March 2025
Welcome to the Valley Fever Center for Excellence’s website. Here we try to provide reliable and timely information about coccidioidomycosis, the medical name for Valley fever.
The Coccidioidomycosis Study Group (CSG) is an organization which had its start in 1956 as an informal meeting of physicians and microbiologists, mostly based within California military and Veterans Administration hospitals, as a satellite to another meeting focused on tuberculosis. The CSG has met annually ever since, growing from a couple of dozen attendees to a meeting with more than 200 participants in person and online. This year the meeting is being hosted in Phoenix by Arizona State University faculty on April 4 and 5. For those interested, details of the group can be found at CocciStudyGroup.org.
One of the reasons for this group’s growth has been the growing recognition of the importance Valley fever has as a public health problem, both nationally and in the most affected states of Arizona and California. For example, the National Institute for Allergy and Infectious Diseases (NIAID) has funded five Coccidioidomycosis Collaborative Research Centers for the past three years. Also, California state funds have been provided to establish the Valley Fever Institute in Bakersfield. In 2022 the Arizona Board of Regents (ABOR) awarded a research grant to collaborating investigators from Northern Arizona University, Arizona State University and the University of Arizona to better understand how the Valley fever fungus, which is endemic within the soil, results in disease. Because of this support, the recipients now have new information which makes the CSG annual meeting increasingly interesting to a national audience. Another collaboration, spawned by the ABOR award, has developed between faculty at the VFCE and Arizona State University’s Decision Theater to combine the interest in improving the early diagnosis of Valley fever in newly infected patients with a machine learning approach to predicting how likely future infections are to happen in the Phoenix area.
VFCE investigators have been working for several years with Banner Health to increase the testing of patients for Valley fever. This unfortunately is all too frequently neglected even though the usual testing is readily available and relatively inexpensive. With help from Banner’s data analytics staff, over the past four years the VFCE has improved the testing of patients with pneumonia in Banner’s urgent care clinics from less than 2% to more than 40% of patients. One of the keys to that success was the development of a dashboard that provided nearly real time estimates of how many patients at the urgent care clinics had pneumonia, how many with pneumonia were tested for Valley fever, and how many of those tests were positive. This information has led to several very useful kinds of results:
- In the Figure, the black curve shows the percentage of how many pneumonia patients tested for Valley fever were positive from 2021 through 2024. Clearly, that percentages vary at different times, ranging from nearly none to as high as 44%, but the overall rate of positivity was 13%. Also apparent is that these lows and highs come at different times of the year on different years. Therefore, having access to this information is helpful to both doctors taking care of patients in Maricopa County but also for Maricopa residents which is why our website provides that information to the public. Check out “Current Maricopa County Valley Fever Activity” for more info.
- A second finding is how many pneumonias due to Valley fever are seen daily in urgent care. This estimate is calculated by multiplying the total pneumonia numbers each day by the percentage of tested pneumonia patients that are positive (shown in red). This statistic is much more directly an estimate of the actual intensity of Valley fever in the community since it is not influenced by how many pneumonias are due to other causes such as bacterial or viral infections. The ability from the Banner urgent care Valley fever dashboard to estimate the intensity of Valley fever in the community has been used by our colleagues at ASU’s Decision Theater to create a prototype computer model from weather and other environmental data to predict the intensity of Valley fever in the coming weeks and has just been published in the Lancet Regional Health-Americas.
- A third finding is that more patients in Banner urgent care were diagnosed with Valley fever who did not have a diagnosis of pneumonia than the number who did. We know that newly infected patients have a variety of symptoms including diffuse arthralgias, fatigue, and other rashes. Also, when respiratory symptoms are present, they may be attributed to bronchitis and not to pneumonia. None of these symptoms are very specific, and all are frequently seen in ambulatory practices everywhere. However, by using artificial intelligence and new machine learning approaches to analyze the particular words and phrases found in clinic notes written by the doctors caring for these patients, it may be possible to find patterns that identify which patients are more likely be suffering from Valley fever and should be tested.
Making a predictive model for Valley fever intensity in the community and a more precise understanding from patient’s symptoms about who are most likely to have Valley fever are no longer just interesting ideas. This month the Arizona Biomedical Research Commission awarded a grant application to the VFCE and the Decision Theater to begin making these ideas real. I very much look forward to what will be learned from this funding over the next three years.
John Galgiani MD