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Valley Fever Example Research Paper
TA: Mikkkk #12345678
PH 1 Spring 2016 Grad Student Dr. Zebra Angel
Melissa Matlock 3/26/2016 11:58 PM
Comment : Stuff to notice:
Font choice, page limits, and reference guidelines are all followed
No use of quotes. It is minus 10 points for every use of quotes! If you use 5 quotes, its minus 50 points
Turnitin rules are very strict. Any research paper published in peer review journals – is a creative work
from researchers, papers with slight similarities in writing would be not accepted. You can refer in your text to other articles but you need to use your own words in describing it. You can’t use… According…. and than copy and paste sentences!!! Also, to decrease match
% points, read an article, close your article/put it away, and type how you would explain it. See page 7 in the syllabus for more information.
Make it easy for the graders, use the key words like “in my opinion,” “risk factors,” “risk in the future,” etc. It helps us know when reading that you hit all the points.
Public Health Problem
Coccidioidomycosis, also known as Valley Fever, is a reemerging infectious disease that is endemic to the southwest United States (California, Arizona, Utah, Texas, Nevada, and New Mexico), Mexico, Central America, and South America . Disease infection results from inhaling the spores from soil fungus Coccidioides immitis or Coccidioides posadasii . The two fungi are located in separate regional locations, however, studies have shown that they are relatively identical and manifest the disease in the same way. Calling home in arid, desert areas, Coccidioidomycosis spores are found in lower elevations, 4 inches or more under sandy soil. They are endemic in areas with less than 20 inches of rain per year . The most common opportunity to become infected is when the soil is disrupted by construction, entertainment activities, or environmental factors like earthquakes, landslides, and dust storms .
40% of the infected population is asymptomatic or they receive mild, flu-like, symptoms that resolve without the use of medication . However, for those that develop a severe infection, such as pulmonary disease and community-acquired pneumonia, hospitalization may be required . Coccidioidomycosis infection can also spread to the central nervous system .
The first patients suffering from Coccidioidomycosis were described over a hundred years ago. The patients had travelled through the San Joaquin Valley, an endemic area, and they were suspected of contracting San Joaquin fever . It was not until 1936 that the disease was discovered to be due to a fungus. At the time, central California had the highest prevalence of cases .
In the 1950s and 1960s, researchers attempted to understand Coccidioidomycosis’ desert habitat, but once a new antifungal drug, Amphotericin B, was introduced in the 1950s, there was a lack of demand for drugs and information about the disease. Since then, the development of new drugs has been slow, with only 5 introduced to the industry since .
There have been several massive outbreaks of this disease in the last two decades. In 1977, a massive dust storm, covering 90,000 km2, originated in Bakersfield and brought the disease to Sacramento, where 115 new cases were diagnosed . In January 1994, the 6.7 Northridge Earthquake in California disturbed the soil and as a result of the magnitude, aftershocks, and subsequent landslides, Coccidioidomycosis fungi became aerosolized and dispersed . 203 cases were identified in Ventura County, but Coccidioidomycosis was not the original diagnosis .
Data on Coccidioidomycosis is limited due to varieties in state reporting, testing practices, and misunderstanding of the disease . A general conclusion is that 10-50% of those living in endemic areas have been exposed to some form of the disease and each year, approximately 150,000 new cases will occur in the United States . In 2010, Arizona and California were the two states with the highest incidence of Coccidioidomycosis, with 186 new cases per 100,000 population in Arizona and 11.5 new cases per 100,000 in California . From 2000-2011, there were 25,217 hospitalizations for 15,747 patients in California . Many patients were readmitted because they relapsed at least once after their medication prescription ended. This totaled over $2 billion in hospital bills .
Over the years, the highest communities at risk have been men, people over the age of 65, Hispanics, Filipinos, Native Americans, pregnant women, and those with
Melissa Matlock 3/26/2016 11:45 PM
Comment : How this happens
Melissa Matlock 3/26/2016 11:44 PM
Comment : Why this is a problem in society
Melissa Matlock 3/26/2016 11:45 PM
Comment : Etiological factors
immunosuppressive conditions, such as HIV. However, the demographic risks could be related to profession or location of these communities relative to endemic regions.
Today, the disease is seen as an unknown disease, although cases and treatment have been around for years. However, the reemergence of this disease is thought to be due to migration into endemic areas that historically had been sparsely populated, but now, house big industrial cities and residential communities. The risk of this disease in the United States is predicted to increase in the future due to climate change, increase in travellers, and construction activities.
How to Solve the Public Health Problem
Coccidioidomycosis does not contribute to an overall high number of deaths on the global scale, but there is so much unknown and Coccidioidomycosis is often misrepresented in the diagnosis of the disease. In an epidemiological study on Coccidioidomycosis, several conditions were represented on death records, indicating a high co-morbidity and co-mortality rate . Several coexisting conditions were vasculitis, rheumatoid arthritis, systemic lupus erythematosus, HIV infection, tuberculosis, diabetes mellitus, chronic obstructive pulmonary disease, meningitis, and non-Hodgkin lymphoma . In addition, many clinicians will also diagnose a patient with pneumonia and prescribe medication, when the true cause of the illness could be related to Coccidioidomycosis. Since getting sick involved breathing in spores, anyone travelling through the area can get exposed and then subsequently infected. There have been several cases discovered in Australia after individuals travelled along the coast of California .
There is also an increased risk of complications and death in those that have immunosuppression, diabetes, men over 65 years old, men, people of African, Native American, or Filipino descent, pregnant women, and those with preexisting cardiopulmonary disease . In addition, in the highly mobile world, travellers to endemic regions may return home and develop the disease 1-4 weeks after exposure. The homelands of the travellers may not know how to treat the disease properly and may inaccurately diagnosis the disease as pneumonia or pulmonary infections. Treatment may also be limited and not well understood in these regions.
Disasters and climate change are environmental risk factors whose future effects on Coccidioidomycosis is relatively unknown. This can also increase exposure to travellers in endemic regions, with the potential of Coccidioidomycosis to spread to non- endemic regions and could result in huge outbreaks. Especially in the face of disease spread through dust storms and air quality issues, environmental factors related to Coccidioidomycosis should be considered. The unknown risk of Coccidioidomycosis, the longevity of infection, and the lack of proper diagnosis are issues that need to be researched and solved before Valley Fever can be eradicated. Overall, it is important to document adequate travel history and understand the nature of the disease in patients that show signs of pneumonia and meningitis .
There are also huge financial costs associated with Coccidioidomycosis. One patient can spend between $5000- $20,000 a year in hospital bills . Alone, this is a huge burden to the health care system, but other costs, like missing work and at-home care, has not been calculated. In my opinion, the findings from this type of analysis could lead to more funding in more effective anti-viral medication.
Public Health in the Future
Melissa Matlock 3/26/2016 11:47 PM
Comment : Risks in the future
Melissa Matlock 3/26/2016 11:48 PM
Comment : Example country
Melissa Matlock 3/26/2016 11:49 PM
Comment : How problem needs to be solved
Coccidioidomycosis is a disease with a large amount of knowledge yet to be researched. Throughout the review of various research studies, several themes emerged. Investigation is needed to understand the general exposure risks and why one person may be symptomatic, but the general population is asymptomatic. Research can be done at the molecular level to understand why some medications work and why there is a high relapse rate of the disease . Also, health disparities and exposure could yield results that could be beneficial to educating the public living in endemic areas about the disease. Arizona has been focusing on educating their health practitioners, so they can be aware of the disease and look out for early symptoms to catch the disease before it moves to an untreatable stage.
Several studies have indicated that incidence of Coccidioidomycosis has been increasing, but the reason is unknown. Many researchers believe this could be due to climate related factors . Understanding the connection between outbreaks and climate factors on a temporal scale could help address the potential burden of this disease in the face of climate change. In my opinion, developing a predictive model using climate factors to estimate exposure and incidence could help prevent the disease.
Huang JY, Bristow B, Shafir S, and Sorvillo F. Coccidioidomycosis-associated Deaths, United States, 1990-2008. Emerg Infect Dis. 2012;18(11):1723-8. doi:10.3201/eid1811.120752.
Kim MM, Blair JE, Carey EJ, Wu Q, and Smilack JD. Coccidioidal pneumonia, Phoenix, Arizona, USA, 2000-2004. Emerg Infect Dis. 2009;15(3):397-401. doi:10.3201/eid1563.081007.
Sondermeyer G, Lee L, Gilliss D, Tabnak F, and Vugia D. Coccidioidomycosis- associated hospitalizations, California, USA, 2000-2011. Emerg Infect Dis. 2013;19(10):1590-7. doi:10.3201/eid1910.130427.
Galgiani JN. Coccidioidomycosis: a regional disease of national importance. Rethinking approaches for control. Ann Intern Med. 1999;130(4 Pt 1):293-300.
Benedict K, and Park BJ. Invasive fungal infections after natural disasters. Emerg Infect Dis. 2014;20(3):349-55. doi:10.3201/eid2003.131230.
Subedi S, Broom J, Caffery M, Bint M, and Sowden D. Coccidioidomycosis in returned Australian travellers. Intern Med J. 2012;42(8):940-3. doi:10.1111/j.1445- 5994.2012.02855.x.
Chang DC, Anderson S, Wannemuehler K, Engelthaler DM, Erhart L, Sunenshine RH, Burwell LA, and Park BJ. Testing for coccidioidomycosis among patients with community-acquired pneumonia. Emerg Infect Dis. 2008;14(7):1053-9. doi:10.3201/eid1407.070832.
Melissa Matlock 3/26/2016 11:50 PM Comment : Conclusion from literature Melissa Matlock 3/26/2016 11:50 PM Comment : How its being solved
Melissa Matlock 3/26/2016 11:51 PM
Comment : Opinion statement