Coccidioidomycosis [kok-sid-ee-oi-doh-mahy-koh-sis]

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Coccidioidomycosis kok-sid-ee-oi-doh-mahy-koh-si
s

• Also known as
• Cocci,
• Valley Fever,
• San Joaquin Fever

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Coccidioides immitis Lifecycle phases
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History

• 1892 First reported as disease
• 1920-1930
• Soil recognized as reservoir for agent
• 1987
• CDC adds coccidioidomycosis to annual survey of
  HIV-associated diseases

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History

• 1991-1995
• Incidence increases tenfold in San Joaquin
  Valley, CA

The number of new cases of coccidioidomycosis
identified by serologic testing at the Kern
County Public Health Laboratory (source of data
Dr. Ron Talbot). The asterisk indicates a
projected number. Emerging Infectious Diseases.
Coccidioidomycosis A reemerging disease. Vol 2
(3). July-Sept. 1996.
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Economic Impact

• Infection is costly
• Time lost from work
• Direct medical costs
• 1990 Kern County, CA
• Cost more than 66 million
• Infection can be widespread

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Morbidity/Mortality

• Two forms in humans
• 60 asymptomatic
• Only identified with positive skin test
• 40 mild to severe disease
• Can be fatal
• Immuno-compromised persons highly susceptible to
  serious infection
• Difficult to assess morbidity in animals

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Human Transmission

• Direct inhalation of C. immitis spores
• Present in contaminated soil and dust
• Only established mode of transmission
• Not person-to-person
• Not animal-to-person
• Increased incidence after disturbance

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Human Transmission

• Natural disturbances
• Dust storms
• Earthquakes
• Human disturbances
• Construction sites
• Archaeological digs

http//vfce.arl.arizona.edu
http//griefnet.org
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Clinical Signs Primary Form

• Incubation period 1-4 weeks
• Usually subclinical
• Fever, chills, cough, sore throat
• Chest pain
• Nodular lesions
• Nonspecific respiratory symptoms
• Complications less common
• Pneumonia, pleural effusion

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Clinical Signs Disseminated Form

• Severe form of disease
• Weeks to months to years after
  primary infection
• Symptoms include
• Low-grade fever, anorexia, weight loss
• Muscle aches and stiffness, weakness
• Excessive sweating
• Widespread focal lesions
• In HIV-infected persons
• Mucopurulent or bloody sputum

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Diagnosis

• Differentials
• Tuberculosis
• Clinical
• Coccidioidomycosis should be considered
• In endemic areas
• Following a dust/soil disturbance
• With characteristic clinical signs

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Cocci Endemic Areas
The geographic distribution of coccidioidomycosis.
Cross-hatching indicates the heavily
disease-endemic area, single hatching, the
moderately disease-endemic area. Emerging
Infectious Diseases. Coccidioidomycosis A
reemerging Infectious Disease. Vol. 2 (3).
July-September 1996
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Diagnosis

• C. immitis spherules visualized in
• Sputum, pleural fluid, cerebrospinal fluid or
  exudates from draining lesions
• Complement fixation
• IgG anticoccidioidal antibodies
• Titer ?14 current or recent infection
• Titer ?132 increased risk of extrapulmonary
  dissemination
• Skin test of epidemiological value

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Treatment

• Primary coccidioidomycosis
• Treatment generally unnecessary
• Severe/chronic coccidioidomycosis
• Antifungal agents effective
• Prognosis generally good
• Disseminate coccidioidomycosis
• May require invasive or long-term therapy
• Prognosis poor to guarded

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Vaccination

• No effective immunization available
• Efforts being made to develop vaccine
• Precautionary measures should be taken to avoid
  infection
• Reduce exposure to soil and dust
• Man and animal
• Of particular importance in endemic areas

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Acknowledgments
Author Co-author Reviewer
Jean Marie Gladon, BS James Roth, DVM,
PhD Bindy Comito Sornsin, BA
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Valley Fever Vaccine Projectwhere theyre
headed next...

• Valley Fever Vaccine Project (VFVP)

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Goals of Vaccine Project

• Identify safe and effective acellular vaccine for
  prevention of coccidioidomycosis
• Evaluate the vaccine in humans
• Find a commercial partner

Valley Fever Vaccine Project
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The good news is...

• The vaccine is in hand!
• Ag2/PRA106 CSA chimeric fusion protein

Valley Fever Vaccine Project
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Development Budget

• Project Activity 05-06
• Pilot Manufacturing
• Formulation
• GMP Manufacturing
• Fill/Finish
• Stability/analytical
• Toxicology
• Primate trials
• UCSF
• Regulatory expenses
• Phase 1 trial

100,000 50,000 1,200,000 100,000 75,000 55,000 18
0,000 440,000 20,000 400,000 2,620,000
Valley Fever Vaccine Project
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Supporting Organizations

• CHCF
• State of California (Ashburn)
• CDC (via Congressman Thomas)
• VFVPA Rotary VFVF
• Kern County
• NIAID (genome project)

Valley Fever Vaccine Project
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Overall Status

• The VFVP has met its research goals
• We have a good, immunogenic vaccine
• We have a plan that takes us to human trials
• We have expectations of success but...
• We need time, effort continued financial
  support to reach Phase 1

Valley Fever Vaccine Project
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Valley Fever Cost Effectiveness - 2001

• Children save 1.9 quality adjusted life
  day(QALD), save 33/person
• Adults save 0.5 QALD at cost of 62k per QA Life
  year
• Comparable to other vaccines
• Assumes 180/series of 3 vac.
• Dissemination rate 0.038
• lt200k cases/yr orphan disease

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COCCIDIOIDOMYCOSIS Reported cases, United States
and U.S. Territories, 2002
In the United States, coccidiodomycosis is
endemic in the southwestern region. However,
Cases have been reported in other states, usually
among travelers returning from areas of endemic
disease.
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COCCIDIOIDOMYCOSIS Number of reported
cases, United States and U.S. Territories, 2003
In the United States, coccidiodomycosis is
endemic in the southwestern states. However,
cases have been reported in other states, usually
among travelers returning from areas in which the
disease is endemic.
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(As of 3/22/2007)
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