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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, Fresh 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 thought that they had contracted it. The other forty percent accumulate symptoms ranging from unruffled to severe, including death. This emerging disease has had a titanic finish on the human and animal populations in the endemic areas. When soil containing these fungal spores is petrified 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 notable 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. 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 collected to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each produce ranges from minor to severe consequences. Most primary of all, is to know what the symptoms of Valley Fever are. There are ways to squawk 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 position. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will originate to do painful rashes and or lumps on the lower state of the legs. Symptoms that can be linked with the disease once contacted include joint swelling, joint injure, 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 ample indicator that the person has contracted the disease and should consult a doctor. Once a body is infected, Valley Fever will note 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 hazardous it can be will vary. The acute obtain is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will explain 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 get is rarer and less approved then the acute perform. It is more uncertain than the acute effect and can cause more problems. The chronic accomplish can become evident and compose 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 acquire lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural station or the dwelling between the lungs and the ribs. This can cause serious pain to the lungs and the person will have a difficult time breathing.

Other symptoms include uncouth grade fever, weight loss, and nodules in the lungs. The disseminated get is the most unsafe 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 do also accept meningitis. This execute can be very deadly as it can cause swelling around the brain and spinal cord. With this create, healthcare providers often ogle ulcers and skin lesions, painful lesions in the skull and spine or bones, and painful, swollen joints. This is a life threatening earn and can cause death if not treated correctly.

It can cause brain wound as well and can affect the brain/mental area of the person. Everyone in the world is different and so not every person is going to be infected the same design. People of different color or urge can contract the disease more readily then others of another accelerate 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 obtain 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 correct after their babies are born, are at an increased risk of getting Valley Fever.

All of these factors will design it easy for them to score the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight relieve as well causing them to accumulate worse quicker and will be more severe. Age is a sizable 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 old-fashioned immune systems are at higher risk for complications which may lead to the disseminated do. It lets the disease spread easier through out the body and lets it score into the primary systems of the body. This can design 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 unique construction or gardening, allowing one to breathe it in.

Once it gets into the lungs it sticks in the inner fragment of the lungs. There it will grow and multiply inside the lungs. Depending on what fabricate it takes it can certain up from there or release pus. This pus then can pick up absorbed into the body and stick to different types of organs. It can especially target places where it can compose up in such as joints, feet, and legs. This is because the fungi catch into the blood stream which will fetch 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 slay 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 regain 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 trim 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 invent 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 settle if there is a Valley Fever infection. Different medical professions expend different ways to resolve 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 space where disease is growing will exhibit up usually arrive 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 peep if the person is infected with the fungus and since it is more sensitive it can select 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 unprejudiced a petite below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will stare at the arm or the station 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 set will become red and swollen. Although this test is not being weak as remarkable anymore because it is not as specific, it however is broken-down in researching to understand the disease.

A more accepted 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 recognize if Valley Fever is prove. The doctor my tap on the chest or have the person inhale steam-like mist to attend cough up the sputum in order to rep 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 indicate 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 peep 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 exhibit in the body. This is the only plan to be 100% determined 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 capture care of the disease. If the spot persists or if there is a higher possibility of complications and it is in its more severe make, antifungal medications would be required to be taken. These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic manufacture or more acute acquire that won’t go away, amphotericin B is usually the medication given to befriend fight off the disease. Then the person is monitored as to do positive the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to assume care of lesions that are localized. For the disseminated execute fluconazole or itraconzole is commonly customary.

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 mature as an alternate in this state if lesions are getting worse more quick and is feeble to diffuse pneumonia. Surgery is well-known in this case and in most reports at this stage it is well-known. This is archaic to retract care of sizable abscesses, destructive lesions or bony sequestrations instability of the spine or the movement on valuable organs such as the heart or tissues such as the spine. Since this accomplish 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 accomplish it go away for worthy as relapses can occur or the person can obtain 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 resolve the longevity and affects of the person.

The short affects include flu like symptoms and will go away. It is an annoyance unprejudiced 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 distress it will do. If it is prolonged in the body for an extended time it will initiate 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 advance benefit.

If not treated, the non-acute get will worsen over time and in most cases gather into other organs of the body and construct the disseminated type. Taking care of the infection early on would be a noble strategy as Valley Fever can cause death if not treated at the lawful time. If the disease is prolonged it can cause other diseases or illnesses. These include forming pneumonia and meningitis which fabricate the condition that great more deadly and difficult to treat. As both of those diseases are fatal as well and can earn dreadful mixes with Valley Fever. Bleeding and lung abscesses could do which have to be medically treated and in some cases have to be done with surgery. Prolonged exposure can set the person at uncouth 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 awful 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 create such as short of breath to something more risky as not getting any air in and conclude 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 unsafe forms in the body. Many problems and complications would have to happen in order for it to salvage 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 prove symptoms and require exiguous to major treatment. This disease changes over longer periods of time. A person may have some time to go recognize a doctor before they feel the severity of the disease.

Though, as stated earlier, waiting for long periods of time to glance medical care would not be qualified 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 query consulting a doctor would be the best course of action so treatment can open so complications don’t arise. There are many necessary stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the boom of Valley Fever. Arguably, the role of infected persons or those that absorb a recent 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 mark 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 allotment of the Southwestern United States where soils possess the Valley Fever fungus, will contract the disease at some point. Only a miniature 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 accepted 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 search for individuals currently struggling with the disease as well as those who have recovered from a serious make of Coccidioidomycosis as a stakeholder with regards to this impart because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an trouble to better succor this claim, the lives of two patients that contracted a serious produce of the infection, will be addressed and analyzed in the following paragraphs.

Before introducing specific cases, it is essential to review some unique facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Relate in October 2008. The relate, 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 impart the research information in a thorough and comprehensive blueprint 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 reflect of this disease as a peaceful illness similar to the well-liked frigid, Valley Fever is a key instruct 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 narrate, 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 earn 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 beget of Coccidioidomycosis each year. The Arizona Department of Health Services reports that the severity of Valley Fever in the site 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 train. Examining the personal accounts of two anonymous patients afflicted with a serious produce 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 believe complete anonymity. The first case will question the inappropriate 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 primary 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 unbiased a cool or some puny 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 quandary, the damage would subside by the time Patient “V” arrived, making it difficult to diagnose the scrape. “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 cramped, dismal plot on his left lung.

The location indicated a relatively diminutive, but critical hole through the lung. The quandary 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 wound 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 fraction of his left lung was, indeed, Coccidioidomycosis. Another surgery to completely hold this section 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 distress 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 injure 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 make 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 consume 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 gradual 1995. Early symptoms experienced in this patient included chronic loss of breath and indecent joint discomfort. The manufacture 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 spacious, round nodule was located somewhere on her left lung. The patient was admitted to the hospital in 1998 and underwent a wedge resection, to seize the infected section (removed in wedge develop) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at paunchy strength for six paunchy 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 tidy the infected set 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 calm petrified to glance the total amount owed from her end 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.

Honest for room and board and a slight 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 drawl 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 set of pick.

It is primary to glimpse medical insurance companies as a stakeholder with regards to the deny 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 thought. 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 Scandalous 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 idea 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 score corpulent 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 mutter 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 yelp bankruptcy if that happened…” Patient “V” explained.

“I live in scare because I know that if I were to obtain 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 leer). 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 Novel York based foundation.

They are currently testing an anti-fungal called Nikkomycin Z, which was first venerable to prevent fungal degradation in effect. 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 abet fund pharmacology studies that will aid effect 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 direct 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 fall significantly. Debates between the government, politicians and special interest groups would decrease as well if no one were in any exact 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 bag because of the availability to a cure, and possibly insurance that covers that cure.

Major medical insurance companies like Aetna, Blue Unfriendly Blue Shield, Cigna and Humana will more freely distribute burly coverage in instances of Valley Fever. Like most vaccinations and cures to accepted infections or diseases, there would be many determined outcomes to releasing this drug into the medical market, pending the completion of all drug safety trials. As essential stakeholders with regards to the state 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 apt with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people glean a contrivance to catch health insurance coverage to some capacity. It is also significant that individuals with preexisting conditions that aren’t on group medical plans lobby for their rights to complete insurance coverage. In considering the scandalous effects of Valley Fever, there are many people who deem this topic is unbiased as primary to the animal world as well. Valley Fever does not only affect people but it is now more commonly being found in animals. Animals are unbiased as likely to come by Valley Fever as humans are.

Animals accept Valley Fever in the same diagram 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 accept sick. Some of the most well-liked 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 site where there should normally be dim patterns. The white spots display that the dog might have cancer in its lungs. The dog is only four years ancient, 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 manufacture as posthaste as it has in this golden retriever. The owner had said impartial two weeks prior to going to the vet that the dog was fleshy of energy on their vacation. The veterinarian doesn’t all the facts add up for the dog to have cancer so she decided to accelerate 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 expeditiously. The dog starts to cough, has a loss of appetite, and minute 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 positive that it must be a fungal disease and it was impartial that, it was Valley Fever (1). Dogs are the largest infected and most commonly reported animals with Valley Fever.

Dogs glean Valley Fever in the same method 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 ruin 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 raze 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 sure symptoms that become display.

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 rep 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 arrive the heart and puts pressure on the dogs windpipe which as a result irritates it (3). After the cough is reveal the loss of appetite and energy is soon to follow. If the infection is not controlled it can become powerful 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 noteworthy worse.

The symptoms that become demonstrate are: swelling of the limbs, benefit and neck distress, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, spy inflammation, and non-healing skin ulcerations (3). Not all symptoms are prove upright away and it can rob several months before positive symptoms appear. It can be several months after a cough appears that other symptoms become display. 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 decide if a dog has Valley Fever there are different test that can be done. Some of the most approved test done to choose 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 present 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 wait on 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 win 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 exiguous side effects. This is usually given to dogs that have afflict 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 exhibit the same symptoms as dogs do but it less likely for a cat to find Valley Fever than it is for a dog. Cats score Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats find the fungus their symptoms are usually a puny 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 procedure.

The same treatment for dogs can be conventional to treat cats with Valley Fever (3). Horses are another animal that have been found to score 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 novel though, and with medical technology improvement chance of survival with original medicine is powerful 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 well-liked animals to secure Valley Fever are: Monkeys, Apes, and other primates. These animals consume the same treatment process as dogs and cats but is usually consists of a lifetime treatment (3). Valley Fever is a very serious order 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 approach in technology has allowed for veterinarians to be able to detect Valley Fever at a less reach stage. The early stage that Valley Fever is caught at allows for a better chance of survival of animals infected with the fungus. 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 essential factors. Among those factors like dry climate, the modern building booms have been one of the most essential factors that have contributed to such increases. The swiftly clearing and building were a distinguished 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 important 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 beget jobs in the field of construction, ranching and agricultural work (1). The decade following the 90’s has had a broad 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 convey. 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 residence to purposely slice 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 well-behaved (3).

This implies its commitment and dedication to monitoring and posing regulations for anything threatening the quality of the air. The EPA has dwelling limits on how great pollution is allowed to be in the air. In its goal to gain 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 primary legislation is the Well-kept Air Act which has been passed to enforce smart air standards and improve human health. The Smart Air Act is an outline for what national, site, and local authorities must follow in order to protect air quality. Under the Natty Air Act, local and plot 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 famous 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 occupy 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 advance attainment for particulate pollution and thus is under federal orders to gash particulate matter pollution. In an attempt to address the insist, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a notion to the EPA to present how the county plans to sever PM emissions by five percent each year until fine levels are reached. The Five Percent Notion outlined more than 50 commitments to cleave 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 gain within superb dust standards. As portion of the compliance, Maricopa County has devised that all sites with terrorized 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 support enforce well-behaved 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 belief to conduct activities any that will disturb a surface state equal to or greater than 0. 1 acre. Complying with the construction permit requirements is often a critical and daunting task. Before applying for a permit, a belief that outlines the measures that will prevent the creation of dust must be presented. This notion 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 plot being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on place understand their responsibility while on position (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 Idea must preserve a written log recording the exact application and execution of the control measures previously outlined and accepted by the Dust Control Idea. 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 part of characterize keeping is the trackout conditions. This rule also requires that all work sites that are more than two acres and possess alarmed 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 itsy-bitsy to 25 cumulative linear feet (6). Rule310 is an extensive and overwhelming spot of requirements established to lower dust emissions.

Fraction 309 list another requirement under Rule310 that companies must abide by. The rule says that if the area of interest is more than one acre a series of dust control training must remove spot. All workers directly keen in the containment of dust like the water truck drivers and water pull drivers must lift a basic dust control training class in which attendees will ultimately become certified if successfully completed the training class. An extension from this fragment lists that a dust control coordinator must be show on job position 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 satisfactory training on regulating emission of fugitive dust and learn practical methods to do so, such as well-kept up, water and dust suppressant applications (6). Construction companies are required by station and federal law to implement a diligent worry 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 quandary 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 positive by the severity of the violation committed. Several factors are primitive to calculate the amount of a penalty. In case there has been an economic wait on 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 serene (9). In the month of September, the amount of $471,613.

30 was smooth in violations all related in one method or another to air quality control. This is the pain construction company’s face for not correctly using effective measures to slash dust in the construction sites, therefore causing potential problems to approach residents and workplaces, eventually becoming a financial predicament due to fines. There is no better plot 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 expansive construction company that has a corporate office in Tempe, AZ. With a put a question to to squawk 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 positive unprejudiced how noteworthy companies who are in the construction industry are affected by laws to aid slice 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 worry for the county is dust control. As a result for the growing pain 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 expend 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 broken-down to beget fugitive dust. If they ever do not comply with these regulations, fines originate 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 relieve possess 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 prick dust in the construction sites, enormous fines will follow. This is yet another stammer companies are dealing with. To the load even greater, these companies also deal with the economical residence 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 effect to Valley Fever is not underestimated. As a result, strict regulations are followed and posed upon companies to gash the incidence of Valley Fever cases. Valley Fever has approach to cost companies thousands of dollars and is becoming every day more of an anxiety. After studying the stakeholders enthusiastic in Valley Fever, it is easy to ogle popular themes between them.

There is no doubt that while not known as a unsafe disease, Valley Fever has the potential to be one. With the number of cases increasing each year and relatively diminutive 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 take areas of the United States, it poses a threat to people throughout the country due to the increasing popularity of visiting and piquant 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 certain that because of this, action must be taken in order to crop the number of cases and to decrease the severity of the cases. This case watch points to a few relatively easy steps to rob in order to decrease the severity of Valley Fever cases. The most critical and most certain 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 eager in prolonged disease available to both the medical community and the population of endemic areas. This in theory would invent an awareness of the disease and befriend earlier testing for it. There are a few steps that can be taken in order to carve the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also succor slash 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 survey it is clear that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the space in some circumstances. These high costs are unacceptable when relatively puny investment is being made in the research of a cure or vaccination. When considering these recommendations, it is principal to review the facts about this disease. Valley Fever is caused by the spores of a fungus that can become airborne when soil is alarmed. This fungus is endemic to mountainous portions of the American southwest including Phoenix, Arizona, the nation’s fifth largest city. Statistically, anyone living in endemic areas is likely to collect 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 certain that Valley Fever has had a well-known impact on our society and that steps need to be taken to cleave its prevalence. (1) Chuang, Amy. “Disseminated Coccidioidomycosis in an Immunocompetent Person Living in Current York City”. Journal of Urban Health: Bulletin of the Unique York Academy of Medicine, Vol. 82, No. 2, doi:10. 1093/jurban/jti057 (1) Arizona Department of Health Services.

(2008). Valley Fever Annual Narrate 2007 (1st ed. ). Phoenix, AZ: Arizona Department of Health Services, Division of Public Health Services. (4) The Associated Press (2007, January 11). Ariz. Valley Fever Cases Soared in 2006. The Washington Post.

All Pages. (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 (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/ (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. , 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 Idea For PM-10 For The Maricopa County Nonattainment Residence. December 2007. Maricopa Association of Governments. < (www.

mag. maricopa.gov)> (2) Maricopa County Air Quality Department. “Air Quality Violators pay over $452K in October”. November 3, 2008. News. Valley Fever is the approved 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, Unique 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 concept that they had contracted it. The other forty percent salvage symptoms ranging from aloof to severe, including death. This emerging disease has had a big achieve on the human and animal populations in the endemic areas. When soil containing these fungal spores is shy 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 new years, cases in prisoners at a California Central Valley correctional have reached as high as 1 inmate in every 10 tested (4).

The considerable 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. 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 pick up unexcited to severe symptoms. The disease can manifest in three different types of forms; acute, chronic, or disseminated. Each obtain ranges from minor to severe consequences.

Most notable of all, is to know what the symptoms of Valley Fever are. There are ways to train 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 area. Those symptoms appear any where from 10-30 days after exposure to the spores. After one or two weeks some people will launch to design 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 wound, arthritis, ankle, feet, leg swelling. All of theses symptoms may not accrue in everyone and can vary from level-headed in some people to severe in others. Showing more then one of these symptoms should be a marvelous 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 design that Valley Fever takes, the severity of the effects on the body and how perilous it can be will vary. The acute execute is rare and about 3% of the people that live in places with coccidiomycosis found in the dirt, will indicate 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 fade like the body has caught the flu. Chronic manufacture is rarer and less current then the acute accomplish. It is more risky than the acute make and can cause more problems. The chronic fabricate can become evident and accomplish 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 execute lung abscesses. These abscesses can pop and erupt, releasing pus into the lungs. This pus then travels to the pleural spot 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 rude grade fever, weight loss, and nodules in the lungs. The disseminated manufacture is the most hazardous 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 construct also score meningitis. This get can be very deadly as it can cause swelling around the brain and spinal cord. With this execute, 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 acquire and can cause death if not treated correctly. It can cause brain wound as well and can affect the brain/mental position of the person. Everyone in the world is different and so not every person is going to be infected the same plan. People of different color or urge 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 bag 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 correct after their babies are born, are at an increased risk of getting Valley Fever. All of these factors will execute it easy for them to obtain the disease because their bodies can’t resist the initial infection. As well as with the lower immunity’s the body can’t fight assist as well causing them to derive worse quicker and will be more severe. Age is a huge 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 extinct immune systems are at higher risk for complications which may lead to the disseminated make. It lets the disease spread easier through out the body and lets it score into the critical systems of the body. This can fabricate 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 novel construction or gardening, allowing one to breathe it in. Once it gets into the lungs it sticks in the inner fraction of the lungs. There it will grow and multiply inside the lungs. Depending on what originate it takes it can sure up from there or release pus.

This pus then can fetch absorbed into the body and stick to different types of organs. It can especially target places where it can execute 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 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 gather 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 spruce 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 originate 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 decide if there is a Valley Fever infection. Different medical professions utilize different ways to decide 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 location where disease is growing will exhibit 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 behold if the person is infected with the fungus and since it is more sensitive it can rob 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 unbiased a cramped below the skin, preferably in the forearm similar to a TB (PPD) test. Then the doctor will inspect at the arm or the state 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 space will become red and swollen. Although this test is not being archaic as great anymore because it is not as specific, it however is extinct 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 observe if Valley Fever is prove. The doctor my tap on the chest or have the person inhale steam-like mist to support cough up the sputum in order to accept 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 demonstrate 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 peek 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 expend in determining more accurately if the disease is explain in the body. This is the only arrangement 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. Current 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 hold care of the disease. If the scrape persists or if there is a higher possibility of complications and it is in its more severe accomplish, antifungal medications would be required to be taken.

These medications would include amphotericin B, ketoconazole, fluconazole, or itraconazole. In a chronic create or more acute earn that won’t go away, amphotericin B is usually the medication given to succor fight off the disease. Then the person is monitored as to construct determined the condition does not worsen which might last from a couple months to a year. Surgical action may be an option to acquire care of lesions that are localized. For the disseminated make fluconazole or itraconzole is commonly outmoded. 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 extinct as an alternate in this position if lesions are getting worse more lickety-split and is stale to diffuse pneumonia. Surgery is principal in this case and in most reports at this stage it is significant.

This is weak to catch care of substantial abscesses, destructive lesions or bony sequestrations instability of the spine or the movement on vital organs such as the heart or tissues such as the spine. Since this invent 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 execute it go away for edifying as relapses can occur or the person can glean 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 fair 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 distress it will do. If it is prolonged in the body for an extended time it will begin 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 conclude 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 assist. If not treated, the non-acute accomplish will worsen over time and in most cases gather into other organs of the body and fabricate 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 lawful time. If the disease is prolonged it can cause other diseases or illnesses.

These include forming pneumonia and meningitis which manufacture the condition that mighty more deadly and difficult to treat. As both of those diseases are fatal as well and can design awful 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 assign the person at coarse 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 fetch 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 execute such as short of breath to something more perilous 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 perilous forms in the body.

Many problems and complications would have to happen in order for it to bag 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 explain symptoms and require limited to major treatment. This disease changes over longer periods of time. A person may have some time to go seek a doctor before they feel the severity of the disease. Though, as stated earlier, waiting for long periods of time to look medical care would not be excellent 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 stop with them for years at a time or even there entire life.

This is something that if in expect consulting a doctor would be the best course of action so treatment can launch so complications don’t arise. There are many vital stakeholders that would be affected, at least in some capacity, if an executive decision were to be made with regards to the enlighten of Valley Fever. Arguably, the role of infected persons or those that absorb 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 stamp 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 bear the Valley Fever fungus, will contract the disease at some point. Only a runt percentage of people, however, are diagnosed with a severe enough invent of the infection where medical treatment is needed.

Anti-fungal medication is the most accepted 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 famous to notice individuals currently struggling with the disease as well as those who have recovered from a serious earn of Coccidioidomycosis as a stakeholder with regards to this bid because there exist many factors that affect the lifestyles of those individuals, their families and their friends. In an distress to better help this claim, the lives of two patients that contracted a serious do of the infection, will be addressed and analyzed in the following paragraphs. Before introducing specific cases, it is well-known to review some unusual facts and figures with regards to the disease. The Arizona Department of Health Services released their annual Valley Fever Characterize in October 2008. The represent, 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 stutter the research information in a thorough and comprehensive method 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 collected illness similar to the approved cool, Valley Fever is a key express 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 do 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 invent 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 suppose. Examining the personal accounts of two anonymous patients afflicted with a serious construct 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 have complete anonymity. The first case will put a question to the contaminated 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 indispensable like most other sufferers settle to do.

“At first, I noticed that my lymph nodes in my neck were unusually swollen…I figured it was unbiased a wintry or some miniature infection or something like that. ” Soon after the initial stages of the disease, Patient “V” began experiencing constant, severe harm in the left side of his chest. Although he made numerous medical appointments for this spot, the afflict 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 microscopic, dim area on his left lung. The set indicated a relatively runt, but famous hole through the lung. The predicament 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 fragment of his left lung was, indeed, Coccidioidomycosis. Another surgery to completely retract this fragment 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 harm 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 hurt 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 accomplish 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 favorite drug distributed to sufferers of the infection. Patient “V” was required to capture 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 behind 1995. Early symptoms experienced in this patient included chronic loss of breath and grievous 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 stout, round nodule was located somewhere on her left lung. The patient was admitted to the hospital in 1998 and underwent a wedge resection, to win the infected portion (removed in wedge develop) of the lung. After the first surgery, Patient “F” was prescribed anti-fungal medication similar to Diflucan at pudgy strength for six chubby 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 neat the infected space 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 cramped out-of-pocket costs through United American. However, she was calm shy to gape the total amount owed from her pause 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 wonderful. Objective for room and board and a petite 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 lisp of Valley Fever.

“Educate physicians on the east soar and west flit, 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 set of occupy. It is notable to perceive medical insurance companies as a stakeholder with regards to the content 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 notion.

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 Infamous 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 current belief 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 procure 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 affirm 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 bellow bankruptcy if that happened…” Patient “V” explained. “I live in scare because I know that if I were to net 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 see). 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 place 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 Current York based foundation. They are currently testing an anti-fungal called Nikkomycin Z, which was first veteran to prevent fungal degradation in do. 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 support 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 deliver 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 descend 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 find because of the availability to a cure, and possibly insurance that covers that cure. Major medical insurance companies like Aetna, Blue Contaminated Blue Shield, Cigna and Humana will more freely distribute fat coverage in instances of Valley Fever. Like most vaccinations and cures to celebrated infections or diseases, there would be many distinct outcomes to releasing this drug into the medical market, pending the completion of all drug safety trials. As critical stakeholders with regards to the negate 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 generous with regards to a feasible solution to the Coccidioidomycosis fungus, it is imperative that all people bag a device to derive health insurance coverage to some capacity. It is also principal that individuals with preexisting conditions that aren’t on group medical plans lobby for their rights to complete insurance coverage. In considering the inferior effects of Valley Fever, there are many people who deem this topic is unprejudiced as notable to the animal world as well. Valley Fever does not only affect people but it is now more commonly being found in animals. Animals are honest as likely to regain Valley Fever as humans are. Animals gain Valley Fever in the same design 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 accumulate sick.

Some of the most approved 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 dismal patterns. The white spots present that the dog might have cancer in its lungs. The dog is only four years broken-down, 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 perform as hastily as it has in this golden retriever. The owner had said objective two weeks prior to going to the vet that the dog was fleshy of energy on their vacation. The veterinarian doesn’t all the facts add up for the dog to have cancer so she decided to speed 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 rapidly. The dog starts to cough, has a loss of appetite, and itsy-bitsy 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 sure 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 come by Valley Fever in the same diagram 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 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 destroy off the infection and the infection continues to spread into the lungs and then can go throughout the dog’s body (3). Once a dog is infected with Valley Fever, there are clear symptoms that become show. 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 secure 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 come the heart and puts pressure on the dogs windpipe which as a result irritates it (3). After the cough is indicate the loss of appetite and energy is soon to follow. If the infection is not controlled it can become noteworthy 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 considerable worse. The symptoms that become expose are: swelling of the limbs, attend and neck afflict, seizures, soft swelling under the skin that resembles abscesses, swollen lymph nodes, view inflammation, and non-healing skin ulcerations (3). Not all symptoms are demonstrate true away and it can acquire several months before sure symptoms appear. It can be several months after a cough appears that other symptoms become display.

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 reveal 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 wait on 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 occupy 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 puny side effects. This is usually given to dogs that have distress 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 demonstrate the same symptoms as dogs do but it less likely for a cat to derive Valley Fever than it is for a dog. Cats acquire Valley Fever about every 1 case compared to 50 cases in dogs (3). When cats derive the fungus their symptoms are usually a cramped 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 contrivance. The same treatment for dogs can be frail to treat cats with Valley Fever (3). Horses are another animal that have been found to secure 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 new though, and with medical technology improvement chance of survival with recent medicine is considerable 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 accepted animals to find Valley Fever are: Monkeys, Apes, and other primates. These animals employ the same treatment process as dogs and cats but is usually consists of a lifetime treatment (3). Valley Fever is a very serious deny 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 reach 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. 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 trusty 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 necessary factors. Among those factors like dry climate, the modern building booms have been one of the most considerable factors that have contributed to such increases. The rapid 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 vital 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 compose jobs in the field of construction, ranching and agricultural work (1). The decade following the 90’s has had a immense 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 speak. 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 plot to purposely slit 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 honorable (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 mighty pollution is allowed to be in the air. In its goal to beget 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 principal legislation is the Neat Air Act which has been passed to enforce well-kept air standards and improve human health. The Orderly Air Act is an outline for what national, spot, and local authorities must follow in order to protect air quality. Under the Smart Air Act, local and position 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 well-known to know Maricopa County has 24 air monitoring sites in the Valley.

The plot of Arizona, under the Arizona department of environmental quality has its maintain 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 advance attainment for particulate pollution and thus is under federal orders to prick particulate matter pollution. In an attempt to address the boom, Maricopa County, the Maricopa Association of Governments (MAG) and local cities and towns submitted a thought to the EPA to exhibit how the county plans to slash PM emissions by five percent each year until proper levels are reached. The Five Percent Opinion outlined more than 50 commitments to gash 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 friendly dust standards. As fragment of the compliance, Maricopa County has devised that all sites with haunted 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 benefit enforce first-rate 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 concept to conduct activities any that will disturb a surface space equal to or greater than 0. 1 acre. Complying with the construction permit requirements is often a indispensable and daunting task.

Before applying for a permit, a opinion that outlines the measures that will prevent the creation of dust must be presented. This idea 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 map being the first of many that have been imposed on construction companies, entitles that all workers or subcontractors on location 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 View must withhold a written log recording the right application and execution of the control measures previously outlined and celebrated by the Dust Control Notion. 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 portion of picture keeping is the trackout conditions.

This rule also requires that all work sites that are more than two acres and own haunted surfaces must install a trackout control devise. These devises are immense 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 cramped to 25 cumulative linear feet (6). Rule310 is an extensive and overwhelming location of requirements established to lower dust emissions. Fragment 309 list another requirement under Rule310 that companies must abide by. The rule says that if the region of interest is more than one acre a series of dust control training must rob dwelling. All workers directly interested in the containment of dust like the water truck drivers and water pull drivers must retract a basic dust control training class in which attendees will ultimately become certified if successfully completed the training class.

An extension from this fraction lists that a dust control coordinator must be point to on job place if the dimension of the job situation is five acres and up (5). These onsite coordinators must have completed a comprehensive dust control training in which they are given generous training on regulating emission of fugitive dust and learn practical methods to do so, such as trim up, water and dust suppressant applications (6). Construction companies are required by location and federal law to implement a diligent inconvenience 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 scrape 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 venerable 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 aloof in violations all related in one procedure or another to air quality control. This is the disaster construction company’s face for not correctly using effective measures to slash dust in the construction sites, therefore causing potential problems to advance residents and workplaces, eventually becoming a financial predicament 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 large construction company that has a corporate office in Tempe, AZ. With a quiz to say 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 determined fair how remarkable companies who are in the construction industry are affected by laws to succor slice 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 wretchedness for the county is dust control. As a result for the growing danger 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 exercise 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 ancient to maintain fugitive dust. If they ever do not comply with these regulations, fines begin 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 quandary 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 enjoy 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 sever dust in the construction sites, titanic fines will follow. This is yet another yell companies are dealing with. To the load even greater, these companies also deal with the economical position backs from following these regulations.

For companies to crop and comply with county regulation, thousands of dollars are being forcefully spent by such companies. The contributions construction companies execute 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 approach to cost companies thousands of dollars and is becoming every day more of an worry. After studying the stakeholders enthusiastic in Valley Fever, it is easy to eye popular themes between them. There is no doubt that while not known as a hazardous disease, Valley Fever has the potential to be one. With the number of cases increasing each year and relatively dinky 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 piquant 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 clear that because of this, action must be taken in order to sever the number of cases and to decrease the severity of the cases. This case peep points to a few relatively easy steps to lift in order to decrease the severity of Valley Fever cases. The most principal and most certain 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 eager in prolonged disease available to both the medical community and the population of endemic areas.

This in theory would fabricate an awareness of the disease and aid earlier testing for it. There are a few steps that can be taken in order to sever the number of cases of Valley Fever. As well as promoting early detection, public awareness of the disease could also befriend gash the number of cases. Public awareness of Valley Fever would prick 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 discover it is determined that contracting this disease could potentially be very costly. The financial burden will then be on either the infected individual themselves or on the situation in some circumstances. These high costs are unacceptable when relatively slight 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 tremulous. This fungus is endemic to enormous portions of the American southwest including Phoenix, Arizona, the nation’s fifth largest city. Statistically, anyone living in endemic areas is likely to catch this disease at least once in their lifetime. On top of those living in endemic areas, those visiting the set 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 considerable impact on our society and that steps need to be taken to slash its prevalence. (1) Chuang, Amy.

“Disseminated Coccidioidomycosis in an Immunocompetent Person Living in Unusual York City”. Journal of Urban Health: Bulletin of the Recent York Academy of Medicine, Vol. 82, No. 2, doi:10. 1093/jurban/jti057 (1) Arizona Department of Health Services. (2008). Valley Fever Annual Record 2007 (1st ed. ).

Phoenix, AZ: Arizona Department of Health Services, Division of Public Health Services. (4) The Associated Press (2007, January 11). Ariz. Valley Fever Cases Soared in 2006. The Washington Post. All Pages. (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 (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/ (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. , 2005. 1 June. (3) U.S Environmental Protection Agency. The neat 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 Place. December 2007. Maricopa Association of Governments. < (www. mag.