diagnostic Valley fever often overlooked by primary care physicians

diagnostic Valley fever often overlooked by primary care physicians -

For patients with pneumonia or flu symptoms during live or have visited the west or to the southwest of the United States, particularly in Arizona and central California, experts recommend infectious disease doctors suspect the valley fever, an often overlooked fungal infection. Early diagnosis allows for better management and reduces unnecessary tests and treatment, the updated guidelines of notes issued by the Infectious Diseases Society of America (IDSA) and published in the journal Clinical Infectious Diseases.

Each year, an estimated 150,000 persons receive the infection, called coccidioidomycosis, originally dubbed fever San Joaquin Valley, and about 0 die, note the guidelines. Valley fever is endemic in desert areas from West Texas, Arizona and northern Mexico in the Central San Joaquin Valley of California, and an area in south-central Washington State . Some areas of Central and South America are home to both fungi

The fungi that cause infection -. Coccidioides immitis and Coccidioides posadasii - live in the desert floor. Fungal spores become airborne when the wind blows dust around, are easily inhaled and settle deep in the lungs, causing pneumonia, a lung infection that can range from mild to severe.

"There is an equal opportunity bug, and everyone who is exposed has the same chance of being infected," said John N. Galgiani, MD, lead author of the guidelines, professor at the University of Arizona College of Medicine and director of the Centre fever of the valley for excellence, Tucson. "in many patients, it is more debilitating than mononucleosis. These patients feel awful, they can not get out of bed or go to work and often they are sick for weeks or months. Many fear they have cancer or another disease and get a proper diagnosis puts a name to the disease and dispel this fear "

updates guidelines. - Written by a multidisciplinary committee headed by infectious disease specialists - are now much more oriented toward primary care clinicians who are usually the first to see and treat patients with pneumonia They can ignore the valley fever as a potential cause of the disease and prescribe. unnecessary tests (such as blood and imaging tests and biopsies) and therapy (such as antibiotics or steroids).

"valley fever is underdiagnosed in part because directives past were directed to the specialists, while most of these patients first see their primary care physicians, many are not aware how common this infection, "said Dr. Galgiani. "About a third of pneumonia cases in Arizona are caused by valley fever. Physicians should ask patients with pneumonia on their travel history and if they have recently traveled to endemic areas, and should take account of valley fever. "

Although 60 percent of people of valley fever have a mild infection with little or no symptoms, others may have fever, fatigue, cough, headache, chest pain, skin rashes and joint pain. in extreme cases, it can cause severe pneumonia, holes in the lungs (cavities), lung nodules, skin lesions and meningitis. pregnant women and people who are immunosuppressed (those with HIV who had a transplant organ or take medication for rheumatic diseases) or who have diabetes are at very high risk of complications.

50 to 80 percent of people who are infected do not require medication. Their immune system eventually rid their body of the infection and they will become immune to future infections. However, they may benefit from physical therapy and should be seen by a health care provider regularly for two years to ensure that their symptoms are worse, the guidelines say.

Those who need treatment should be treated with anti-fungal drugs such as fluconazole. The drug does not cure the infection, but removes the symptoms. The guidelines indicate that some patients with more severe disease, including Coccidioides meningitis, will stay on antifungal therapy for life.

guidelines recommend treatment with fluconazole for women suffering complications from valley fever who are in their second or third trimester of pregnancy. This is a change from previous guidelines (published by IDSA in 05), who recommended that pregnant women be treated with amphotericin B, which does not harm the fetus, but is very toxic to the mother and requires treatment intravenously three times per week. Fluconazole is not toxic to the mother, can be taken orally, although not recommended during the first quarter, appears safe during the second and third trimesters, the guidelines say. The infection itself is not harmful to the fetus.

The guidelines indicate valley fever can be diagnosed by simple blood tests called for enzyme immunoassays (EIA), which test for antibodies against the fungus. Because it can take weeks or months for an EIA to show a positive result, taking a sputum culture of mushroom is another option.

The guidelines include recommendations for primary care providers who can handle the mild and moderate cases of valley fever, once they have made the right diagnosis, Dr. Galgiani said. Patients with complications and more serious infections should be called infectious disease specialists.