Valley Fever Fungal Infection on Rise in Southwest

Title: Valley Fever Fungal Infection on Rise in Southwest
Category: Health News
Created: 3/28/2013 4:36:00 PM
Last Editorial Review: 3/29/2013 12:00:00 AM

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Valley Fever Fungal Infection on Rise in Southwest

Flu-like symptoms can last weeks or months, CDC researchers say

By Robert Preidt

HealthDay Reporter

THURSDAY, March 28 (HealthDay News) -- Cases of a fungal lung infection called Valley Fever increased sharply in several southwestern states since the late 1990s, according to a report released Thursday.

In Arizona, California, Nevada, New Mexico and Utah, the number of cases climbed from less than 2,300 in 1998 to more than 22,000 in 2011, the U.S. Centers for Disease Control and Prevention found.

During that time, Arizona and California had the largest average increases in Valley Fever incidence, at 66 percent and 31 percent per year, respectively.

Valley Fever (Coccidioidomycosis) is caused by inhaling a fungus called Coccidioides, which lives in the soil in southwestern states. Not everyone who is exposed to the fungus gets sick, but those who do become ill typically have flu-like symptoms that can last for weeks or months.

More than 40 percent of patients who get sick may require hospitalization, with an average cost of nearly $50,000 per visit. And research has shown that 75 percent of those who get sick miss work or school for about two weeks, the CDC said.

Between 1998 and 2011, nearly 112,000 cases of Valley Fever were reported in 28 states and Washington, D.C., but 66 percent of the cases were in Arizona, 31 percent were in California, 1 percent were in Nevada, New Mexico and Utah, and about 1 percent were in all other states combined.

More research is needed to determine what is causing the increase in Valley Fever and how to reduce its effects, the CDC said. Possible reasons could be population growth, weather changes that could affect where the fungus grows and how much of it is circulating, or changes in the way the disease is detected and reported to the CDC.

"Valley Fever is causing real health problems for many people living in the southwestern United States," Dr. Tom Frieden, director of the CDC, said in an agency news release. "Because fungus particles spread through the air, it's nearly impossible to completely avoid exposure to this fungus in these hardest-hit states. It's important that people be aware of Valley Fever if they live in or have traveled to the southwest United States."

Doctors and patients need to be aware that the symptoms of Valley Fever are very similar to flu or pneumonia symptoms, the CDC said. A lab test is the only way to diagnosis Valley Fever.

Not everyone who gets Valley Fever requires treatment, but early diagnosis and treatment are important for those at risk for the more severe forms of the disease. Those at higher risk for severe disease include people of Asian descent (particularly Filipino), blacks, pregnant women and people with weakened immune systems, according to the CDC website.

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Oral Allergy Treatment May Ease Asthma, Hay Fever, Study Finds

This under-the-tongue alternative to shots is used in Europe, but not approved in U.S.

By Amy Norton

HealthDay Reporter

TUESDAY, March 26 (HealthDay News) -- Spring is here, and so are seasonal allergies. For the millions who suffer from hay fever or asthma in the United States, a new under-the-tongue treatment may hold promise.

Pills and drops designed to desensitize the immune system to allergens could bring some of these allergy patients relief, a new research review finds.

The review, published March 27 in the Journal of the American Medical Association, pulled together 63 studies on so-called sublingual immunotherapy.

The therapy, commonly used in Europe and Asia, essentially allows people to get traditional allergy shots in the form of pills or drops that dissolve under the tongue. The principle is the same: Expose the immune system to extracts of the substance causing a person's allergy -- grass pollen, for example -- until it builds up a tolerance.

Right now, no under-the-tongue allergy products are approved in the United States. But some doctors offer the therapy anyway; they take the extracts approved for allergy shots and give them to patients to use orally.

In the new review, researchers found "strong" evidence that under-the-tongue immunotherapy eased symptoms of allergy-induced asthma: In eight of 13 studies, patients saw more than a 40 percent improvement in symptoms, versus patients who either got a drug-free placebo or standard medication.

The evidence was weaker when it came to nasal allergies. Only nine of 36 studies showed a more than 40 percent drop in symptoms such as congestion, runny nose and itchy eyes.

Still, the majority of studies did show some benefit, said lead researcher Dr. Sandra Lin, an associate professor of otolaryngology at Johns Hopkins University School of Medicine in Baltimore.

Under-the-tongue products are being evaluated for approval by the U.S. Food and Drug Administration (FDA), and those results will be helpful, said Lin.

She said the results from European trials cannot be simply translated to the United States because of differences in the potency of the allergen extracts used.

"We need studies to see what are the most effective doses for U.S. patients," Lin said.

The idea of taking pills instead of getting shots definitely appeals to patients, said Dr. Harold Nelson, an allergy specialist at National Jewish Health in Denver, who wrote an editorial published with the study.

But his advice to U.S. patients was to wait for products to be approved by the FDA.

Even if your doctor offers under-the-tongue immunotherapy, "there's no guarantee" it would be the same as the products studied in clinical trials, Nelson said. He noted that U.S. doctors commonly give a patient a mix of different allergen extracts, because that's how it is done with allergy shots.

But the under-the-tongue products used in clinical trials have contained only a single allergen extract, Nelson said.

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Homegrown Strain of Dengue Fever Virus Pinpointed in Florida

Some 2009-2010 cases originated in Key West mosquitoes, not from travelers, CDC says

By Alan Mozes

HealthDay Reporter

THURSDAY, March 14 (HealthDay News) -- Some people who fell prey to a 2009-2010 outbreak of dengue fever in Florida carried a particular viral strain that they did not bring into the country from a recent trip abroad, according to a fresh genetic analysis conducted by the U.S. Centers for Disease Control and Prevention.

To date, most cases of dengue fever on American soil have typically involved travelers who "import" the painful mosquito-borne disease after having been bitten elsewhere. But though the disease cannot move from person to person, mosquitoes are able to pick up dengue from infected patients and, in turn, spread the disease among a local populace.

The CDC's viral fingerprinting of Key West, Fla., dengue patients therefore raises the specter that a disease more commonly found in parts of Africa, the Caribbean, South America and Asia might be gaining traction among North American mosquito populations.

"Florida has the mosquitoes that transmit dengue and the climate to sustain these mosquitoes all year around," cautioned study lead author Jorge Munoz-Jordan. "So, there is potential for the dengue virus to be transmitted locally, and cause dengue outbreaks like the ones we saw in Key West in 2009 and 2010," he said.

"Every year more countries add another one of the dengue virus subtypes to their lists of locally transmitted viruses, and this could be the case with Florida," said Munoz-Jordan, chief of CDC's molecular diagnostics activity in the dengue branch of the division of vector-borne disease.

He and his colleagues report their findings in the April issue of CDC's Emerging Infectious Diseases.

Dengue fever is the most widespread mosquito-borne viral disease in the world, now found in roughly 100 countries, the study authors noted.

That said, until the 2009-2010 southern Florida outbreak, the United States had remained basically dengue-free for more than half a century.

Ultimately, 93 patients in the Key West area alone were diagnosed with the disease during the outbreak, which seemingly ended in 2010, with no new cases reported in 2011.

But the lack of later cases does not give experts much comfort. The reason: 75 percent of infected patients show no symptoms, and the large "house mosquito" population in the region remains a disease-transmitting disaster waiting to happen.

To try and get a handle on just how serious that risk might be, the CDC team looked at blood samples from 16 of Florida's 67 counties, collected from dengue patients by the Florida Department of Health.

Rigorous genetic testing revealed what researchers feared: the identification of a local Key West strain among dengue patients who had not recently traveled outside the United States.

The team was able to trace the new Key West strain back to its original imported source: a Central American viral strain initially brought into Florida by patients infected in that region. But they stressed that as the local mosquito population acquired the virus from this first round of patients, it developed into a distinct strain of its own. In turn, the new strain was passed on to local residents who had not recently visited Central America.

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Acupuncture May Help Ease Hay Fever

By Amy Norton

HealthDay Reporter

MONDAY, Feb. 18 (HealthDay News) -- Hay fever sufferers may find some relief with acupuncture, a new study suggests, though the therapy's appeal in the "real world" is yet to be seen.

The study, of 422 people with grass and pollen allergies, found that those randomly assigned to a dozen acupuncture sessions fared better than patients who did not receive the procedure.

On average, they reported greater symptom improvements and were able to use less antihistamine medication over eight weeks. The advantage, however, was gone after another eight weeks, according to findings reported in the Feb. 19 issue of the Annals of Internal Medicine.

Still, that doesn't necessarily mean that acupuncture's benefits fade, said lead researcher Dr. Benno Brinkhaus, of Charite-University Medical Center in Berlin.

Hay fever symptoms were much better in all three study groups by week 16, and Brinkhaus said that's probably because pollen season was dying down at that point.

The study was well done and "positive," because acupuncture seemed helpful, said Dr. Harold Nelson, an allergist at National Jewish Health, a Denver hospital that specializes in respiratory diseases.

But Nelson doubted whether the time, inconvenience and expense of acupuncture sessions would seem worthwhile to many hay fever sufferers -- especially because there are simpler ways to manage the condition.

"I don't know how many people will want to wait in an acupuncturist's office, then sit with 16 needles in them for 20 minutes, and do that 12 times, when they could use a nasal spray," Nelson said.

Specifically, Nelson pointed to prescription nasal sprays that contain anti-inflammatory corticosteroids. The sprays -- which include brand names like Flonase and Nasonex -- are taken daily to help prevent hay fever symptoms.

Patients in this study were not using nasal steroids. They were taking antihistamines as needed -- which, Nelson said, is not the most effective way to manage hay fever.

Still, Nelson added, there are people who want to avoid medication, and they may be interested in acupuncture as an option.

Many studies have suggested that acupuncture helps ease various types of pain, such as migraines and backaches, as well as treat nausea and vomiting related to surgery or chemotherapy. According to traditional Chinese medicine, acupuncture works by stimulating certain points on the skin believed to affect the flow of energy, or "qi" (pronounced "chee"), through the body.

But some recent research suggests that the needle stimulation also triggers the release of pain- and inflammation-fighting chemicals in the body. No one is sure why acupuncture would help with hay fever, but there is evidence that it curbs inflammatory immune-system substances involved in allergic reactions.

For the new study, Brinkhaus and colleagues recruited 422 adults with hay fever. They randomly assigned the patients to one of three groups: one that received 12 acupuncture sessions over eight weeks; one that received a "sham" version of acupuncture; and one that received no acupuncture.

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