interviewed roughly ten percent of all Arizonans diagnosed with Coccidioidomycosis during that year. According to the ADHS, the following are some of the most alarming facts that were discovered from the interviews:

• People missed an average of 1 month of work, for a total of 4,918 days

• People with Valley Fever could not execute daily activities for an average of 3 months or a total of 92 years

• People with the disease waited an average of 44 days before seeking healthcare

• Patients saw their doctors three times before they were tested for Valley Fever

• There were $86 million dollars in hospital charges for Valley Fever in 2007

Furthermore, Arizona has the highest number of reported Valley Fever cases annually in the United States, accounting for sixty percent nationwide. In total, more than 150,000 people across the country are estimated to contract some produce of Coccidioidomycosis each year. The Arizona Department of Health Services reports that the severity of Valley Fever in the dwelling continues to grow as do the overall number of persons infected each year. Due to the fact that currently there is no cure or vaccine for the disease, every person that is susceptible to the effects of Valley Fever certainly shares some kind of stake in the debates of the content. Examining the personal accounts of two anonymous patients afflicted with a serious acquire of Coccidioidomycosis can bring further clarity to this claim. Any and all personal information for the following accounts has either been fictionalized, changed or generalized to fill complete anonymity.

The first case will seek information from the unpleasant effects of Coccidioidomycosis on a male patient of early adulthood age. This individual will be referred to as Patient “V” throughout this paragraph. Patient “V” began his ordeal with Valley Fever in the summer months of 2001. A younger man in the final years of adolescence, Patient “V” experienced generic, flu-like symptoms, which he disregarded as nothing significant like most other sufferers determine to do. “At first, I noticed that my lymph nodes in my neck were unusually swollen…I figured it was impartial a wintry or some dinky infection or something like that.” Soon after the initial stages of the disease, Patient “V” began experiencing constant, severe wound in the left side of his chest. Although he made numerous medical appointments for this predicament, the hurt would subside by the time Patient “V” arrived, making it difficult to diagnose the pickle. “What was happening was my left lung had a hole in it and it kept collapsing and then re-inflating by the time I got to the doctor’s office.” Eventually, a chest x-ray was performed on Patient “V” and this revealed a slight, shaded status on his left lung. The state indicated a relatively petite, but primary hole through the lung. The dilemma required corrective surgery and Patient “V” was admitted to one of Arizona’s hospitals in August, 2001. Surgeons sewed up the hole in Patient “V’s” left lung and released him after a day of recovery. Within weeks following the surgery, Patient “V” experienced a relapse of his earlier symptoms. “…I was playing Volleyball one night and in an instant, there was this intense damage in my chest…I felt dizzy and could hardly breathe.” Patient “V” immediately returned to the hospital sometime in November of that year where further tests concluded that the infected share of his left lung was, indeed, Coccidioidomycosis. Another surgery to completely bewitch this portion of infected lung was performed successfully and Patient “V” spent more time recovering in the hospital. “The effects from the disease itself were painful enough, but the worst injure came from the chest tubes that were inserted into me in the hospital…At one point, they shoved one of the tubes through my ribcage and into my lung and I wasn’t even on wound medication.” Fortunately for Patient “V”, the second surgery was successful and he survived his brush with Valley Fever. In many cases, patients who contract and fend off the infectious spore fabricate up life-long immunities. However, reports have also shown that patients in remission from Coccidioidomycosis can be more vulnerable to a reoccurrence of the disease than those that have never contracted it. Following his surgical recovery, Patient “V” was prescribed an anti-fungal medication called Diflucan, a celebrated drug distributed to sufferers of the infection. Patient “V” was required to grasp this medication daily for 2-3 years. He now receives chest x-rays once a year to check for any returning signs of the fungus. Patient “V’s” scar tissue has also become virtually unrecognizable after nearly a decade of recovery.

The second case to be analyzed will be that of a middle-aged female patient. Appropriately, this patient will be referred to as Patient “F” throughout the analysis. Patient “F” contracted Valley Fever in slack 1995. Early symptoms experienced in this patient included chronic loss of breath and indecent joint discomfort. The design of Coccidioidomycosis contracted by Patient “F” was not diagnosed correctly until 2 ½ years after symptoms began. Before visiting a pulmonologist, Patient “F” was given a chest x-ray, where a ample, round nodule was located somewhere on her left lung. The patient was admitted to the hospital in 1998 and underwent a wedge resection, to retract the infected portion (removed in wedge originate) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at paunchy strength for six corpulent months; and then half the dosage for another six months. The patient continued to have fevers following the surgery. She also had an excess amount of fluid in her lung. Patient “F” returned for a second surgery to further natty the infected station and completed another sequence of antibiotics afterwards. The time spent in the hospital for recovery totaled at six days for each surgery. Patient “F” was fortunate enough to have flexible employment benefits to fully recover. “My company provided short-term disability; up to 6 months with 100% pay…I was very lucky.” As far as medical coverage is concerned, Patient “F” had diminutive out-of-pocket costs through United American. However, she was composed jumpy to behold the total amount owed from her quit in the hospital. “The bill after six days in the hospital, which included one day in ICU and five days on a regular floor, was astounding. Honest for room and board and a exiguous medication, the bill was $28,000.00.” Today, Patient “F” has fully recovered from the infection and only has one suggestion with regards to the negate of Valley Fever. “Educate physicians on the east wing and west cruise, all over the Untied States to properly test for Valley Fever.”

Needless to say, there are always financial burdens associated with any type of surgery as well as prescription medication. In the case of Patient “V”, a total of nearly $180,000.00 was accrued in hospital bills after the two surgeries were performed. Additionally, the drug Diflucan can range from 36 dollars to 60 dollars for 100mg/10 pills depending on the space of select. It is necessary to view medical insurance companies as a stakeholder with regards to the enlighten of Valley Fever as well. Because there is no cure or vaccination for the infection, insurance companies limit the amount of coverage to persons with preexisting conditions. If a cure were to be developed and released into the market, insurance companies would most likely include Valley Fever coverage into any opinion. Unfortunately, without medical insurance, the overall amount of money needed to recover from a serious infection like Valley Fever is simply insurmountable for the majority of Americans. Even with sufficient medical insurance, however, people who have had Valley Fever in the past are typically not covered for a relapse of the infection. Patient “V” currently receives individual health insurance under a PPO from Blue Substandard Blue Shield of Arizona. As mentioned earlier, however, major insurance companies like this one tend to limit coverage to individuals with preexisting conditions. According to an article on www.howstuffworks.com, a preexisting condition is a health condition or illness that you have had before your first day of coverage on a novel concept with an insurance company. Typically under group coverage, such as that offered by a corporation under an employee’s benefits, a person with a preexisting condition can pick up chunky coverage, but will have to wait anywhere from nine months to a year before it kicks in. This period is enforced by insurance companies to insure that a patient is not constantly having relapses of the same condition. However, a person with a preexisting condition will rarely receive private health coverage that includes their condition. This is referred to as the preexisting conditions exclusion. Our attempts to contact major medical insurance companies or medical insurance agents for further clarity on this relate went unanswered. Unfortunately, people like Patient “V” who have preexisting conditions, are self-employed and do not qualify for group medical insurance will have to pay out-of-pocket if their conditions return. “I would have to stammer bankruptcy if that happened…” Patient “V” explained. “I live in alarm because I know that if I were to fetch it again, that would be disastrous.”

Currently, a vaccination for Coccidioidomycosis is under development at the BIO5 Institute on the campus of the University of Arizona. Leading the development is Dr. John Galgiani, Director of the Valley Fever Center for Excellence and Chief Medical Officer for Valley Fever Solutions, Inc. This vaccination will be intended for both humans and dogs, which can also contract deadly forms of Valley Fever (this topic will be further discussed in later sections of this notice). In March, 2008, Dr. Galgiani teamed up with fellow BIO5 colleague Dr. David Nix of the Department of Pharmacy Practice and Science to research the vaccination. “We had some complimentary expertise and mine’s mainly in the site of drug development and drug development science and so on. And Dr. Galgiani is kind of the world’s expert on Valley Fever,” Dr. Nix reported in a 2008 Valley Fever instructional video produced by the University of Arizona. The two physicians, under the company name Valley Fever Solutions Inc., are financially backed by the University, private donors and C-Path, a Unusual York based foundation. They are currently testing an anti-fungal called Nikkomycin Z, which was first aged to prevent fungal degradation in compose. With approval from the U.S. Food and Drug Administration, Nikkomycin Z is in Phase 1 of drug safety trials. According to a news release published on the BIO5 Institute’s website, “The company has already obtained a Science and Translational Technology Research (STTR) grant from the National Institutes for Health that will back fund pharmacology studies that will serve develop future clinical trials. The first phase of that grant is worth more than $100,000, with the potential for an additional $700,000.” If this vaccination proves to be a viable cure for Coccidioidomycosis, many aspects of the hiss of Valley Fever would certainly change. Once a cure hits the market, the number of deaths and serious cases as a result of Valley Fever would tumble significantly. Debates between the government, politicians and special interest groups would decrease as well if no one were in any right threat of the infection anymore. Briefly returning to the topic of medical insurance, people with Valley Fever as a preexisting condition will be able to feel more catch because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Unpleasant Blue Shield, Cigna and Humana will more freely distribute elephantine coverage in instances of Valley Fever. Like most vaccinations and cures to well-liked infections or diseases, there would be many clear outcomes to releasing this drug into the medical market, pending the completion of all drug safety trials.

As indispensable stakeholders with regards to the allege of Valley Fever, both infected persons and medical insurance companies would be greatly affected if an executive decision were to be made, or possibly a vaccination released into the market. While the future looks kindly with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people net a plot to earn health insurance coverage to some capacity. It is also notable that individuals with preexisting conditions that aren’t on group medical plans lobby for their rights to complete insurance coverage. In considering the depraved effects of Valley Fever, there are many people who believe this topic is fair as essential to the animal world as well.

Infected Animals

Valley Fever does not only affect people but it is now more commonly being found in animals. Animals are unbiased as likely to collect Valley Fever as humans are. Animals rep Valley Fever in the same blueprint as humans do, by breathing the fungus. It has been found that more and more animals are being reported of becoming ill due to this fungus. It has been found the 30-40% of animals who breathe in the fungus bag sick. Some of the most popular animals to be reported with Valley Fever are dogs, cats, llamas, non human primates, horses, and zoo animals (3).

A golden retriever went into the vet’s office; the dog wasn’t feeling well and wasn’t acting himself. The vet takes an x-ray of the dog’s lungs and sees white spots in the lung plot where there should normally be sunless patterns. The white spots demonstrate that the dog might have cancer in its lungs. The dog is only four years aged, which is when a dog should be at its prime and not getting lung cancer. Lung cancer isn’t usually found at this young of an age and doesn’t seem to beget as quickly as it has in this golden retriever. The owner had said impartial two weeks prior to going to the vet that the dog was bulky of energy on their vacation. The veterinarian doesn’t all the facts add up for the dog to have cancer so she decided to bustle a few more test before she starting treatment for lung cancer. The dog’s health over the course of time starts to go downhill and very hastily. The dog starts to cough, has a loss of appetite, and miniature to no energy. The vet then found out where the human family had recently traveled and they were in the Southwest. After hearing this, the vet distinct that it must be a fungal disease and it was objective that, it was Valley Fever (1).

Dogs are the largest infected and most commonly reported animals with Valley Fever. Dogs catch Valley Fever in the same arrangement that humans do and in the same regions as humans do. The fungus is spread through spores which dogs can easily inhale. Once the fungus is inhaled, the spores grow into spherules which enlarge and eventually burst into hundreds of endospores (3). This causes the spreading of the infection into the lungs. A dog’s immune system should reply and surround the infection to raze it. Dogs that do not become sick due to the fungus are considered to be asymptomatic (2). When a dog does become sick from Valley Fever, their immune system fails to slay off the infection and the infection continues to spread into the lungs and then can proceed throughout the dog’s body (3).

Once a dog is infected with Valley Fever, there are obvious symptoms that become indicate. Some of the symptoms that are seen in dogs are weight loss, coughing, fever, lack of appetite, and lack of energy (3). The cough in dogs can be seen as early as the first week of getting the infection to as slow as 3 weeks. The cough that dogs earn is due to the development of pneumonia which is visible on x-rays. The coughing can be caused due to pressure on the lymph node reach the heart and puts pressure on the dogs windpipe which as a result irritates it (3). After the cough is exhibit the loss of appetite and energy is soon to follow. If the infection is not controlled it can become great worse and spread throughout the body. When the fungus is spread throughout the body it causes systemic or disseminated disease (3). When this happens the symptoms and condition of the dog becomes remarkable worse. The symptoms that become display are: swelling of the limbs, wait on and neck wound, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, leer inflammation, and non-healing skin ulcerations (3). Not all symptoms are display apt away and it can steal several months before obvious symptoms appear. It can be several months after a cough appears that other symptoms become indicate. There is typically an order that the fungus spreads throughout the dog’s body. The first organ to be effected is lung, and then the infection usually spreads into the bone, than eyes, heart, testicles, brain, spinal cord, and finally abdominal organs (2).

To settle if a dog has Valley Fever there are different test that can be done. Some of the most accepted test done to settle if a dog has been infected is blood tests, chest x-rays, bone and joint x-rays, and Valley Fever blood test (3). Test results may demonstrate up negative up to 3-4 weeks of receiving the infection so in some cases test need to be repeated to confirm that the dog does or does not have Valley Fever (2).

There are different treatments that be done to back fight the fungus. The process of treating Valley Fever may be long; medication can be given for up to one year (2). The length of time that the treatment will assume usually depends on how far the fungus has spread throughout the body. Most commonly oral antifungal medication is given to the dog. These antifungal medications are ketoconazole, itraconazole, and fluconazole (2). Ketoconazole is the most commonly prescribed medication due to the fact that is it the least expensive. This drug is usually given twice daily and with food. Itraconazole is a more expensive medication but has fewer side effects than ketoconazole. Itraconazole is also better for dogs that are having problems keeping their food down because it has a faster absorption rate (3). The third medicine most commonly given out for treatment is Fluconazole and it is also expensive with miniature side effects. This is usually given to dogs that have pain done to their spinal cord and nervous system (3).

Cats, llamas, non human primates, horses, and zoo animals are other animals that have been reported with Valley Fever. Cats that have Valley Fever point to the same symptoms as dogs do but it less likely for a cat to salvage Valley Fever than it is for a dog. Cats net Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats glean the fungus their symptoms are usually a small more advanced than dogs. Two of the major symptoms seen in cats that have Valley Fever are unexplained weight loss and skin ulcerations that won’t go scheme. The same treatment for dogs can be extinct to treat cats with Valley Fever (3).

Horses are another animal that have been found to procure Valley Fever. There have not been very many cases reported but in the ones that have only one horse has survived Valley Fever with treatment. All the other horses that were reported with Valley Fever had to be euthanized. The reports of these cases are not very unusual though, and with medical technology improvement chance of survival with unique medicine is worthy better for horses today (3). Llamas are another animal that have been infected with Valley Fever. Llamas are very sensitive to this fungus. In most cases, if a llama has Valley Fever death is almost always the outcome.

Zoo’s that are located in the Southwest are very aware of Valley Fever. Many zoos have lost animals due to Valley Fever before they were aware of what is was and how to treat for it. When animals become sick, Valley Fever is something that is tested early so treatment can be started. In zoos, the most favorite animals to come by Valley Fever are: Monkeys, Apes, and other primates. These animals exhaust the same treatment process as dogs and cats but is usually consists of a lifetime treatment (3).

Valley Fever is a very serious announce that is rising in animals. Currently there are no preventatives for Valley Fever. The treatments for Valley Fever for animals has become better and better over time. The near in technology has allowed for veterinarians to be able to detect Valley Fever at a less approach stage. The early stage that Valley Fever is caught at allows for a better chance of survival of animals infected with the fungus.

Construction

There is no doubt that construction companies contribute significantly to Valley Fever. According to the MayoClinic, institution known for prominence in the medical field recognized the increase in actual estate has contributed to the spew of “thousands of tons” of dust carrying this fungus into the air. The article looks at how in the 1990s the accounts of Valley Fever increase in the states of Arizona and California due to some significant factors. Among those factors like dry climate, the unusual building booms have been one of the most primary factors that have contributed to such increases. The fleet clearing and building were a important source for the increase in reported cases of Valley Fever. Among all the contributing factors of Valley Fever, environmental exposure ranks high, if not the well-known cause. Experts also added that almost half of the people who live in areas where Valley Fever is prevalent have contracted the disease. Interestingly, people who are at most risk are those who are exposed to directly to dust like those who develop jobs in the field of construction, ranching and agricultural work (1).

The decade following the 90’s has had a vast increase in reported cases of Valley Fever. Those areas that have reported such increases are the states of California and Arizona. These states have been induced with a massive building tell. The mass migration to these “sun belt” states made for a widespread land clearing and construction, which ultimately directly contributed the spread of the air borne fungus (2). Importantly, some measures are currently in state to purposely chop the amount of dust construction companies contribute to the environment.

The Environmental Protection Agency (EPA) is an agency of the federal government of the United States who is in charge of protecting human health by maintaining the natural environment capable (3). This implies its commitment and dedication to monitoring and posing regulations for anything threatening the quality of the air. The EPA has region limits on how great pollution is allowed to be in the air. In its goal to fill and manage the air we breathe, EPA has passed several pieces of legislation that have reduced the amount of smog and pollutants in the air. Among distinguished legislation is the Desirable Air Act which has been passed to enforce tidy air standards and improve human health. The Well-kept Air Act is an outline for what national, space, and local authorities must follow in order to protect air quality. Under the Shapely Air Act, local and dwelling authorities are responsible for abiding by the national ambient air quality standards. The Environmental Protection Agency states Maricopa Country cannot exceed the federal health standard for particulate pollution more than three times in a three year period (4).

According to the Environmental Protection Agency (EPA), Maricopa County has been in violation of particulate pollution since 1996. Particularly 2008, there have been nine different days where at least one of the monitors exceeded the federal health standard for particulate pollution. The health standard for particulate pollution is that it cannot exceed more than 150 micrograms per cubic meter measured over a 24 hour period of time. It’s primary to know Maricopa County has 24 air monitoring sites in the Valley. The dwelling of Arizona, under the Arizona department of environmental quality has its bear air monitoring sites as well. If any of these monitors exceeds the federal health standard for a given pollutant, the EPA will believe Maricopa County accountable. According to the Environmental Protection Agency (EPA), Maricopa County failed to approach attainment for particulate pollution and thus is under federal orders to slash particulate matter pollution. In an attempt to address the train, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a idea to the EPA to present how the county plans to cut PM₁₀ emissions by five percent each year until agreeable levels are reached. The Five Percent Thought outlined more than 50 commitments to chop dust. Of these commitments, some affect the procedures and guidelines on construction entities (4).

Speaking with Erin Dunsey of Maricopa County Air Quality Department, the county is currently working hard to pose regulations on construction companies in order to lower dust emissions and ultimately lowering the potential threats from Valley Fever. The principle responsibility for The Maricopa County Air Quality Department’s Dust Compliance Division is to protect the public from the dangers that near from airborne particulate matter (7). This division of dust compliance deals with fugitive dust sources and the rules to minimize the production of it. This means that fugitive dust from any source, including constructions areas, must be restricted in their construction operations to possess within first-rate dust standards. As section of the compliance, Maricopa County has devised that all sites with apprehensive surface areas of dust must comply with “Rule 310″ (5).

Under Rule 310, the Dust Compliance Division has established limitations and requirements for the implementation of process controls as well as other guidelines that will relieve enforce worthy fugitive dust control measures. One of the first major steps for construction companies to follow is the obtainment of a permit. The Air Quality Department requires a construction permit for companies who understanding to conduct activities any that will disturb a surface status equal to or greater than 0.1 acre. Complying with the construction permit requirements is often a distinguished and daunting task. Before applying for a permit, a idea that outlines the measures that will prevent the creation of dust must be presented. This concept also describes all the measures that will be implemented at anytime during the phase of construction. Therefore, this guideline requires dust generating sources to meet standards and at the same time apply best the available control measures in order to attempt to minimize fugitive dust emissions. This design being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on residence understand their responsibility while on set (6).

Another hassle that companies have to deal with is the logging of control measures. Once again, under Maricopa County’s Rule 310, construction companies who conduct a dust generating operations that require a Dust Control Opinion must sustain a written log recording the true application and execution of the control measures previously outlined and favorite by the Dust Control Opinion. This is a daily detailed recordkeeping which records what actions are being conducted in dust-generating operations in what may include daily inspections for crusted or damp soil. Another allotment of picture keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and fill shrinking surfaces must install a trackout control devise. These devises are tremendous contributors to the retention of fugitive dust. Trackout is simply the particulate matter from tires and other sources that have fallen onto paved areas that are accessible to the public. The rule states that trackout must be miniature to 25 cumulative linear feet (6).

Rule310 is an extensive and overwhelming region of requirements established to lower dust emissions. Allotment 309 list another requirement under Rule310 that companies must abide by. The rule says that if the location of interest is more than one acre a series of dust control training must buy state. All workers directly keen in the containment of dust like the water truck drivers and water pull drivers must seize a basic dust control training class in which attendees will ultimately become certified if successfully completed the training class. An extension from this part lists that a dust control coordinator must be explain on job status if the dimension of the job region is five acres and up (5). These onsite coordinators must have completed a comprehensive dust control training in which they are given qualified training on regulating emission of fugitive dust and learn practical methods to do so, such as tidy up, water and dust suppressant applications (6).

Construction companies are required by spot and federal law to implement a diligent distress to control dust pollution. If at any time violations are committed, these companies will be subject a fines and penalties. This has been yet another spot companies have had to face on a regular basis. The penalty policy held by the Maricopa County Air Quality Department seeks to prevent future violations. Fines that are placed upon companies are certain by the severity of the violation committed. Several factors are stale to calculate the amount of a penalty. In case there has been an economic assist of noncompliance by the company, the penalty will consist of weighing out the benefits that were looked to have been extracted.

Dust control compliance has also become a financial setback for construction entities. The Maricopa County Air Quality Department announced that in the month of October $452,589.90 in air quality violations was calm (9). In the month of September, the amount of $471,613.30 was smooth in violations all related in one intention or another to air quality control. This is the inconvenience construction company’s face for not correctly using effective measures to slit dust in the construction sites, therefore causing potential problems to reach residents and workplaces, eventually becoming a financial plight due to fines.

There is no better draw to understand how troublesome the strict regulations have become a burden for construction companies. While searching for construction companies within the valley, Turner Construction Inc. drew attention as it is well known as a spacious construction company that has a corporate office in Tempe, AZ. With a interrogate to pronounce to a construction manager, a brief conversation was held with a construction project manager from Turner Construction. The conversation revolved around how Valley Fever has affected their procedures during construction or related tasks. Immediately it became definite objective how powerful companies who are in the construction industry are affected by laws to assist prick the incidents of Valley Fever. Jason Jones, who is a project manager at Turner Construction Company, explained that all construction companies have been hit hard by Maricopa County. Amongst the things mentioned was the fact that the main anxiety for the county is dust control. As a result for the growing pains over dust control, they have to follow a “rigorous dust program” to comply with regulations. Jason explained how they are currently working on a 242 acre development complex and have had to exhaust around 400,000-750,000 gallons of water to control dust governed by Maricopa country. He added that this adds to the costs of the construction project as trucks and workers are venerable to hold fugitive dust. If they ever do not comply with these regulations, fines commence from about $1,000 to 10’s of thousands of dollars. He added that Maricopa is the “worst county in America for dust regulations” (8).

The main scrape is that construction companies have to follow strict regulations on their dust production. The county of Maricopa has been enforcing even stricter laws to prevent and assist acquire dust levels to a minimum as they have recently been under serious scrutiny from the Environmental Protection Agency. If for some reason these companies are not correctly using effective measures to nick dust in the construction sites, grand fines will follow. This is yet another teach companies are dealing with. To the load even greater, these companies also deal with the economical space backs from following these regulations. For companies to slit and comply with county regulation, thousands of dollars are being forcefully spent by such companies. The contributions construction companies manufacture to Valley Fever is not underestimated. As a result, strict regulations are followed and posed upon companies to carve the incidence of Valley Fever cases. Valley Fever has approach to cost companies thousands of dollars and is becoming every day more of an effort.

Conclusion

After studying the stakeholders keen in Valley Fever, it is easy to peep approved themes between them. There is no doubt that while not known as a perilous disease, Valley Fever has the potential to be one. With the number of cases increasing each year and relatively tiny research being done for prevention and cures, Valley Fever has earned the title as an emerging epidemic. While Coccidioides immitis only lives in a few catch areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and spirited to endemic areas. It also must not be forgotten that Valley Fever has the capability to affect animals as well humans increasing the cost of the disease for these species. It is sure that because of this, action must be taken in order to slice the number of cases and to decrease the severity of the cases.

This case peer points to a few relatively easy steps to engage in order to decrease the severity of Valley Fever cases. The most essential and most clear step is early detection. It was shown that the earlier that the disease is diagnosed, the less severe the symptoms and the less impact it has on the infected individual. Despite this easy solution, doctors saw their patients and average of three times before they tested for Valley Fever and the patients on average waited 44 days before treatment. These statistics point to a general lack of awareness this disease in both the patient and the medical world. In order to promote early detection, there must be better instruction of symptoms and complications keen in prolonged disease available to both the medical community and the population of endemic areas. This in theory would compose an awareness of the disease and wait on earlier testing for it.

There are a few steps that can be taken in order to slit the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also support slice the number of cases. Public awareness of Valley Fever would cleave the number of cases by providing the people with knowledge of its causes and ways to avoid exposure to the Coccidioides immitis spores. The second step that should be taken is a national focus on research in vaccines and cures for this disease. From this case leer it is definite that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the residence in some circumstances. These high costs are unacceptable when relatively small investment is being made in the research of a cure or vaccination.

When considering these recommendations, it is primary to review the facts about this disease. Valley Fever is caused by the spores of a fungus that can become airborne when soil is stupefied. This fungus is endemic to tall portions of the American southwest including Phoenix, Arizona, the nation’s fifth largest city. Statistically, anyone living in endemic areas is likely to accumulate this disease at least once in their lifetime. On top of those living in endemic areas, those visiting the situation have a high chance of contracting the disease. The number of cases has risen consistently each year for at least the last seven years. After reviewing these facts it is certain that Valley Fever has had a notable impact on our society and that steps need to be taken to slash its prevalence.

References

Introduction

(1) Chuang, Amy. “Disseminated Coccidioidomycosis in an Immunocompetent Person Living in Novel York City”. Journal of Urban Health: Bulletin of the Recent York Academy of Medicine, Vol. 82, No. 2, doi:10.1093/jurban/jti057

(2) Comrie, Andrew C. “Climate factors influencing coccidioidomycosis seasonality and outbreaks. Environmental Health Perspectives. June 2005 http://findarticles.com/p/articles/mi_m0CYP/is_/ai_n14816419

(3) DiSalvo, Dr. Arthur. Mycology – Chapter Six Dimorphic Fungi. 21 Nov. 2008 http://pathmicro.med.sc.edu/mycology/mycology-6.htm

(4) McKinley, Jesse. “Valley Fever hits epidemic numbers from Texas to Northern California”. Unique York Times. 30 Dec. 2007 http://www.sfgate.com/cgi bin/article.cgi? f=/c/a/2007/12/30/MN12U6OGF.DTL&feed=rss.news

(5) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .

Medical Industry

(1) “Coccidioidomycosis..” NGC – National Guideline Clearinghouse . 1 Nov. 2005. 2 Nov. 2008
(2) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .

(3) “Valley Fever – Valley Fever Connections.” Valley Fever – Valley Fever Connections. 22 Nov. 2008 .

(4) “Valley fever – MayoClinic.com.” Mayo Clinic medical information and tools for healthy living – MayoClinic.com. 15 Mar. 2008. 22 Nov. 2008 .

(5) Interview Roni Cummings, Quality risk management: Notes in hand

Infected Individuals & Insurance Companies

(1) Arizona Department of Health Services. (2008). Valley Fever Annual Relate 2007 (1^st ed.). Phoenix, AZ: Arizona Department of Health Services, Division of Public Health Services.

(2) Interview with Anonymous Patient #1: Patient “V”. (Personal Communication, November 15, 2008).

(3) Interview with Anonymous Patient #2: Patient “F”. (Personal Communication, November 17, 2008).

(4) The Associated Press (2007, January 11). Ariz. Valley Fever Cases Soared in 2006. The Washington Post. All Pages.

(5) Unknown Author. (2008, October 29). Arizona Company Seeks Valley Fever Cure. BIO5 Institute News Archives. All Pages.

(6) Arizona Department of Health Services Webmaster. (2008, November 3). Infectious Disease Epidemiology. Retrieved November 15, 2008, from http://azdhs.gov/phs/oids/epi/disease /cocci/index.htm

(7) Author Unknown. (Last modified October 30, 2008). How Pre-Existing Conditions Work. Retrieved November 15, 2008, from http://health.howstuffworks.com/pre-existing-condition.htm

(8) BIO5 Institute at the University of Arizona. (2008). BIO5 Institute Home Page. Retrieved November 15, 2008, from http://bio5.arizona.edu/index.php

(9) Pfizer Inc. (Unknown Date). Pfizer Products. Retrieved November 15, 2008, from http://www.pfizer.com/products/rx/rx_product_diflucan.jsp

(10) Roerig, Division of Pfizer. (Last revised March 2008). Diflucan (LAB-0099-10.0). Retrieved November 15, 2008, from http://media.pfizer.com/files/products/uspi_diflucan.pdf

(11) The Mayo Clinic. (2006, March 17). Diseases and Conditions Valley Fever. CNN.com & MayoClinic.com. Retrieved from http://azdhs.gov/phs/oids/epi/disease/cocci/index.htm

(12) The University of Arizona. (Video Production). (2008, March 8). Innovation Day at UA 2008, UA @ the Leading Edge [Episode 1]. Development of the Valley Fever Vaccine. Video retrieved from http://www.youtube.com/watch? v=kgT0hFo49G4

(13) Valley Fever Center for Excellence at the University of Arizona. (2003). Valley Fever Center for Excellence: Coccidioidomycosis. Retrieved November 15, 2008, from http://www.vfce.ar izona.edu/

Infected Animals

(1) Mitchell, Chris. Blastomycosis, Cryptococcosis, Coccidioidomycosis (Valley Fever), Histoplasmosis, Disease and more. Animal Shelter Org. 2004. November 4, 2008.

(2) Valley Fever (Coccidiodomycosis). Mar Vista Animal Medical Center. 2006. November 5, 2008. http://www.marvistavet.com/index.html

(3) Valley Fever in Dogs. Valley Fever Center for Excellence. 2008. October 18, 2008.

Construction

(1) “Valley Fever” 1998-2008 Mayo Foundation for Medical Education and Research. Outbreak grips Arizona. March 17, 2006

(2) Benjamin J. Park, Keith Sigel, Victorio Vaz, Ken Komatsu, Cheryl McRill, Maureen Phelan, Timothy Colman, Andrew C. Comrie, David W. Warnock, John N. Galgiani, and Rana A. Hajjeh. “An Epidemic of Coccidioidomycosis in Arizona”, 1998-2001. The Journal of Infectious Diseases, 2005. 1 June.

(3) U.S Environmental Protection Agency. The smart air act amendments of 1990. Clean Air Act. November 10th, 2008.

(4) MAG 2007 Five Percent View For PM-10 For The Maricopa County Nonattainment Situation. December 2007. Maricopa Association of Governments. < (www.mag.maricopa.gov)>

(5) Maricopa Air Quality Department. (2008). Dust Control. [Brochure]. Dust Compliance Resources Maricopa County.

(6) Maricopa County Air Pollution Control Regulations, Regulation III-Control of Air Contaminants Rule 310.

(7) Toribio, Jeovanny. “Maricopa County and dust regulations‏.” E-mail to Erin Dunsey. Oct. 21, 2008.

(1) Jason Jones, Turner Construction Inc, Oral interview, Done 10-21-2008

Notes in Authors hand

(2) Maricopa County Air Quality Department. “Air Quality Violators pay over $452K in October”. November 3, 2008. News.

Valley Fever is the celebrated name for the disease called coccidioidomycosis caused by the fungus Coccidioides immitis(2). This fungus grows in the San Joaquin Valley and south central California, Arizona, Unusual Mexico, western Texas, southern Nevada, the south western corner of Utah, and northern Mexico (1). First reported in the United States in 1894, Valley Fever was officially declared an epidemic by the Arizona health department in 2006 after 5,500 cases were reported that year, including 33 deaths (3). In approximately 60 percent of the time the infection is asymptomatic and the host has no opinion that they had contracted it. The other forty percent fetch symptoms ranging from calm to severe, including death. This emerging disease has had a substantial execute on the human and animal populations in the endemic areas.

When soil containing these fungal spores is alarmed they become airborne and can be inhaled by humans and animals. This disturbance can be caused by anything from humans digging and animals playing in the soil to dust storms and earthquakes. Immunocompromised patients, young children, the elderly and members of several ethnic minorities have a higher risk of contracting Valley Fever (4). Although these groups have a higher level of risk, coccidioidomycosis has been known to affect a wide range of individuals from prison inmates and archaeologists, to drug sniffing dogs along the Mexican border. In unusual years, cases in prisoners at a California Central Valley correctional have reached as high as 1 inmate in every 10 tested (4).

The significant things to understand when learning about this disease are its cause, what is being done to prevent and cure it, its prevalence, and risk factors. This paper has been assembled to address these issues regarding Valley Fever. This paper focuses on four main stakeholders in this Valley Fever epidemic, the medical industry, infected individuals and insurance companies, infected animals and construction companies.

Medical Industry

Valley Fever is a respiratory disease caused by airborne fungi spores from Coccidioides immitis that enter and grow inside the lungs and cause infections. About 60% of the people do not realize that they have this disease because it can cause no recognizable symptoms and can only be positively identified by a skin test. The 40% of the remaining population can secure composed to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each perform ranges from minor to severe consequences. Most significant of all, is to know what the symptoms of Valley Fever are. There are ways to direct if someone might be infected and those symptoms include chest pain-which is a constriction that makes it difficult to breath, fever, muscle stiffness, joint stiffness, wheezing, cough, loss of appetite, chills, and change in mental spot. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will inaugurate to make painful rashes and or lumps on the lower plot of the legs. Symptoms that can be linked with the disease once contacted include joint swelling, joint hurt, arthritis, ankle, feet, leg swelling. All of theses symptoms may not accrue in everyone and can vary from quiet in some people to severe in others. Showing more then one of these symptoms should be a trustworthy indicator that the person has contracted the disease and should consult a doctor.

Once a body is infected, Valley Fever will point to up in one of three forms acute, chronic, or disseminated. Some of the forms are more rare then others. Depending on the originate that Valley Fever takes, the severity of the effects on the body and how perilous it can be will vary. The acute compose is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will note the development of the disease. This can happen at any time during the year or any season. It affects both men and women equally and the systems will move like the body has caught the flu. Chronic produce is rarer and less current then the acute obtain. It is more perilous than the acute gain and can cause more problems. The chronic manufacture can become evident and build after 20 or more years from when the person first got the infection. This may not have been found, treated, or even discovered by the person with the disease.

Valley Fever can cause infections in the body and effect lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural position or the state between the lungs and the ribs. This can cause serious harm to the lungs and the person will have a difficult time breathing. Other symptoms include rude grade fever, weight loss, and nodules in the lungs. The disseminated beget is the most risky and severe out of the three. This is when the disease spreads to the different parts of the body. The infection gets into the person’s bones, lungs, liver, meninges, brain, skin, heart, and around the heart. It is found that 30% to 50% of those people infected with this make also glean meningitis. This create can be very deadly as it can cause swelling around the brain and spinal cord. With this create, healthcare providers often study ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening invent and can cause death if not treated correctly. It can cause brain harm as well and can affect the brain/mental station of the person.

Everyone in the world is different and so not every person is going to be infected the same intention. People of different color or speed can contract the disease more readily then others of another bustle can. The people of Asian, Hispanic and African descent are more susceptible to the diseases than Caucasians. Even though it is really unclear why, those of color are 10-20 times more likely to regain the disease. Most cases that ended up in the emergency rooms were of Hispanic or African origin. Other people that have a high infection rate are people that are diabetics or weakened immune systems such as those with AIDS. Also women that are pregnant, in their third trimester or moral after their babies are born, are at an increased risk of getting Valley Fever. All of these factors will gain it easy for them to bag the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight encourage as well causing them to bag worse quicker and will be more severe. Age is a spacious factor as well seeing as older adults have a higher chance of developing Valley Fever then an younger age. This is because their immune systems are less active or have other medical conditions that lower their ability to fight off the infection. Individuals with musty immune systems are at higher risk for complications which may lead to the disseminated get. It lets the disease spread easier through out the body and lets it gain into the considerable systems of the body. This can gain the body more susceptible to other types of infections because of the further weakening in the immunity from Valley Fever.

Valley Fever, as stated, gets stirred up into the air from recent construction or gardening, allowing one to breathe it in. Once it gets into the lungs it sticks in the inner share of the lungs. There it will grow and multiply inside the lungs. Depending on what design it takes it can definite up from there or release pus. This pus then can catch absorbed into the body and stick to different types of organs. It can especially target places where it can manufacture up in such as joints, feet, and legs. This is because the fungi collect into the blood stream which will pick up absorbed by muscles, bones, and under the skin where it can deposit and grow. If the immune system is not strong enough, it can not extinguish the infection which allows it to further mitigate as it builds in different spots of the body. Since it goes into the body’s blood stream it can earn to where ever the blood is flowing. This includes vessels around brain and the spine. This will cause different reactions such as the person affected might lose some perception and awareness because of the lack of well-organized blood being given to the brain. With the fungi being deposited in places such as the feet or skin it causes swelling because it will compose liquid or more pus-like substance. This will cause the joints to swell up because of excess liquid causing arthritis. Besides looking at the symptoms of the person there are many other ways to resolve if there is a Valley Fever infection. Different medical professions expend different ways to choose the infection in the body and depending on the degree of the disease.

A chest x-ray can be taken to figure out if one is infected. In the x-ray the doctor would be looking for light areas in the lungs that are poorly defined or patch areas. The status where disease is growing will indicate up usually approach or next to the ribs as most of it grows and deposits there. A skin test can be given as well and it is called the spheriulin skin test. This test looks to gaze if the person is infected with the fungus and since it is more sensitive it can catch up signs of an earlier infection accurately. Spheriulin is an antigen that is connected with the fungi that causes Valley Fever. This substance is injected objective a petite below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will study at the arm or the region it was injected at 24 and 48 hours after the test. If the body has antibodies to the fungus, and it is in their system, the body with react and the status will become red and swollen. Although this test is not being extinct as considerable anymore because it is not as specific, it however is primitive in researching to understand the disease. A more popular test is a sputum culture. This is where the doctor or nurse retrieves sputum from the patient. Sputum is the mucus-like secretion in the bronchi tubes or where the air goes to the lungs, and comes up with deep coughing. The doctor or nurse will ask the patient to cough deeply and spit up any sputum into a sterile cup. This will be taken to a lab that allows it to grow to peer if Valley Fever is expose. The doctor my tap on the chest or have the person inhale steam-like mist to aid cough up the sputum in order to score a better sample. One of the last tests that may be done is a coccidiodes antibody test. This test is where the blood is taken to analyze if there are any antibodies to the fungus in the body. If the antibodies are explain it can mean that there is an ongoing infection or a prior one. The test and blood may be taken a couple of weeks after to observe if there is a rise in the antibody count which determines the infection and how severe it may be. The higher the titer or antibody counts the worse the infection it is. These are all tests that the doctors may employ in determining more accurately if the disease is show in the body. This is the only map to be 100% certain that there is an infection.

Depending on the magnitude of the infection different treatment options will be provided by the doctors. Some of the forms may even dissipate with no medical interactions as well. The acute disease will usually go away without medical intervention. Approved management is bed rest and treatment for flu symptoms until the fever goes away. With any of the other forms, medication would be needed to recall care of the disease. If the predicament persists or if there is a higher possibility of complications and it is in its more severe fabricate, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic effect or more acute invent that won’t go away, amphotericin B is usually the medication given to assist fight off the disease. Then the person is monitored as to develop certain the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to occupy care of lesions that are localized. For the disseminated build fluconazole or itraconzole is commonly musty. The dosage is usually 400mg per day and in some cases 2000 mg of fluconazole or 800mg of itraconzole per day may have to be taken in 200mg doses. Amphoterican B may be venerable as an alternate in this spot if lesions are getting worse more speedily and is primitive to diffuse pneumonia. Surgery is notable in this case and in most reports at this stage it is valuable. This is dilapidated to acquire care of big abscesses, destructive lesions or bony sequestrations instability of the spine or the movement on notable organs such as the heart or tissues such as the spine. Since this produce is the worst and in most of the time fatal more actions are required in recovery as compared to the more acute forms. Treatment of the disease does not design it go away for first-rate as relapses can occur or the person can derive it again.

The disease can have short affects and long term effects on the body. Depending on the person or the amount of spores inhaled, this will choose the longevity and affects of the person. The short affects include flu like symptoms and will go away. It is an annoyance fair like any time someone gets sick and the person can go on with their life with no injure. These people probably have higher immune systems. However, the longer the disease stays around in the body the more wound it will do. If it is prolonged in the body for an extended time it will launch having more harsh affects on the body. The infection can spread to the bones in the body and cause deterioration or holes in the bones. This will pause with the patient through out their life. If it is in the body for the extended time it can cause variations of getting better then getting worse fluctuations as well as can cause relapses of the disease where it can reach befriend. If not treated, the non-acute manufacture will worsen over time and in most cases gather into other organs of the body and invent the disseminated type. Taking care of the infection early on would be a qualified strategy as Valley Fever can cause death if not treated at the upright time. If the disease is prolonged it can cause other diseases or illnesses. These include forming pneumonia and meningitis which beget the condition that worthy more deadly and difficult to treat. As both of those diseases are fatal as well and can perform dreadful mixes with Valley Fever. Bleeding and lung abscesses could make which have to be medically treated and in some cases have to be done with surgery. Prolonged exposure can set aside the person at indecent discomfort as the pus gets into the lungs and fills the lungs making them feel like they’re drowning and can’t breathe. This can cause many poor effects as the body can’t accept enough oxygen into the body. People that already have respiratory problems such as asthma can be compromised and hinder the lungs from working efficiently. This can cause a more acute acquire such as short of breath to something more hazardous as not getting any air in and finish breathing without medication or immediate treatment. Most importantly the disease should not be taken as lightly as it can cause death if overly prolonged or gets into its most uncertain forms in the body. Many problems and complications would have to happen in order for it to pick up to that severe of stage. As long as the disease is recognized and treated (if need be) then the affected person can easily recover.

Many people who have Valley Fever don’t even know they have had it because the severity changes in everyone and 40% of the people would display symptoms and require microscopic to major treatment. This disease changes over longer periods of time. A person may have some time to go observe a doctor before they feel the severity of the disease. Though, as stated earlier, waiting for long periods of time to peep medical care would not be worthy to one’s health. This disease is taken in most of the medical field taken very lightly even though misdiagnosis and prolonged exposure to the disease can be fatal to the person’s health. It can have affects on the body that cease with them for years at a time or even there entire life. This is something that if in examine consulting a doctor would be the best course of action so treatment can originate so complications don’t arise.

Infected Individuals & Insurance Companies

There are many principal stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the reveal of Valley Fever. Arguably, the role of infected persons or those that possess a new vulnerability to the disease is top priority on the decision-maker’s list. Each year, thousands of people are diagnosed with Coccidioidomycosis in Arizona alone. In a 2007 article, the Washington Post wrote that Valley Fever cases diagnosed in 2006 were up fifty-six percent from a year earlier. This prompted Arizona health officials to trace the disease at, “epidemic proportions,” as thousands of other cases likely went undocumented. It has also been reported that anyone who has spent enough time in Arizona, or any other fraction of the Southwestern United States where soils acquire the Valley Fever fungus, will contract the disease at some point. Only a microscopic percentage of people, however, are diagnosed with a severe enough develop of the infection where medical treatment is needed. Anti-fungal medication is the most celebrated treatment for Valley Fever. But, there are rare cases where surgery is required to fully recover from the disease. Overall, tens of thousands of cases are reported around the United States annually and the number of Valley Fever-related deaths is estimated at 50-100 each year. It is necessary to explore individuals currently struggling with the disease as well as those who have recovered from a serious gain of Coccidioidomycosis as a stakeholder with regards to this screech because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an grief to better serve this claim, the lives of two patients that contracted a serious acquire of the infection, will be addressed and analyzed in the following paragraphs.

Before introducing specific cases, it is significant to review some original facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Narrate in October 2008. The narrate, co-compiled by the Office of Infectious Disease Services and the Bureau of Epidemiology and Disease Control, presents the amount of Coccidioidomycosis cases reported in 2007 through a myriad of graphs. These graphs command the research information in a thorough and comprehensive plan to the reader by dividing up Valley Fever statistics for the 2007 year in a multitude of categories. Some of these categories include: cases reported in ‘07 according to specific age groups compared years past and a five-year average, separating the number of Valley Fever cases reported by counties in Arizona, and separating the number of Valley Fever cases reported in both mining and non-mining areas within the residence. Although many people believe of this disease as a quiet illness similar to the celebrated chilly, Valley Fever is a key disclose amongst Arizona residents as well as both local and national governments. In 2008, the Arizona Department of Health Services received funds for Valley Fever prevention and control from a legislative appropriations committee. The Center for Disease Control and Prevention (CDC) also awarded the department funds for continued research. As share of the 2007 relate, Health Services interviewed roughly ten percent of all Arizonans diagnosed with Coccidioidomycosis during that year. According to the ADHS, the following are some of the most alarming facts that were discovered from the interviews:

• People missed an average of 1 month of work, for a total of 4,918 days

• People with Valley Fever could not obtain daily activities for an average of 3 months or a total of 92 years

• People with the disease waited an average of 44 days before seeking healthcare

• Patients saw their doctors three times before they were tested for Valley Fever

• There were $86 million dollars in hospital charges for Valley Fever in 2007

Furthermore, Arizona has the highest number of reported Valley Fever cases annually in the United States, accounting for sixty percent nationwide. In total, more than 150,000 people across the country are estimated to contract some create of Coccidioidomycosis each year. The Arizona Department of Health Services reports that the severity of Valley Fever in the dwelling continues to grow as do the overall number of persons infected each year. Due to the fact that currently there is no cure or vaccine for the disease, every person that is susceptible to the effects of Valley Fever certainly shares some kind of stake in the debates of the assure. Examining the personal accounts of two anonymous patients afflicted with a serious get of Coccidioidomycosis can bring further clarity to this claim. Any and all personal information for the following accounts has either been fictionalized, changed or generalized to beget complete anonymity.

The first case will request the tainted effects of Coccidioidomycosis on a male patient of early adulthood age. This individual will be referred to as Patient “V” throughout this paragraph. Patient “V” began his ordeal with Valley Fever in the summer months of 2001. A younger man in the final years of adolescence, Patient “V” experienced generic, flu-like symptoms, which he disregarded as nothing well-known like most other sufferers decide to do. “At first, I noticed that my lymph nodes in my neck were unusually swollen…I figured it was fair a chilly or some little infection or something like that.” Soon after the initial stages of the disease, Patient “V” began experiencing constant, severe hurt in the left side of his chest. Although he made numerous medical appointments for this predicament, the distress would subside by the time Patient “V” arrived, making it difficult to diagnose the plight. “What was happening was my left lung had a hole in it and it kept collapsing and then re-inflating by the time I got to the doctor’s office.” Eventually, a chest x-ray was performed on Patient “V” and this revealed a little, gloomy dwelling on his left lung. The status indicated a relatively miniature, but primary hole through the lung. The scrape required corrective surgery and Patient “V” was admitted to one of Arizona’s hospitals in August, 2001. Surgeons sewed up the hole in Patient “V’s” left lung and released him after a day of recovery. Within weeks following the surgery, Patient “V” experienced a relapse of his earlier symptoms. “…I was playing Volleyball one night and in an instant, there was this intense distress in my chest…I felt dizzy and could hardly breathe.” Patient “V” immediately returned to the hospital sometime in November of that year where further tests concluded that the infected allotment of his left lung was, indeed, Coccidioidomycosis. Another surgery to completely recall this fraction of infected lung was performed successfully and Patient “V” spent more time recovering in the hospital. “The effects from the disease itself were painful enough, but the worst afflict came from the chest tubes that were inserted into me in the hospital…At one point, they shoved one of the tubes through my ribcage and into my lung and I wasn’t even on harm medication.” Fortunately for Patient “V”, the second surgery was successful and he survived his brush with Valley Fever. In many cases, patients who contract and fend off the infectious spore effect up life-long immunities. However, reports have also shown that patients in remission from Coccidioidomycosis can be more vulnerable to a reoccurrence of the disease than those that have never contracted it. Following his surgical recovery, Patient “V” was prescribed an anti-fungal medication called Diflucan, a popular drug distributed to sufferers of the infection. Patient “V” was required to hold this medication daily for 2-3 years. He now receives chest x-rays once a year to check for any returning signs of the fungus. Patient “V’s” scar tissue has also become virtually unrecognizable after nearly a decade of recovery.

The second case to be analyzed will be that of a middle-aged female patient. Appropriately, this patient will be referred to as Patient “F” throughout the analysis. Patient “F” contracted Valley Fever in slow 1995. Early symptoms experienced in this patient included chronic loss of breath and shameful joint discomfort. The fabricate of Coccidioidomycosis contracted by Patient “F” was not diagnosed correctly until 2 ½ years after symptoms began. Before visiting a pulmonologist, Patient “F” was given a chest x-ray, where a astronomical, round nodule was located somewhere on her left lung. The patient was admitted to the hospital in 1998 and underwent a wedge resection, to capture the infected share (removed in wedge acquire) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at beefy strength for six fat months; and then half the dosage for another six months. The patient continued to have fevers following the surgery. She also had an excess amount of fluid in her lung. Patient “F” returned for a second surgery to further desirable the infected residence and completed another sequence of antibiotics afterwards. The time spent in the hospital for recovery totaled at six days for each surgery. Patient “F” was fortunate enough to have flexible employment benefits to fully recover. “My company provided short-term disability; up to 6 months with 100% pay…I was very lucky.” As far as medical coverage is concerned, Patient “F” had itsy-bitsy out-of-pocket costs through United American. However, she was unexcited apprehensive to sight the total amount owed from her finish in the hospital. “The bill after six days in the hospital, which included one day in ICU and five days on a regular floor, was amazing. Impartial for room and board and a microscopic medication, the bill was $28,000.00.” Today, Patient “F” has fully recovered from the infection and only has one suggestion with regards to the mutter of Valley Fever. “Educate physicians on the east flit and west hover, all over the Untied States to properly test for Valley Fever.”

Needless to say, there are always financial burdens associated with any type of surgery as well as prescription medication. In the case of Patient “V”, a total of nearly $180,000.00 was accrued in hospital bills after the two surgeries were performed. Additionally, the drug Diflucan can range from 36 dollars to 60 dollars for 100mg/10 pills depending on the region of assume. It is critical to stare medical insurance companies as a stakeholder with regards to the teach of Valley Fever as well. Because there is no cure or vaccination for the infection, insurance companies limit the amount of coverage to persons with preexisting conditions. If a cure were to be developed and released into the market, insurance companies would most likely include Valley Fever coverage into any opinion. Unfortunately, without medical insurance, the overall amount of money needed to recover from a serious infection like Valley Fever is simply insurmountable for the majority of Americans. Even with sufficient medical insurance, however, people who have had Valley Fever in the past are typically not covered for a relapse of the infection. Patient “V” currently receives individual health insurance under a PPO from Blue Evil Blue Shield of Arizona. As mentioned earlier, however, major insurance companies like this one tend to limit coverage to individuals with preexisting conditions. According to an article on www.howstuffworks.com, a preexisting condition is a health condition or illness that you have had before your first day of coverage on a unique conception with an insurance company. Typically under group coverage, such as that offered by a corporation under an employee’s benefits, a person with a preexisting condition can net bulky coverage, but will have to wait anywhere from nine months to a year before it kicks in. This period is enforced by insurance companies to insure that a patient is not constantly having relapses of the same condition. However, a person with a preexisting condition will rarely receive private health coverage that includes their condition. This is referred to as the preexisting conditions exclusion. Our attempts to contact major medical insurance companies or medical insurance agents for further clarity on this snarl went unanswered. Unfortunately, people like Patient “V” who have preexisting conditions, are self-employed and do not qualify for group medical insurance will have to pay out-of-pocket if their conditions return. “I would have to content bankruptcy if that happened…” Patient “V” explained. “I live in horror because I know that if I were to earn it again, that would be disastrous.”

Currently, a vaccination for Coccidioidomycosis is under development at the BIO5 Institute on the campus of the University of Arizona. Leading the development is Dr. John Galgiani, Director of the Valley Fever Center for Excellence and Chief Medical Officer for Valley Fever Solutions, Inc. This vaccination will be intended for both humans and dogs, which can also contract deadly forms of Valley Fever (this topic will be further discussed in later sections of this stare). In March, 2008, Dr. Galgiani teamed up with fellow BIO5 colleague Dr. David Nix of the Department of Pharmacy Practice and Science to research the vaccination. “We had some complimentary expertise and mine’s mainly in the region of drug development and drug development science and so on. And Dr. Galgiani is kind of the world’s expert on Valley Fever,” Dr. Nix reported in a 2008 Valley Fever instructional video produced by the University of Arizona. The two physicians, under the company name Valley Fever Solutions Inc., are financially backed by the University, private donors and C-Path, a Fresh York based foundation. They are currently testing an anti-fungal called Nikkomycin Z, which was first old to prevent fungal degradation in build. With approval from the U.S. Food and Drug Administration, Nikkomycin Z is in Phase 1 of drug safety trials. According to a news release published on the BIO5 Institute’s website, “The company has already obtained a Science and Translational Technology Research (STTR) grant from the National Institutes for Health that will succor fund pharmacology studies that will support construct future clinical trials. The first phase of that grant is worth more than $100,000, with the potential for an additional $700,000.” If this vaccination proves to be a viable cure for Coccidioidomycosis, many aspects of the thunder of Valley Fever would certainly change. Once a cure hits the market, the number of deaths and serious cases as a result of Valley Fever would topple significantly. Debates between the government, politicians and special interest groups would decrease as well if no one were in any valid threat of the infection anymore. Briefly returning to the topic of medical insurance, people with Valley Fever as a preexisting condition will be able to feel more fetch because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Corrupt Blue Shield, Cigna and Humana will more freely distribute fleshy coverage in instances of Valley Fever. Like most vaccinations and cures to approved infections or diseases, there would be many definite outcomes to releasing this drug into the medical market, pending the completion of all drug safety trials.

As famous stakeholders with regards to the tell of Valley Fever, both infected persons and medical insurance companies would be greatly affected if an executive decision were to be made, or possibly a vaccination released into the market. While the future looks ample with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people obtain a procedure to glean health insurance coverage to some capacity. It is also necessary that individuals with preexisting conditions that aren’t on group medical plans lobby for their rights to complete insurance coverage. In considering the horrible effects of Valley Fever, there are many people who consider this topic is unbiased as essential to the animal world as well.

Infected Animals

Valley Fever does not only affect people but it is now more commonly being found in animals. Animals are unbiased as likely to collect Valley Fever as humans are. Animals bag Valley Fever in the same arrangement as humans do, by breathing the fungus. It has been found that more and more animals are being reported of becoming ill due to this fungus. It has been found the 30-40% of animals who breathe in the fungus come by sick. Some of the most favorite animals to be reported with Valley Fever are dogs, cats, llamas, non human primates, horses, and zoo animals (3).

A golden retriever went into the vet’s office; the dog wasn’t feeling well and wasn’t acting himself. The vet takes an x-ray of the dog’s lungs and sees white spots in the lung set where there should normally be dusky patterns. The white spots prove that the dog might have cancer in its lungs. The dog is only four years old-fashioned, which is when a dog should be at its prime and not getting lung cancer. Lung cancer isn’t usually found at this young of an age and doesn’t seem to execute as hastily as it has in this golden retriever. The owner had said fair two weeks prior to going to the vet that the dog was fat of energy on their vacation. The veterinarian doesn’t all the facts add up for the dog to have cancer so she decided to urge a few more test before she starting treatment for lung cancer. The dog’s health over the course of time starts to go downhill and very snappily. The dog starts to cough, has a loss of appetite, and tiny to no energy. The vet then found out where the human family had recently traveled and they were in the Southwest. After hearing this, the vet certain that it must be a fungal disease and it was unbiased that, it was Valley Fever (1).

Dogs are the largest infected and most commonly reported animals with Valley Fever. Dogs catch Valley Fever in the same scheme that humans do and in the same regions as humans do. The fungus is spread through spores which dogs can easily inhale. Once the fungus is inhaled, the spores grow into spherules which enlarge and eventually burst into hundreds of endospores (3). This causes the spreading of the infection into the lungs. A dog’s immune system should answer and surround the infection to kill it. Dogs that do not become sick due to the fungus are considered to be asymptomatic (2). When a dog does become sick from Valley Fever, their immune system fails to end off the infection and the infection continues to spread into the lungs and then can disappear throughout the dog’s body (3).

Once a dog is infected with Valley Fever, there are definite symptoms that become expose. Some of the symptoms that are seen in dogs are weight loss, coughing, fever, lack of appetite, and lack of energy (3). The cough in dogs can be seen as early as the first week of getting the infection to as unhurried as 3 weeks. The cough that dogs accumulate is due to the development of pneumonia which is visible on x-rays. The coughing can be caused due to pressure on the lymph node advance the heart and puts pressure on the dogs windpipe which as a result irritates it (3). After the cough is show the loss of appetite and energy is soon to follow. If the infection is not controlled it can become considerable worse and spread throughout the body. When the fungus is spread throughout the body it causes systemic or disseminated disease (3). When this happens the symptoms and condition of the dog becomes grand worse. The symptoms that become exhibit are: swelling of the limbs, benefit and neck afflict, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, look inflammation, and non-healing skin ulcerations (3). Not all symptoms are exhibit apt away and it can recall several months before definite symptoms appear. It can be several months after a cough appears that other symptoms become note. There is typically an order that the fungus spreads throughout the dog’s body. The first organ to be effected is lung, and then the infection usually spreads into the bone, than eyes, heart, testicles, brain, spinal cord, and finally abdominal organs (2).

To choose if a dog has Valley Fever there are different test that can be done. Some of the most current test done to resolve if a dog has been infected is blood tests, chest x-rays, bone and joint x-rays, and Valley Fever blood test (3). Test results may explain up negative up to 3-4 weeks of receiving the infection so in some cases test need to be repeated to confirm that the dog does or does not have Valley Fever (2).

There are different treatments that be done to abet fight the fungus. The process of treating Valley Fever may be long; medication can be given for up to one year (2). The length of time that the treatment will assume usually depends on how far the fungus has spread throughout the body. Most commonly oral antifungal medication is given to the dog. These antifungal medications are ketoconazole, itraconazole, and fluconazole (2). Ketoconazole is the most commonly prescribed medication due to the fact that is it the least expensive. This drug is usually given twice daily and with food. Itraconazole is a more expensive medication but has fewer side effects than ketoconazole. Itraconazole is also better for dogs that are having problems keeping their food down because it has a faster absorption rate (3). The third medicine most commonly given out for treatment is Fluconazole and it is also expensive with petite side effects. This is usually given to dogs that have injure done to their spinal cord and nervous system (3).

Cats, llamas, non human primates, horses, and zoo animals are other animals that have been reported with Valley Fever. Cats that have Valley Fever present the same symptoms as dogs do but it less likely for a cat to win Valley Fever than it is for a dog. Cats glean Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats collect the fungus their symptoms are usually a slight more advanced than dogs. Two of the major symptoms seen in cats that have Valley Fever are unexplained weight loss and skin ulcerations that won’t go map. The same treatment for dogs can be obsolete to treat cats with Valley Fever (3).

Horses are another animal that have been found to accumulate Valley Fever. There have not been very many cases reported but in the ones that have only one horse has survived Valley Fever with treatment. All the other horses that were reported with Valley Fever had to be euthanized. The reports of these cases are not very original though, and with medical technology improvement chance of survival with original medicine is grand better for horses today (3). Llamas are another animal that have been infected with Valley Fever. Llamas are very sensitive to this fungus. In most cases, if a llama has Valley Fever death is almost always the outcome.

Zoo’s that are located in the Southwest are very aware of Valley Fever. Many zoos have lost animals due to Valley Fever before they were aware of what is was and how to treat for it. When animals become sick, Valley Fever is something that is tested early so treatment can be started. In zoos, the most approved animals to rep Valley Fever are: Monkeys, Apes, and other primates. These animals exhaust the same treatment process as dogs and cats but is usually consists of a lifetime treatment (3).

Valley Fever is a very serious lisp that is rising in animals. Currently there are no preventatives for Valley Fever. The treatments for Valley Fever for animals has become better and better over time. The arrive in technology has allowed for veterinarians to be able to detect Valley Fever at a less come stage. The early stage that Valley Fever is caught at allows for a better chance of survival of animals infected with the fungus.

Construction

There is no doubt that construction companies contribute significantly to Valley Fever. According to the MayoClinic, institution known for prominence in the medical field recognized the increase in accurate estate has contributed to the spew of “thousands of tons” of dust carrying this fungus into the air. The article looks at how in the 1990s the accounts of Valley Fever increase in the states of Arizona and California due to some important factors. Among those factors like dry climate, the unusual building booms have been one of the most necessary factors that have contributed to such increases. The mercurial clearing and building were a valuable source for the increase in reported cases of Valley Fever. Among all the contributing factors of Valley Fever, environmental exposure ranks high, if not the significant cause. Experts also added that almost half of the people who live in areas where Valley Fever is prevalent have contracted the disease. Interestingly, people who are at most risk are those who are exposed to directly to dust like those who obtain jobs in the field of construction, ranching and agricultural work (1).

The decade following the 90’s has had a titanic increase in reported cases of Valley Fever. Those areas that have reported such increases are the states of California and Arizona. These states have been induced with a massive building yelp. The mass migration to these “sun belt” states made for a widespread land clearing and construction, which ultimately directly contributed the spread of the air borne fungus (2). Importantly, some measures are currently in location to purposely crop the amount of dust construction companies contribute to the environment.

The Environmental Protection Agency (EPA) is an agency of the federal government of the United States who is in charge of protecting human health by maintaining the natural environment satisfactory (3). This implies its commitment and dedication to monitoring and posing regulations for anything threatening the quality of the air. The EPA has location limits on how worthy pollution is allowed to be in the air. In its goal to occupy and manage the air we breathe, EPA has passed several pieces of legislation that have reduced the amount of smog and pollutants in the air. Among significant legislation is the Super Air Act which has been passed to enforce natty air standards and improve human health. The Super Air Act is an outline for what national, region, and local authorities must follow in order to protect air quality. Under the Smart Air Act, local and location authorities are responsible for abiding by the national ambient air quality standards. The Environmental Protection Agency states Maricopa Country cannot exceed the federal health standard for particulate pollution more than three times in a three year period (4).

According to the Environmental Protection Agency (EPA), Maricopa County has been in violation of particulate pollution since 1996. Particularly 2008, there have been nine different days where at least one of the monitors exceeded the federal health standard for particulate pollution. The health standard for particulate pollution is that it cannot exceed more than 150 micrograms per cubic meter measured over a 24 hour period of time. It’s considerable to know Maricopa County has 24 air monitoring sites in the Valley. The site of Arizona, under the Arizona department of environmental quality has its possess air monitoring sites as well. If any of these monitors exceeds the federal health standard for a given pollutant, the EPA will gain Maricopa County accountable. According to the Environmental Protection Agency (EPA), Maricopa County failed to near attainment for particulate pollution and thus is under federal orders to chop particulate matter pollution. In an attempt to address the thunder, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a understanding to the EPA to reveal how the county plans to cleave PM₁₀ emissions by five percent each year until expedient levels are reached. The Five Percent Conception outlined more than 50 commitments to slice dust. Of these commitments, some affect the procedures and guidelines on construction entities (4).

Speaking with Erin Dunsey of Maricopa County Air Quality Department, the county is currently working hard to pose regulations on construction companies in order to lower dust emissions and ultimately lowering the potential threats from Valley Fever. The principle responsibility for The Maricopa County Air Quality Department’s Dust Compliance Division is to protect the public from the dangers that advance from airborne particulate matter (7). This division of dust compliance deals with fugitive dust sources and the rules to minimize the production of it. This means that fugitive dust from any source, including constructions areas, must be restricted in their construction operations to occupy within gracious dust standards. As share of the compliance, Maricopa County has devised that all sites with stupefied surface areas of dust must comply with “Rule 310″ (5).

Under Rule 310, the Dust Compliance Division has established limitations and requirements for the implementation of process controls as well as other guidelines that will back enforce reliable fugitive dust control measures. One of the first major steps for construction companies to follow is the obtainment of a permit. The Air Quality Department requires a construction permit for companies who understanding to conduct activities any that will disturb a surface set equal to or greater than 0.1 acre. Complying with the construction permit requirements is often a distinguished and daunting task. Before applying for a permit, a concept that outlines the measures that will prevent the creation of dust must be presented. This opinion also describes all the measures that will be implemented at anytime during the phase of construction. Therefore, this guideline requires dust generating sources to meet standards and at the same time apply best the available control measures in order to attempt to minimize fugitive dust emissions. This plan being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on spot understand their responsibility while on station (6).

Another hassle that companies have to deal with is the logging of control measures. Once again, under Maricopa County’s Rule 310, construction companies who conduct a dust generating operations that require a Dust Control Belief must support a written log recording the dependable application and execution of the control measures previously outlined and popular by the Dust Control Belief. This is a daily detailed recordkeeping which records what actions are being conducted in dust-generating operations in what may include daily inspections for crusted or damp soil. Another share of characterize keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and own stupefied surfaces must install a trackout control devise. These devises are great contributors to the retention of fugitive dust. Trackout is simply the particulate matter from tires and other sources that have fallen onto paved areas that are accessible to the public. The rule states that trackout must be diminutive to 25 cumulative linear feet (6).

Rule310 is an extensive and overwhelming state of requirements established to lower dust emissions. Piece 309 list another requirement under Rule310 that companies must abide by. The rule says that if the plot of interest is more than one acre a series of dust control training must lift area. All workers directly fervent in the containment of dust like the water truck drivers and water pull drivers must rob a basic dust control training class in which attendees will ultimately become certified if successfully completed the training class. An extension from this share lists that a dust control coordinator must be display on job position if the dimension of the job area is five acres and up (5). These onsite coordinators must have completed a comprehensive dust control training in which they are given marvelous training on regulating emission of fugitive dust and learn practical methods to do so, such as well-organized up, water and dust suppressant applications (6).

Construction companies are required by residence and federal law to implement a diligent anxiety to control dust pollution. If at any time violations are committed, these companies will be subject a fines and penalties. This has been yet another plight companies have had to face on a regular basis. The penalty policy held by the Maricopa County Air Quality Department seeks to prevent future violations. Fines that are placed upon companies are clear by the severity of the violation committed. Several factors are conventional to calculate the amount of a penalty. In case there has been an economic serve of noncompliance by the company, the penalty will consist of weighing out the benefits that were looked to have been extracted.

Dust control compliance has also become a financial setback for construction entities. The Maricopa County Air Quality Department announced that in the month of October $452,589.90 in air quality violations was composed (9). In the month of September, the amount of $471,613.30 was composed in violations all related in one map or another to air quality control. This is the pain construction company’s face for not correctly using effective measures to crop dust in the construction sites, therefore causing potential problems to approach residents and workplaces, eventually becoming a financial scrape due to fines.

There is no better intention to understand how troublesome the strict regulations have become a burden for construction companies. While searching for construction companies within the valley, Turner Construction Inc. drew attention as it is well known as a ample construction company that has a corporate office in Tempe, AZ. With a examine to jabber to a construction manager, a brief conversation was held with a construction project manager from Turner Construction. The conversation revolved around how Valley Fever has affected their procedures during construction or related tasks. Immediately it became distinct honest how distinguished companies who are in the construction industry are affected by laws to abet gash the incidents of Valley Fever. Jason Jones, who is a project manager at Turner Construction Company, explained that all construction companies have been hit hard by Maricopa County. Amongst the things mentioned was the fact that the main anxiety for the county is dust control. As a result for the growing anguish over dust control, they have to follow a “rigorous dust program” to comply with regulations. Jason explained how they are currently working on a 242 acre development complex and have had to spend around 400,000-750,000 gallons of water to control dust governed by Maricopa country. He added that this adds to the costs of the construction project as trucks and workers are outmoded to acquire fugitive dust. If they ever do not comply with these regulations, fines inaugurate from about $1,000 to 10’s of thousands of dollars. He added that Maricopa is the “worst county in America for dust regulations” (8).

The main spot is that construction companies have to follow strict regulations on their dust production. The county of Maricopa has been enforcing even stricter laws to prevent and wait on contain dust levels to a minimum as they have recently been under serious scrutiny from the Environmental Protection Agency. If for some reason these companies are not correctly using effective measures to gash dust in the construction sites, substantial fines will follow. This is yet another scream companies are dealing with. To the load even greater, these companies also deal with the economical status backs from following these regulations. For companies to gash and comply with county regulation, thousands of dollars are being forcefully spent by such companies. The contributions construction companies earn to Valley Fever is not underestimated. As a result, strict regulations are followed and posed upon companies to slit the incidence of Valley Fever cases. Valley Fever has arrive to cost companies thousands of dollars and is becoming every day more of an misfortune.

Conclusion

After studying the stakeholders keen in Valley Fever, it is easy to stare popular themes between them. There is no doubt that while not known as a uncertain disease, Valley Fever has the potential to be one. With the number of cases increasing each year and relatively limited research being done for prevention and cures, Valley Fever has earned the title as an emerging epidemic. While Coccidioides immitis only lives in a few purchase areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and attractive to endemic areas. It also must not be forgotten that Valley Fever has the capability to affect animals as well humans increasing the cost of the disease for these species. It is definite that because of this, action must be taken in order to slice the number of cases and to decrease the severity of the cases.

This case discover points to a few relatively easy steps to rob in order to decrease the severity of Valley Fever cases. The most indispensable and most clear step is early detection. It was shown that the earlier that the disease is diagnosed, the less severe the symptoms and the less impact it has on the infected individual. Despite this easy solution, doctors saw their patients and average of three times before they tested for Valley Fever and the patients on average waited 44 days before treatment. These statistics point to a general lack of awareness this disease in both the patient and the medical world. In order to promote early detection, there must be better instruction of symptoms and complications keen in prolonged disease available to both the medical community and the population of endemic areas. This in theory would earn an awareness of the disease and assist earlier testing for it.

There are a few steps that can be taken in order to cleave the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also benefit carve the number of cases. Public awareness of Valley Fever would slice the number of cases by providing the people with knowledge of its causes and ways to avoid exposure to the Coccidioides immitis spores. The second step that should be taken is a national focus on research in vaccines and cures for this disease. From this case glimpse it is certain that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the set in some circumstances. These high costs are unacceptable when relatively itsy-bitsy investment is being made in the research of a cure or vaccination.

When considering these recommendations, it is essential to review the facts about this disease. Valley Fever is caused by the spores of a fungus that can become airborne when soil is petrified. This fungus is endemic to immense portions of the American southwest including Phoenix, Arizona, the nation’s fifth largest city. Statistically, anyone living in endemic areas is likely to pick up this disease at least once in their lifetime. On top of those living in endemic areas, those visiting the location have a high chance of contracting the disease. The number of cases has risen consistently each year for at least the last seven years. After reviewing these facts it is determined that Valley Fever has had a principal impact on our society and that steps need to be taken to gash its prevalence.

References

Introduction

(1) Chuang, Amy. “Disseminated Coccidioidomycosis in an Immunocompetent Person Living in Unusual York City”. Journal of Urban Health: Bulletin of the Unusual York Academy of Medicine, Vol. 82, No. 2, doi:10.1093/jurban/jti057

(2) Comrie, Andrew C. “Climate factors influencing coccidioidomycosis seasonality and outbreaks. Environmental Health Perspectives. June 2005 http://findarticles.com/p/articles/mi_m0CYP/is_/ai_n14816419

(3) DiSalvo, Dr. Arthur. Mycology – Chapter Six Dimorphic Fungi. 21 Nov. 2008 http://pathmicro.med.sc.edu/mycology/mycology-6.htm

(4) McKinley, Jesse. “Valley Fever hits epidemic numbers from Texas to Northern California”. Current York Times. 30 Dec. 2007 http://www.sfgate.com/cgi bin/article.cgi? f=/c/a/2007/12/30/MN12U6OGF.DTL&feed=rss.news

(5) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .

Medical Industry

(1) “Coccidioidomycosis..” NGC – National Guideline Clearinghouse . 1 Nov. 2005. 2 Nov. 2008
(2) Smith, Scott. “MedlinePlus Medical Encyclopedia: Coccidioidomycosis.” National Library of Medicine – National Institutes of Health. 9 Oct. 2006. 22 Nov. 2008 .

(3) “Valley Fever – Valley Fever Connections.” Valley Fever – Valley Fever Connections. 22 Nov. 2008 .

(4) “Valley fever – MayoClinic.com.” Mayo Clinic medical information and tools for healthy living – MayoClinic.com. 15 Mar. 2008. 22 Nov. 2008 .

(5) Interview Roni Cummings, Quality risk management: Notes in hand

Infected Individuals & Insurance Companies

(1) Arizona Department of Health Services. (2008). Valley Fever Annual Record 2007 (1^st ed.). Phoenix, AZ: Arizona Department of Health Services, Division of Public Health Services.

(2) Interview with Anonymous Patient #1: Patient “V”. (Personal Communication, November 15, 2008).

(3) Interview with Anonymous Patient #2: Patient “F”. (Personal Communication, November 17, 2008).

(4) The Associated Press (2007, January 11). Ariz. Valley Fever Cases Soared in 2006. The Washington Post. All Pages.

(5) Unknown Author. (2008, October 29). Arizona Company Seeks Valley Fever Cure. BIO5 Institute News Archives. All Pages.

(6) Arizona Department of Health Services Webmaster. (2008, November 3). Infectious Disease Epidemiology. Retrieved November 15, 2008, from http://azdhs.gov/phs/oids/epi/disease /cocci/index.htm

(7) Author Unknown. (Last modified October 30, 2008). How Pre-Existing Conditions Work. Retrieved November 15, 2008, from http://health.howstuffworks.com/pre-existing-condition.htm

(8) BIO5 Institute at the University of Arizona. (2008). BIO5 Institute Home Page. Retrieved November 15, 2008, from http://bio5.arizona.edu/index.php

(9) Pfizer Inc. (Unknown Date). Pfizer Products. Retrieved November 15, 2008, from http://www.pfizer.com/products/rx/rx_product_diflucan.jsp

(10) Roerig, Division of Pfizer. (Last revised March 2008). Diflucan (LAB-0099-10.0). Retrieved November 15, 2008, from http://media.pfizer.com/files/products/uspi_diflucan.pdf

(11) The Mayo Clinic. (2006, March 17). Diseases and Conditions Valley Fever. CNN.com & MayoClinic.com. Retrieved from http://azdhs.gov/phs/oids/epi/disease/cocci/index.htm

(12) The University of Arizona. (Video Production). (2008, March 8). Innovation Day at UA 2008, UA @ the Leading Edge [Episode 1]. Development of the Valley Fever Vaccine. Video retrieved from http://www.youtube.com/watch? v=kgT0hFo49G4

(13) Valley Fever Center for Excellence at the University of Arizona. (2003). Valley Fever Center for Excellence: Coccidioidomycosis. Retrieved November 15, 2008, from http://www.vfce.ar izona.edu/

Infected Animals

(1) Mitchell, Chris. Blastomycosis, Cryptococcosis, Coccidioidomycosis (Valley Fever), Histoplasmosis, Disease and more. Animal Shelter Org. 2004. November 4, 2008.

(2) Valley Fever (Coccidiodomycosis). Mar Vista Animal Medical Center. 2006. November 5, 2008. http://www.marvistavet.com/index.html

(3) Valley Fever in Dogs. Valley Fever Center for Excellence. 2008. October 18, 2008.

Construction

(1) “Valley Fever” 1998-2008 Mayo Foundation for Medical Education and Research. Outbreak grips Arizona. March 17, 2006

(2) Benjamin J. Park, Keith Sigel, Victorio Vaz, Ken Komatsu, Cheryl McRill, Maureen Phelan, Timothy Colman, Andrew C. Comrie, David W. Warnock, John N. Galgiani, and Rana A. Hajjeh. “An Epidemic of Coccidioidomycosis in Arizona”, 1998-2001. The Journal of Infectious Diseases, 2005. 1 June.

(3) U.S Environmental Protection Agency. The natty air act amendments of 1990. Clean Air Act. November 10th, 2008.

(4) MAG 2007 Five Percent Belief For PM-10 For The Maricopa County Nonattainment Station. December 2007. Maricopa Association of Governments. < (www.mag.maricopa.gov)>

(5) Maricopa Air Quality Department. (2008). Dust Control. [Brochure]. Dust Compliance Resources Maricopa County.

(6) Maricopa County Air Pollution Control Regulations, Regulation III-Control of Air Contaminants Rule 310.

(7) Toribio, Jeovanny. “Maricopa County and dust regulations‏.” E-mail to Erin Dunsey. Oct. 21, 2008.

(1) Jason Jones, Turner Construction Inc, Oral interview, Done 10-21-2008

Notes in Authors hand

(2) Maricopa County Air Quality Department. “Air Quality Violators pay over $452K in October”. November 3, 2008. News.

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