Arizona Congressmen Look for Suggestions, Solutions to Diagnosing and Treating Valley Fever

Two Arizona congressmen hosted a Valley Fever (coccidioidomycosis) roundtable Wednesday, Aug. 21, at the University of Arizona College of Medicine – Phoenix to gather updated information on the fungal infection from physicians, scientists, health care advocates and survivors.

U.S. Reps. David Schweikert and Greg Stanton are co-sponsoring a bipartisan bill that would address short-, medium- and long-term objectives that range from supporting basic research for Valley Fever and other fungal diseases, streamlining the U.S. Food and Drug Administration approval process for new anti-fungal diagnostics and treatments, and promoting development of a Valley Fever vaccine.

Reported cases of Valley Fever in Arizona are on the rise, with the state Department of Health Services reporting 6,200 cases so far this year. That’s a nearly 20 percent increase for the same period last year and 75 percent higher than in 2017. The fungi that cause Valley Fever thrive in southern Arizona, Nevada and California’s San Joaquin Valley.

The congressmen convened the session to learn from experts and patients about the infection, which is often first diagnosed as the flu or pneumonia. Other issues for patients are the side effects of common antifungal drugs such as fluconazole and itraconazole.

Ken Knox, MD, a pulmonologist and associate dean of Faculty Affairs and Career Development at the College of Medicine – Phoenix, joined Stephen Johnson, PhD, director for the Center for Innovations in Medicine at the Biodesign Institute at Arizona State University, as medical experts at the roundtable.

Some of the discussion centered on the acute diagnosis and treatment of the illness, with patients weighing in on how long it took for their physicians to determine that they were suffering from Valley Fever instead of the flu, pneumonia or lung cancer.

“Most of the people who have had pneumonia often have a scar, or a nodule, on their lung, and those nodules look for all the world like a cancer on a chest X-ray,” Dr. Knox said. “In my clinic, not a day goes by where we’re not looking at a nodule on a CT scan and wondering if it’s cancer. The patient often ends up with a biopsy or surgery, and we have to grapple with that.”

Dr. Knox suggested that a reliable diagnostic test for Valley Fever would greatly assist physicians in being able to treat the fungal infection with speed and accuracy.

Rep. Schweikert asked for clarification on disseminated coccidioidomycosis, when the fungal infection goes beyond the lungs and affects other parts of the body.

Many cases resemble pneumonia, Dr. Knox said. But when “the lung environment doesn’t control the infection, it can escape and pretty much go anywhere.”

He said the most common places for the infection to show up are in bones or as meningitis.

“We don’t know why certain people get disseminated disease as opposed to just pneumonia,” Dr. Knox said. “Five to ten percent will get the disseminated disease or meningitis for no apparent reason. Also, patients are at a greater risk if they are immunosuppressed.”

Another area of concern for the congressmen and patients was the difficulty many patients had tolerating medications used to treat Valley Fever.

Felipe Gutierrez, MD, an infectious disease specialist with the Phoenix VA Medical Center, said while the medications are difficult to tolerate, they are key to recovery.

“There are good guidelines from our infectious disease societies and the American Thoracic Society that we follow,” Dr. Knox said. “For healthy people, six months would be a normal course of anti-fungal therapy. But in people where it’s unclear if their immune system is suppressed, stopping the medication is always difficult. Patients with disseminated disease may need lifelong therapy.”

The Finding Orphan disease Remedies with Antifungal Research and Development (FORWARD) Act was introduced in the U.S. House of Representatives in May and, in addition to Congressmen Schweikert and Stanton, is sponsored by Reps. Kevin McCarthy and Karen Bass, both from California.

Photos from the event