July marks the beginning of the high risk season for valley fever, a prevalent fungal infection in Arizona that can be hard to diagnose and treat, and the recent dust storm may have exposed many residents to its spores.
The tiny particles can stay airborne for extended periods of time, even after the storm is over, said Pat White, a local valley fever expert and founder of Arizona Victims of Valley Fever.
"If you live here for long enough, you will probably be exposed to it," White said.
About 60 percent of the people exposed to the fungus either have few or no symptoms, according to the Arizona Department of Health Services. The majority of these people will not need to see a doctor. But for those who do, the disease can be life changing.
Locally, Catholic Healthcare West Urgent Care in Ahwatukee Foothills hasn't seen an influx of people with symptoms of the disease as of yet but the medical director for the facility expects that to change in the coming weeks.
"It takes a few weeks to incubate and I have no doubt we will see a lot of valley fever in urgent care," said Dr. Rick Swearingen, medical director of the urgent care. "The reality of it is, it goes away without treatment but if symptoms persist than we urge people to come in here or to their doctor if they have a cough and fever."
Another issue with valley fever, Swearingen said, is whether or not to treat the disease with medicine.
Because it can go away on its own, it is sometimes better to let the body deal with it rather than fight it with antifungal medication.
"It is an issue of great debate - do you give someone potent medicine, and how much?" Swearingen said. "Part of it depends on comorbidities (additional conditions) and race plays a factor as well."
On the other side, dogs are subject to valley fever as well. A local veterinarian said their noses are in prime position to take in the spores, usually about 18 inches from the ground.
"Valley fever usually shows up in a cough that won't go away and, unlike in humans, needs to be treated in order for it to go away," said Dr. Jeff Jenkins of Ahwatukee Animal Care Hospital. "It has been too soon (from the dust storm) to see a dramatic increase in cases of valley fever, but people need to be aware that if you have a dog acting sick with a limp or a cough that won't go away, he needs to be seen immediately."
A blood test doesn't always get a positive result even for those who have valley fever. In an effort to reduce the number of false-positive test results, the sensitivity for true positive test results are reduced, according to the website of the Valley Fever Center for Excellence at the University of Arizona.
White was diagnosed six years ago with valley fever and she never had a positive blood test. It took a lung biopsy to confirm she had the disease.
"It is common that people go to multiple doctors," said Dr. Loreto Sulit, a pulmonologist at Banner Baywood Medical Center in Mesa.
Dust storm aftermath
In the search for a correct diagnosis, the UA center reports valley fever can be mistaken for cancer, tuberculosis, chronic obstructive pulmonary disease, chronic fatigue syndrome and others.
People who react to valley fever spores from the July 5 dust storm probably will start experiencing symptoms this week at the earliest, Sulit said.
Sulit is expecting to see an influx of patients with valley fever, but it probably won't happen for another three to four weeks.
A typical patient is treated for pneumonia with a couple rounds of antibiotics, Sulit said. Since those antibiotics treat bacterial pneumonia, it's not effective against a fungal lung infection.
There are a slew of valley fever symptoms, but the top five to look for are cough, fever, shortness of breath, rash and extreme fatigue, Sulit said.
Other symptoms include headache, joint ache, chest pain, night sweats, nausea, loss of appetite, and rapid weight loss.
Some people may not exhibit all the symptoms.
Valley fever is caused by a fungus - Coccidioides immitis (commonly referred to as "cocci") - that grows in the soil of California, Arizona, New Mexico, Texas and southern portions of Utah and Nevada, according to the Centers for Disease Control and Prevention.
When spores of cocci are lifted into the air, they can be easily inhaled. Most people who are exposed to spores won't show symptoms for seven to 28 days. The highest times for exposure in Arizona are July through August and October through November.
In 2010, there were 11,888 valley fever cases in Arizona, according to the Arizona Department of Health Services. Two-thirds of cases diagnosed in the United States are from Maricopa, Pima and Pinal counties, according to the Valley Fever Center for Excellence.
Many labels, little research
The center describes valley fever as an "orphan disease," which means that although there are a large number of people in Arizona who contract it, there isn't a large enough group in the country to make it worth the research and drug production costs for pharmaceutical companies.
Because pharmaceutical companies aren't trying to find new ways to treat valley fever, most of the new research is being done in Tucson by the UA center.
It is funded primarily by contributions from Arizonans, local businesses and cities in Maricopa, Pinal and Pima counties.
The best way to reduce chances of exposure is to stay inside when dust is blowing, according to Cara Christ, an Arizona Department of Health Services medical officer.
The department doesn't recommend that people wear masks, because the particles are so small that barriers don't protect very well, Christ said. As many as 15 trillion spores can fit in a square inch.
Instead, people who have been treated for pneumonia and aren't getting better after a few weeks should ask their doctor for a valley fever blood test, Christ said.