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Article: Valley Fever Phobia
Written on 1/23/2008
You have Valley Fever. You know someone who has Valley Fever. Your sister’s babysitter’s cousin has Valley Fever. It’s dangerous. It’s toxic. It’s rampant…
Or – NOT!
Valley Fever phobia is sweeping the valley. The Arizona Republic claims that “Doctors (are) not checking enough for the disease,” and urges testing for all patients who present with cough, fever and fatigue. Let’s see, that would be…um…everyone.
OK, allow me to educate you a bit about this innocuous illness. Coccidioidomycosis or Valley Fever is a disease endemic to the Sonoran Desert (Southwestern United States and Mexico.) It is caused by a fungus that lives in the soil. People can acquire it by breathing in dust contaminated with the spores. Medical statistics show that anyone who has lived in the Phoenix metropolitan area for longer than 5 years has a greater than 90% chance of having had the disease. So nearly all children who have lived in Arizona for 5 years will show lab evidence of past infection without ever knowing they were sick.
The infection usually comes with no symptoms or mild symptoms, and those symptoms usually go away without treatment. Serious infection can occur in about 2% of cases, but usually only occurs in the elderly or immunocompromised individuals.
Treatment for Valley Fever is brutal. It’s traditionally done with Amphotericin (nicknamed Amphoterrible in medical circles). It is given intravenously over several hours on a daily basis. The minimum treatment length is one month but may continue for over a year. Infusion related reactions include fever, chills, nausea, vomiting, headaches, generalized malaise, low blood pressure and heart issues, and those are just the minor ones. If you’re really unlucky, you could end up with toxicity in the kidneys, liver, blood vessels, blood cells or nervous system.
This presents a bit of a dilemma. Here’s a disease that is almost always benign and usually undetectable, with a course of treatment that is difficult and almost always toxic. If we start looking for it in everybody, we will find it, because most of us will test positive for it since we’ve likely had it at one time or another.
The Arizona Republic comes down hard on doctors and implores patients with cough, fever and fatigue to push their doctors into Valley Fever testing. That’s both ridiculous and wasteful. So unless you enjoy toxic IV therapy and want to spend the next 6 months of your life as an outpatient, I’d back off on the Valley Fever hysteria and let your doctor advise you when testing is necessary.