Coccidiomycosis, otherwise known as valley fever, has made a dramatic recurrence in the United States—especially in southwestern states such as Arizona and California.
Valley fever is a fungal infection caused by direct inhalation of spores which are found in the soil from these areas. Most common for those between the ages of 25 and 55, the disease has dramatically increased in incidence over the last few years.
When soil in a given area is either kicked up by new construction, digging, or farming, or when strong winds disturb the terrain, spores become airborne and are capable of being directly inhaled. This is true whether for residents, visitors or even those just passing through the area.
Most people who come in contact with coccidiomycosis have no discernible symptoms, but up to 40 percent may be affected. The incubation period is rather long (between 10 and 30 days) and most often manifests as a respiratory illness that can include fever, chills or flu-like symptoms. Pulmonary disease may follow in about 5 percent of cases.
While most affected will explain away transient findings as a cold or flu, persistent fever, cough, chest discomfort and fatigue are signs that the individual should seek medical attention. Skin lesions, meningitis or infection in the bones may also be found.
Diagnosing valley fever infection usually comes with a high index of suspicion—those living in an endemic area or working in occupations that have dust or dirt exposure, older people who are more immunocompromised, or those who develop progressive signs and symptoms of respiratory illness traceable to a stay in such an affected area.
Testing for coccidiomycosis involves directed blood testing. Serologic testing helps to determine both diagnosis and long term prognosis. Immunodiffusion tests help check antibodies against the disease, and culture and histopathology also help; however, as mentioned earlier, the key is having a high index of suspicion for the illness. X-ray findings may show patchy, nodular pulmonary haziness and thin walled cavities but, again, these findings aren’t specific to valley fever, and diagnosis must be confirmed by other means.
Those who have mild disease may not need anything more than supportive treatment—eventually the body develops antibodies through its own immune system and reinfection becomes unlikely. However, more serious disease requires strong antifungal medication that may need to be administered intravenously. When serious, it may require up to six months of continuous therapy. Those who develop persistent pulmonary cavities, pus, or blood within the lungs have a poorer prognosis, as do those where extension into the nervous system (meningitis) occurs. Thankfully, most infected people are asymptomatic and treatment isn’t required. An x-ray may find evidence of old exposure.
In the absence of any current or systemic disease, the prognosis is excellent and best class insurance is available.
When the disease becomes systemic or requires prolonged therapy, postponement is generally the rule. As time progresses without evidence of acute infection and with normal pulmonary testing and blood test findings, the most favorable underwriting applies.
Robert Goldstone, MD, FACE, FLMI
MD, FACE, FLMI, board certified internist and endocrinologist, was most recently vice president and chief medical officer for Pacific Life and Pacific Life and Annuity. He has extensive brokerage and life insurance experience, having been medical director at both MetLife Brokerage and Transamerica Occidental Life. Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World since 1991. Goldstone does consulting full or part-time as well as on a fill-in basis for companies who need a medical director/physician. He can be reached by telephone at 949-943-2310. Emaill: firstname.lastname@example.org.