Horizon, Host: Ted Simons

October 29, 2009


Host: Richard Ruelas

Valley Fever


  • Dr. John Galgiani, Director of the University of Arizona’s Valley Fever Center for Excellence, talks about efforts to treat and prevent this growing disease in Maricopa County and the desert Southwest. Learn how you can help fight the disease during events planned for Valley Fever Awareness Week in early November.
    Related Links:
    Valley Fever Center for Excellence
    Walk for Valley Fever (November 1, 2009)
Guests:
  • Dr. John Galgiani - Director, University of Arizona’s Valley Fever Center for Excellence


View Transcript
Richard Ruelas: This Sunday a march will be held in Downtown Phoenix to raise awareness and money to fight Valley Fever. The disease put Arizona Diamondbacks outfielder Conor Jackson out of commission for much of the season. And it also did quite a number on a man in Prescott, as David Majure shows us.

David Majure: The one in front of us here is thumb butte. Late 2008, Joe was getting sick a lot.

Joe La Barge: Just about thanksgiving. And I felt like I had the flu, headache, body ache, skeletal pains.

David Majure: The 71-year-old who lives with his wife in Prescott was treated for pneumonia with antibiotics. He felt briefly, then the symptoms returned.

Joe La Barge: So I went back to the doctor and he said, "Well, maybe we just didn't catch it all the first time."
David Majure: 10 more days of antibiotics produced the same result.

Joe La Barge: I was chatting occasionally with my sister in Tucson, who is a retired nurse, and I was describing my symptoms to her and she said "You know, I don't think you have pneumonia. I think you have valley fever." and I thought to myself, well, I've heard the term, but I know nothing about it.

David Majure: After a third bout of pneumonia, Joe's doctor ordered a cat scan. It revealed spots on his right lung. The radiologist said these nodules were compatible with lung cancer.

Joe La Barge: I thought to myself, well, I hope it's not that, and I don't think it is somehow, but given my history, medical history of having had Hodgkins Lymphoma 10 to 12 years ago, and having had complication was the chemo in my lungs, I could not rule that out as a possibility.

David Majure: But to know for sure, doctors had to remove a piece of Joe's lung.

Joe La Barge: They found one lump in the middle of my right lung, and they took a section of that out to send to the pathology lab. At this point it was felt that cancer was not the correct diagnosis. The lung surgeon said he was quite confident that it was valley fever, and when that frozen tissue section came back from the pathology lab, they said definitely Valley Fever.

David Majure: Valley Fever is a lung infection caused by a fungus that grows in soil in the southwest United States. People get the disease simply by inhaling an airborne fungal spore. A blood test is used to diagnose Valley Fever, not the major surgery that put Joe in the hospital for nine days.

Joe La Barge: The doctors probably need to be better educated, or have a heightened sensitivity for the possibility of this disease being prevalent in people who present with symptoms that look a lot like pneumonia or lung cancer. And very often it is pneumonia. Sometimes it is lung cancer, but it's not always pneumonia or always lung cancer. And we need to find a way to arrive at the truth earlier in the process so that people don't go through unnecessary surgeries and procedures when they don't have to.

Linda La Barge: People depend on their physicians to make the correct diagnosis, and I think it could have been done sooner.

David Majure: Joe's wife Linda, a former nurse, thinks his surgery could have been avoided.

Linda La Barge: I really do. And I think at least they could have done a blood type to see if he had valley fever.

Joe La Barge: I don't fault the doctors for presuming that I probably had lung cancer.

David Majure: Given his medical history, Joe says even if he knew he had valley fever, he still might have opted for surgery to rule out any chance of cancer. Joe's been taking an antifungal drug to treat valley fever and has spent a lot of time researching the disease. He believes everyone should become more aware of valley fever, even in places like Prescott, where infections are less common.

Joe La Barge: Which admittedly is on the fringe of the -- on the edge of the area where valley fever is most prevalent, which is southern Arizona, and southern California. But people do travel, and they travel a lot.

David Majure: As it turns out, Joe may have contracted his valley fever during a doctor's visit in Phoenix.

Richard Ruelas: Joining me to talk about Valley Fever is Dr. John Galgiani, director of the University of Arizona's Valley Fever Center for Excellence. Thanks for joining us this evening.

John Galgiani: My pleasure. Thank you.

Richard Ruelas: This disease has been around it seems forever. There's been television campaigns, some awareness in the '70s, I remember. What is the level of awareness now and why does it seems to rise and fall? Why can't this disease get the traction we need?

John Galgiani: Well, I think it's been around actually like we were discussing, the first case was 1893. And the name valley fever comes from the San Joaquin Valley of California. I think actually my friends in the central valley of California have been consistently pushing for vaccine work, and other improvements in handling this disease. It may be because the phoenix area and the Central Arizona has been exploding in terms of its population, that people have moved in from areas that don't really know much about this disease. And so there's a continuous learning curve going on pretty much continuously. And we'd like to change that.

Richard Ruelas: Does that extend not only to residents -- obviously like the piece we just saw, that man if he had been aware of valley fever might have been something he might have raised with his doctor. Is there an awareness in the medical community, with so many doctors moving into the state?

John Galgiani: That's right. We're trying to educate patients, but also the medical community. The actual numbers are in the United States are about 150,000 infections every year. Two-thirds of those occur in Arizona, and almost all of them occur in the corridor between here and phoenix, and where I live, in Tucson. And that sort of frames the idea of a valley fever corridor up and down i-10 between Maricopa, and into Pima counties. I think that the physicians in that area as well as the rest of the country really need to identify and diagnose this a lot more frequently than they r the disease most of the time looks very much like pneumonia, and many doctors treat it as such. Whether they make a diagnosis or not depends sometimes on their age, because older individuals are more likely to get this diagnosis. And part of that reason is because they think it looks a lot like cancer. And you heard this piece here, I was noticing in the news, Suzanne Somers is actually -- was on Larry King talking about her being told that she had cancer, but it was only after a biopsy they discovered it was really valley fever. So that's actually a very common theme.

Richard Ruelas: What is the treatment for valley fever? Say, different from pneumonia? Obviously drastically different than cancer, but --

John Galgiani: Yeah. And this is a fungus. Most pneumonias people think of a bacterial infection, but this doesn’t react to the same drugs prescribed for pneumonia. Fortunately the immune system, three-quarters of the time, will control it. It may take weeks or many months to eventually get over this, but it's a self-limited process. A small percentage of people end up having much more complicated disease, Meningitis, life-threatening Pneumonia and other problems, and that's a small percentage. But there are about 100 deaths a year from this.

Richard Ruelas: With no real treatment options, it sounds like it's not a matter of if it's misdiagnosed, the trouble is any harm that the drugs to treat --

John Galgiani: Those drugs have their own toxicities. But there are treatments for fungal infections, and some patients benefit from that. So an earlier diagnosis would get improvement. But I would also emphasize that telling the patient what's wrong with them has enormous benefit to the patient. For example, if someone is telling you, I think you have cancer, when in fact it turns out you don't, finding that out as soon as possible and thinking of that diagnosis, or even at the beginning saying, you might have cancer or you may have these other things, it's a very different kind of way of managing a patient's problem.

Richard Ruelas: This is a very Arizona disease, and it sounds like outside -- outside of essentially Arizona and southern California, there are virtually no other cases in the United States.

John Galgiani: Most of the disease is in Arizona, California runs half as many cases as we do. And if you take them all together, it would be considered an orphan disease. That is, less than 2,000 ill people at any one time. And if you spread that over the whole united states, that's a pretty small problem, but as you see, it's condensed down to this 150-mile portion of Arizona for so many of them, that it's an intensely important problem to our state.

Richard Ruelas: Which is the reason the board of regents has authorized the valley center for excellence in Tucson, and who is having the inaugural walk to fund-raise. How much do you hope to get, and where would the money go?

John Galgiani: The walk is the 1st, and it will be Sunday morning from 8:00 to noon. Down in Central Phoenix. And it's hopefully will be mostly raising awareness. There is a registration fee, and some other funds. And those monies will be used for a project we're calling the valley fever corridor project to increase education, and also to develop a network amongst clinicians so that when people have really serious problems with this disease, the clinicians themselves will know who else has the specialty areas of expertise to help fit a specific case it.

Richard Ruelas: Sounds like there's a possible drug, maybe a vaccine?

John Galgiani: Well, at the Valley Fever center we're developing -- working on a vaccine which I think is a long-term play. It would be wonderful if we could eliminate the problem with a vaccine, but there's a drug which actually the University of Arizona is acting as a sponsor for at the FDA. It's in clinical trials, and we hope to continue its progress and commercialize it.

Richard Ruelas: Is there a prevention message? We keep our windows up as we go from Phoenix to Tucson? Is it avoid dust?

John Galgiani: It sounds like a good idea, but if you live in Arizona, I think you have a risk.

Richard Ruelas: Ok. Doctor, thanks for joining us. We hope the walk is successful this Sunday.

John Galgiani: Thank you very much. My pleasure.

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