As temperatures cool, the flu season starts in Arizona. It’s also the height of Valley Fever season, with 65 percent of all cases nationwide happening in Arizona. Jessica Rigler, Chief of the Bureau of Epidemiology and Disease Control for the Arizona Department of Health Services, will discuss Valley Fever.
Ted Simons: 'Tis the season for valley fever, an often misunderstood lung disease that can be confused with other illnesses and conditions. November is when valley fever cases seem to spike here in Arizona, and joining us with more is Jessica Rigler, chief of the bureau of epidemiology and disease control for the Arizona department 6 health services, which put out a report on valley fever. Good to see you again, and thanks for joining us.
Jessica Rigler: Thank you for having me.
Ted Simons: Let's do some basics here first. What is valley fever?
Jessica Rigler: It is the diseased that is caused by inhaling fungal spores from the soil. It can cause things like cough, tiredness, headaches.
Ted Simons: Are there symptoms that -- I mean, cough, tiredness and headaches can be a variety of things. Talk about the symptoms and the diagnosis. It's difficult.
Jessica Rigler: Valley fever is an interesting disease because about 60% of the people sick with it don't realize it. They will never go to the doctor and get diagnosed. It's the other 40% that we really see the severe symptoms where they are feeling flu-like, where they are fatigued, and they have the cough and the fever. And in those, they go to the doctor and have blood drawn, and you test that blood.
Ted Simons: Now, is that blood test definitive, though? I have heard sometimes there is a false positive, or a false negative, or how does that work?
Jessica Rigler: There is a number of kinds of tests, and some of them are better than others. There is no good gold standard out there where we can say for sure this is what you have, but the valley fever, unlike flu, which will resolve in a week or two, it is going to last for longer than that, and so that's one indicator that may be this is not the flu. It's valley fever.
Ted Simons: And is there a lung infection? I know that, that the x-rays are involved, as well, correct?
Jessica Rigler: That's true, so in most cases, that are exhibiting symptoms, it does prevent lung, as lung infection. You can see pneumonia or other kinds of coughs. In 5ers approximate of the cases we see disseminated disease, and we can see bone or joint infection.
Ted Simons: So, this is again, I have heard, nodules on the lung can appear? And that can that can be confused with very serious stuff.
Jessica Rigler: It's true, sometimes valley fever is confused with cancer or with tuberculosis, so that's one of the things that we see, there is often a very long time between the time someone starts feeling and I can and the time that they are diagnosed. Up to two months.
Ted Simons: To two, so you would not know is it if you are out in the dust storm or could you be passing through town with the window open?
Jessica Rigler: Anything is possible here. We know that, that the valley fever is caused by inhaling these fungal spores. But, we're still really looking into what that means, if people are sick more when there is dust storms, or we're seeing increases in cases because of an increased population migration to Arizona, or some folks that work in construction or archaeological digs, we have seen higher incidents.
Ted Simons: Are they people that just moved here?
Jessica Rigler: It depends, we see a high incidence of cases in the elderly so we can look at snowbirds, as a source here, or not a source but folks that are getting the disease. It's possible people who lived here a long time have had the disease, and didn't realize it and had no symptoms.
Ted Simons: How about someone who lived here for 20, 30 years, can they just all of a sudden get it?
Jessica Rigler: It's possible. I always wonder, I'm an Arizona native, if I have had it before or going to get it, and you just don't know.
Ted Simons: And you don't know. There is no -- you cannot do a blood test to find resistance or exposure in the past.
Jessica Rigler: There are tests to do to determine past exposure but the problem with knows tests, sometimes you find things that you might not want to find. You may think maybe you are infected and then you get treated for something when you don't have any symptoms. The treatment for this is nasty.
Ted Simons: Describe it.
Jessica Rigler: So, lots of people recover on their own without treatment, which is why, you know, you don't necessarily want to just go looking for things, if you are not feeling sick, but if you are feeling sick, there are saint fungals you can be treated with fending on your doctor. Those have side effects like nausea or vomiting or loss of appetite.
Ted Simons: Pills or shots?
Jessica Rigler: They are usually pills.
Ted Simons: But with bad side effects?
Jessica Rigler: Right.
Ted Simons: You mentioned that it can spread in certain ways and become more than just a lung disease. Talk about it. You can get a pretty severe reaction here to the valley fever, can't you?
Jessica Rigler: That's correct. We see some tragic cases. Folks get what we call disseminated diseases. It spreads outside of the lungs, and can cause brain inflammation or meningitis and death in some cases.
Ted Simons: It can develop into a chronic condition?
Jessica Rigler: It can. We have seen, especially disseminated diseases where it gets into the bone, folks have chronic coxy, people will be having multiple surgeries.
Ted Simons: And it goes on and on. Are some more genetically susceptible to this?
Jessica Rigler: What we found is that folks that are male, African-American or Filipino or have immunocompromising conditions or are pregnant are more likely to experience disseminated disease, so the more severe forms.
Ted Simons: But faster the catching of valley fever, there is really no genetic research as of yet?
Jessica Rigler: Not that we found that hits young and old and male and female.
Ted Simons: Just being outside, when you should not be, in a dust storm or as you mentioned, rolling the window down if you are going to catch it, you are going to catch it.
Jessica Rigler: You want to avoid exposure to dust, so if you are outside gardening, wet it down so it's not blowing up in your face, and it lives in the top two to eight inches of the soil here. So, if you are digging deep, it is not as big of a problem.
Ted Simons: The backyard is not the desert.
Jessica Rigler: It has the desert soil, though, from here in Arizona.
Ted Simons: It always blows in and settles in?
Jessica Rigler: Right.
Ted Simons: So you are messing around in your backyard and you have lawn and all sorts of things, and you can catch it?
Jessica Rigler: That's true. I think the most important point is if you are having a cough or a fever, feeling tired, go to your doctor and ask about valley fever testing. We know that folks that know more about it are more likely to be tested and, and receive stream.
Ted Simons: Why is this the peak season for valley fever?
Jessica Rigler: You know, it's, actually, a misnomer so we see a lot of cases reported between June and August and November and December. But, like I said, it can take, you know, two months for a case to be diagnosed. So, it's potentially, potential that the folks have been exposed six months ago because it took them a month to develop symptoms.
Ted Simons: So interesting so basically, the low time is January, December, because you are passed the exposure time, and we have not hit the dust storm season yet.
Jessica Rigler: It's hard to say when people are getting it, because it can look like so many other things, but people think that they have something else before they diagnosed it.
Ted Simons: Are more getting it because of better diagnosis, more knowledge about this. Did people just sit there and take it, and now they are getting treatment?
Jessica Rigler: We would like to think so. We have seen a doubling in rates over the last decade, and I think a lot of that is because physicians are more educated about testing for the disease, and then our public here in Arizona know that's something that they may have. They are asking their doctors for testing.
Ted Simons: And as far as travel is concerned, and Arizona is, is a focal point but, around the southwest, Mexico, what are you seeing out there?
Jessica Rigler: Arizona gets about 66% of the reported cases in the whole nation of valley fever. We do know in southern California, there is cases, also in Mexico, and a bit in New Mexico and Texas. Arizona is one of the primary places where folks are getting valley fever.
Ted Simons: Is it the same kind of valley fever? Are there different kinds? Not that we know of. To our knowledge, it's all the same kind. So you could be in the san Joaqin valley getting the same fever as in west Texas.
Jessica Rigler: Yes.
Ted Simons: Who knew the dust blew that far. So you are a patient, watching in and concerned, what do you ask your doctor?
Jessica Rigler: I think you ask the doctor, what do you think? Do you think that maybe my symptoms are compatible with valley fever? It's a simple blood test, so if you are ok giving blood, they can send it off to the lab.
Ted Simons: And just how long of a wait to find out if that's --
Jessica Rigler: It depends on the lab running the specimen. It should not be more than a couple days.
Ted Simons: Last question here, as far as the research into the valley fever, what more needs to be done, what do you think -- what research do you think still needs to be done or should be done regarding valley fever?
Jessica Rigler: We have really great partners at the University of Arizona's valley fever center for excellence, as well as our local health departments, so they are looking more into what are the triggers for causing disease, if it is dust storms, that there is something else, and they are exploring treatment options and vaccine options for valley fever, since it is so hard to prevent.
Ted Simons: So the research goes on because as we mentioned, this is often either misunderstood, misdiagnosed, undiagnosed.
Jessica Rigler: Correct. And that's being worked on as we speak.
Ted Simons: Very good. Thank you very much for joining us. We appreciate it.
Jessica Rigler: Thanks for having me, Ted.
Jessica Rigler:Chief, Bureau of Epidemiology and Disease Control for Arizona Department of Health Services;