1. Kayla Davis Northern Arizona University
Coccidioidomycosis
Kayla Davis
Northern Arizona University

2. Introduction Alias: Valley Fever or San Joaquin Fever
Non-infectious fungal infection
Cannot be passed from person to person, animal to animal, or animal to person
Caused by Coccidioides posadasii and Coccidioides immitis (Buhrow, 2013)
Commonly dispersed into the air by any means that disrupts soil (Angus, Schmidt, Dockrell & Grant, 2011)
Farming
Construction
Earthquakes
Large gusts of wind

3. Ecology Endemic to arid desert regions of: SW United States Mexico
Arizona
California
New Mexico
Texas
Mexico
Central America
South America (Buhrow, 2013)
Figure 1: Geographic distribution of coccidioidomycosis in the Americas.
Reprinted from R. Laniado-Laborin. (2007a).

4. Predisposing Factors Increased susceptibility to disseminated disease
Being elderly
Immunosuppressed
Pregnant
Especially the third trimester (Gago et al., 2014)
Certain races
African American
Hispanic
Filipino (Choleva, 2010)

5. Disease Process
Once the spore is inhaled, incubation is 1-3 weeks (Coccidioidomycosis, 2010).
60% of people remain asymptomatic
1-4 weeks after exposure 40% of people will present symptoms (Buhrow, 2013).
Mild cases: Flu-like symptoms which include
Fever, rash, cough, headache, chest pain, night sweats, and myalgias (Buhrow, 2013).
Valley fever is restricted to respiratory system (90%)
10% will develop pulmonary lesions (Coccidioidomycosis, 2010)
<1% of cases fungus disseminates to other systems (commonly the brain)
Change in mental status, respiratory distress, bone or joint pain (Tsang et al., 2010)

6. Stage of Recovery, Disability, or death
95% of mild cases recover without intervention (Change et al., 2008)
Antifungal medication given to reduce intensity of infection
Untreated disseminated disease will expire
Surgery may be required
Lifetime treatment may be necessary to prevent reinfection
There is no vaccination or cure for coccidioidomycosis

7. Figure 2: The life cycles of valley fever. (Buhrow,2013)

8. Data and Measures Used Tools Measures
National Electronic Telecommunication System for Surveillance
U.S. Census Bureau
Measures
retrospective cohort studies
case-control studies
statistical analysis     (Chang et al., 2008)
Data and Measures Used

9. Incidence Rate Worldwide
Valley Fever is unique in a way that incidence and prevalence can be extremely hard to measure because many symptoms are commonly misdiagnosed.
Many cases in Latin America are misdiagnosed as Tuberculosis
“prevalence rates in Latin America are either fragmented or simply not available” (Laniado-Laborin, 2007a)
It is only reportable in Arizona and California based on global research.

10. Incidence Rate Worldwide
United States
111,717 cases were reported to the CDC from 28 states and the District of Columbia
66% Arizona
31% California
1% other endemic states
<1% non endemic states (Tsang, Tabnak, Vugia, Chillder, & Park, 2013)
Mexico
No prevalence studies have been conducted since 1960
Central America
Most current studies over 40 years ago
21% of children in Guatemala tested positive
25% of children tested positive in Honduras (Laniado-Laborin, 2007a)
South America
Endemic areas include Argentina, Brazil, Paraguay, Bolivia, Colombia
Little known about these countries due to lack of research

11. Mortality rate worldwide
3.089 coccidioidomycosis related deaths in U.S.( )
Crude mortality rate of 0.58 per 1 million person-years (Huang, Bristow, Shafir, & Sorvillo, 2012)
Mortality rates outside the United States were unavailable

12. Patterns of Disease
In the United States

13. United States Notifiable disease 1995-2010
Arizona and California only states that report these infections after 2010
Endemic states were only taken into account
Arizona
California
Nevada
New Mexico
Texas *not reportable
Utah
National rates rose from 12,868 cases in increased to 16,664 cases in 2010 (Tsang et al., 2013)
National prevalence rate in 2011 was 22,401.
National incidence rate of 42.6 per 100,000 people (Tsang et al., 2013)
Figure 3: Geographic distribution in the Southwestern United States. (“U of A”, n.d.)

14. Arizona Arizona has the highest prevalence rate in the country.
12,920 cases in 2012
22% decrease from 2011 (“Valley Fever”, )
Figure 4: Reported cases of valley fever per 100,000 population,
Arizona 1990 – Reprinted from Valley Fever 2012 Annual Report.
(2013). Retrieved from

15. Gender Historically males are more prone than women
In Arizona, recently, this is not the case
2009: 55% of cases were women (Tsang et al., 2013)
2012: 58% of cases were women (“Valley Fever”, 2013)
California incidence rates
: 7.6/100,000 men vs. 4.0/100,000 women
2011: 20.5/100,000 men vs. 9.7/100,000
These variations may be due to higher-risk factors associated with men
Occupation, smoking habits, sex hormones

16. Race/Ethnicity In Arizona only 18.7% of reported cases identified race
Unable to calculate incidence rates based off this (“Valley Fever”, 2013)
Hospitalization rates for African Americans were 12 times higher than Causasians and 20.8 times higher than Hispanics in Arizona (Seitz, Prevots, & Holland, 2012).
1940 study
Found African Americans had dissemination rates 8-10 times higher than Caucasians in California (Brown et al., 2013)

17. Age Elderly are the most susceptible age group 2011
40-59 years of age: per 100,000 people
60-79 years of age: per 100,000 people
80+ years of age: per 100,000 people
Unites States averaged an incident rate of 43.2 per 100,000 people (Tsang et al., 2013)
345 cases were identified during
Median age was 75.7 years old (Baddley et al.,2011)
Arizona has the highest incidence of cases among those over the age of 65
2,752 cases 65+ years old in 2012

18. Geographic Location California (per 100,000 people)
2010: 9.0 (Hector et al., 2011)
BY COUNTY ( ; per 100,000 people)
Kern: 144.0
Kings: 68.0
Tulare: 37
Fresno: 33
Madera: 15
San Luis Obispo: 31 (Hector et al., 2011)
Figure 6: Coccidioidomycosis county-specific incidence rate ranges,
California, (Hector et al., 2011)
Figure 7: Coccidioidomycosis incidence rates,
California, (Hector et al., 2011)

19. Geographic Location Arizona (per 100,000 people)
2010:
2011: (Tsang et al., 2013)
2012: (“Valley Fever”, 2013)
BY COUNTY (2009; per 100,000 people):
Maricopa:
Pinal:
Pima: (Hector et al., 2011)
The remaining endemic states (Combined incidence rate; per 100,000 people)
-Nevada, Utah, and New Mexico-
2010: 2.1
2011: 3.1
Figure 5: Cases per 100,000 population by county, Reprinted from Valley Fever 2012 Annual Report.(2013). Retrieved from

20. Patterns of Disease
In Latin America

21. References
Laniado-Laborín, R. (2007).[Image file]. Expanding understanding of epidemiology of coccidioidomycosis in the western hemisphere. Annals of the New York Academy of Sciences, 1111,
“Life Cycles.” (n.d.) [Image file]. Retrieved from content/uploads/2012/10/Valley-fever-4.jpg
“U of A.” (n.d.). [Image file]. Retrieved from
Valley Fever 2012 Annual Report. (2013). Retrieved from