Patient-Ordered Tests Indicate Valley Fever Uptick in State, UA Infectious Diseases Specialist Says

TUCSON, Ariz. – Results of patient-ordered tests for Valley fever are showing disease activity, indicating a possible second spike in cases of the respiratory ailment since last fall when the first spike was reported by University of Arizona infectious diseases specialists to have occurred.

Recent data made available to the UA Valley Fever Center for Excellence by Sonora Quest Laboratories show the percentage of positive tests ordered by patients themselves is rising at least two months sooner than are total cases reported to the state.

This increase ahead of state statistics is especially pronounced with results for the “early antibodies” test, a term used on the patient-ordered results that usually indicates recent or current infection. Patient-ordered lab tests are referred to as direct-access testing or “DAT.”

In the accompanying graph, the percentage of positive early antibody results—shown as hatched bars—began to rise in September, two months ahead of the state numbers. They have been rising from March to present, while the state numbers have not yet shown that increase.

“This pattern suggests cases of Valley fever are increasing in Phoenix and in Maricopa County, where most DAT tests were ordered, and probably elsewhere such as around Tucson and Pinal County where seasonal Valley fever rates closely follow Maricopa,” said John N. Galgiani, MD, director of the Banner – University Medicine Valley Fever Program and the UA Valley Fever Center for Excellence, and professor of medicine at the University of Arizona Colleges of Medicine in Tucson and Phoenix. “Right now,” he added, “residents, doctors and visitors in these areas should be on a greater lookout for Valley fever.”

Although this pattern looks real, people should be cautious about over-interpreting it, Dr. Galgiani said. “The ability for patients to order their own Valley fever tests has been available for less than two years and the numbers are not very large—many fewer than those that currently come from doctors doing the ordering. However, the increases in the early antibodies results are showing up exactly when we expect the seasonal increases to occur based on previous studies.”

Other factors also should be weighed, he stressed. Since anyone can order their own tests, it isn’t yet known what motivates patients to do this. Sonora Quest provides guidance of when the test is appropriate to order, but it’s the patient who makes the decision to be tested. Yet how Valley fever affects people varies—some may show few if any symptoms while others become critically ill. Thus, a positive result for someone otherwise healthy may affect the interpretation.

Another difference is that DAT results are based on the percent positive of total tests done, while state statistics usually show only the number of positives—not as a percentage of all tests performed. Whether these differences are important now is under study by the Arizona Department of Health Services working with more of Sonora Quest’s Valley fever test results.

For now, though, predictions of higher than usual Valley fever activity this year are holding true. Through the end of May, State of Arizona statistics show 3,717 new Valley fever cases for 2018. This is 60 percent higher than a year ago at the same time, a trend first noticed last winter.

In 2015, the State of Arizona passed a law to allow any consumer to purchase a laboratory test without a physician’s order. In fall 2016, Sonora Quest Laboratories began offering a Valley fever screening test on their DAT menu. Requests for the Valley Fever Screen have continued to increase since first becoming available.

The Banner – University Medicine Valley Fever Program is a collaboration between the UA Valley Fever Center for Excellence, Banner Health and Sonora Quest Laboratories. The program focuses on reducing delays in accurate diagnosis of patients who develop Valley fever, optimizing their medical care and providing a platform to conduct research and clinical trials to improve understanding of the disease. Studies currently under way address the value of early antifungal treatment and differences in patients’ immune systems and genetics that are responsible for disease severity.

EXTRA INFO: Should You Get Tested?

Lung x-ray of patient with Valley feverPatients who develop persistent symptoms of pneumonia, such as fever, cough, chest pain, or shortness of breath, especially if associated with unusual skin rashes, joint pain or extreme fatigue, should ask their doctor whether they ought to be tested for Valley fever.

How Coccidioides fungal spores develop and spreadAlso known as coccidioidomycosis or cocci, Valley fever is caused by inhaled spores of the fungus Coccidioides that are endemic to soils of the U.S. Southwest. Most cases occur in Arizona—largely in the Tucson and Phoenix areas—and California, but travelers to the region can show symptoms after they return home as well. The respiratory ailment also may cause complications for rheumatology, transplant and other patients whose health may be immunocompromised.

Animals, including pets, also can contract Valley fever. In dogs, it’s characterized most commonly by coughing, lethargy, lack of appetite, weight loss (often rapid) and fever. They may exhibit lameness or back or neck pain without any respiratory signs if the disease goes to the bones, or they might have fever with the bone disease. Consult your veterinarian if you suspect your pet may be affected.

Researchers at the University of Arizona Valley Fever Center for Excellence are involved in numerous studies related to genetic disparities in incidence of the disease, early detection and treatment, and development of a vaccine. For more information, visit the center’s website at vfce.arizona.edu

To learn more about clinical research studies at the University of Arizona Health Sciences colleges, visit studies.medicine.arizona.edu

NOTE TO MEDIA: For educational pamphlets, brochures, images and graphics related to Valley fever—as well as contact information for University of Arizona faculty knowledgeable about the illness—visit the following webpage: UA Expertise on Valley Fever (Coccidioidomycosis)

About Sonora Quest Laboratories

Sonora Quest Laboratories, a joint venture between Banner Health and Quest Diagnostics, is part of the nation’s largest integrated laboratory system with approximately 3,100 employees serving more than 23,000 patients daily throughout Arizona. Sonora Quest’s My Lab ReQuest™ program is a service allowing patients to directly order their own testing from a select menu and is available in all Patient Service Centers throughout Arizona. Sonora Quest is accredited by the College of American Pathologists, which helps labs maintain accuracy of test results and ensure accurate patient diagnosis. Learn more at sonoraquest.com

About the UA Valley Fever Center for Excellence

In 1996, the Arizona Board of Regents established the University of Arizona Valley Fever Center for Excellence to address problems created by the fungus, coccidioides, which causes Valley fever or coccidioidomycosis. Some cases are mild, but some are so severe that cocci spread past the lungs. The disease also affects animals, including pets and livestock. The center works to spread public awareness and education about Valley fever, promote high-quality care for the disease and pursue research to improve treatment therapies and develop a vaccine. To learn more, please visit vfce.arizona.edu

About the University of Arizona Health Sciences

The University of Arizona Health Sciences is the statewide leader in biomedical research and health professions training. The UA Health Sciences includes the UA Colleges of Medicine (Phoenix and Tucson), Nursing, Pharmacy and Mel and Enid Zuckerman College of Public Health, with main campus locations in Tucson and the growing Phoenix Biomedical Campus in downtown Phoenix. From these vantage points, the UA Health Sciences reaches across the state of Arizona and the greater Southwest to provide cutting-edge health education, research, patient care and community outreach services. A major economic engine, the UA Health Sciences employs approximately 4,000 people, has approximately 800 faculty members and garners more than $140 million in research grants and contracts annually. For more information: uahs.arizona.edu (Follow us: Facebook | Twitter | YouTube | LinkedIn | Instagram)

Release Date: 
06/12/2018 - 10:30am
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