Coccidioidomycosis, aka Valley Fever

Transcription

1 Coccidioidomycosis, aka Valley Fever Presented to the California Partnership for the San Joaquin Valley June 15, 2018 Karen Haught, MD, MPH Public Health Officer Tulare County Public Health

2 Coccidioidomycosis is a Fungal Infection Coccidioides fungus lives in the soil As soil dries out, the fungus creates spores When air-borne spores are inhaled, they develop into spherules and infect the lungs

3 Where does Cocci occur?

4 Natural Environment of Coccidioides: Loamy Sand and Desert Soils Photo credit: Dr. Antje Lauer, Cal. State Bakersfield

5 County Specific Rates in California, 2016

6 Cocci Cases in Tulare County,

7 Symptoms of Valley Fever About 60% of infections are mild or asymptomatic About 40% of infections result in community acquired pneumonia: Cough Fever Fatigue Shortness of breath Headache Night sweats Muscle aches or joint pain Rash on upper body or legs Weight loss Symptoms may last several weeks to months James Heilman, MD

8 Complications of Valley Fever 5-10% of symptomatic patients may develop serious or long term lung problems; lung nodules are fairly common About 1% of patients may develop disseminated cocci, where the infection spreads beyond the lungs Skin Joints or bones Brain or spinal cord (meningitis)

9 Diagnosis of Valley Fever Symptoms are nonspecific so diagnostic tests are necessary X-rays can show pneumonia Serological tests are most common (testing blood for antibodies to Cocci) Cocci can also be cultured in the laboratory or identified in tissue specimens microscopically

10 Serological Tests Antibody dependent tests may be negative initially and need to be repeated after several weeks EIA Screening test Sensitive test but may have some false positives Immunodiffusion Complement fixation ( CF ) In general, high CF titers are associated with more extensive infection and rising titers with worsening disease

11 Risk Factors for Serious Disease Older adults (60 years and older) African Americns, Filipinos, and Hispanics Pregnant women Persons with diabetes Persons with conditions that weaken the immune system Cancer HIV Treatment with chemotherapy, steroids, or other immunosuppressants Organ transplant

12 California Cases by Estimated Year of Onset

13 Why Increase in ? Not well understood (did not increase in Arizona) May include: Wet spring following several years of drought Increasing non-immune populations into high risk areas Dust generating activities (solar farm installation, new construction)

14 Cases by Estimated Month of Onset 120 Tulare County Valley Fever Cases, Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Confirmed Probable Suspect

15 Reducing the Risk Avoid breathing in dirt/dust in areas where Cocci is common Cover open dirt areas around your home with ground cover (grass, rocks, bark, etc) When it is dusty outside (especially during dust storms): Stay inside and keep windows closed While driving, keep car windows closed and use recirculate option if available If you must be outdoors in dusty conditions, consider wearing an N95 mask or respiratory (must be fitted properly) When working or playing in areas with open dirt: Wet down soil before disturbing it Consider wearing an N95 mask or respirator Source: California Department of Public Health, Valley Fever Fact Sheet

16 Educational Materials Available from CDPH

17 Work-Related Prevention Materials from CDPH s Occupational Health Branch

18 Thank you!