College of Nursing helps strengthen Arizona's fight against Valley Fever
More than 12,000 Arizonans were diagnosed with Valley Fever in 2025, yet many more cases remain undiagnosed or are mistaken for pneumonia, the flu, or other respiratory illnesses. As shortages of primary care physicians persist across Arizona and the nation, nurse practitioners increasingly serve as frontline primary care providers and are often the first health care professionals to evaluate patients with respiratory symptoms. Through faculty scholarship and education, the College of Nursing is helping prepare nurse practitioners to recognize Valley Fever earlier, improve clinical decision-making, and strengthen patient care statewide.
Mary Estrada, DNP, APRN, FNP-BC, assistant clinical professor who teaches in the college’s Doctor of Nursing Practice (DNP) Family Nurse Practitioner (FNP) and Master's Entry to the Profession of Nursing (MEPN) programs, co-authored the article "Valley Fever: Expanding Nurse Practitioner Awareness and Improving Clinical Recognition" with Ayo Adebiyi of the University of California, Merced. Published in the May 2026 issue of the Journal for Nurse Practitioners, the article provides an evidence-based framework to help nurse practitioners recognize, diagnose, and manage uncomplicated cases of Valley Fever and identify patients who require specialist care.
Estrada's research directly informs her teaching of future nurse practitioners, ensuring graduates leave the College of Nursing prepared to recognize Valley Fever in the communities they will serve. Each year, College of Nursing graduates enter health care settings throughout Arizona, where many will care for patients in regions where Valley Fever is endemic. Since its publication, the article has been featured as the top story in the American Association of Nurse Practitioners' (AANP) SmartBrief and covered by television stations in Fresno, California.
Valley Fever (coccidioidomycosis) is caused by inhaling fungal spores in soil and dust across the southwestern United States and parts of the Pacific. According to the Centers for Disease Control and Prevention, the disease has historically been most common in Arizona, California, Nevada, and New Mexico. Symptoms typically appear one to three weeks after exposure and closely resemble the flu or pneumonia, making diagnosis challenging.
Reported cases of Valley Fever have risen sharply over the past two decades, and the disease's geographic range continues to expand. Arizona remains the epicenter, reporting more than 12,000 cases in 2025, after recording 9,515 cases in 2022. California reported 7,459 cases in 2022. Although many people recover without treatment, up to five percent develop severe disease that spreads beyond the lungs to the skin, bones, or central nervous system. There is currently no vaccine to prevent Valley Fever.
Estrada says that because Valley Fever symptoms mimic other respiratory illnesses, patients are often misdiagnosed. Many patients do not receive the correct diagnosis until about 23 days after their first medical office visit. She notes that about 80% of patients receive one or more unnecessary courses of antibiotics before receiving the correct diagnosis, even though antibiotics are ineffective against fungal infections. Delayed diagnosis can prolong illness and increase the risk of serious complications.
As both a nurse practitioner and an educator, Estrada said that increasing clinical recognition of Valley Fever has been a longstanding professional goal.
"Early in my career, I learned from experts at the University of Arizona's Valley Fever Center of Excellence (VFCE) about the importance of Valley Fever testing," Estrada said. "Over time, I realized that testing was not routinely performed, even among providers in endemic areas such as Arizona. When Dr. Adebiyi and I discovered we shared a commitment to educating providers about Valley Fever, it led to this collaboration."
The publication introduces the COCCI framework, an evidence-informed clinical tool adapted from the VFCE's management approach. The framework encourages providers to: consider the diagnosis, order the test, check for risk factors, check for complications, and initiate treatment. It provides nurse practitioners with an easy-to-remember, structured approach to deciding when to test, treat, or refer patients for specialty care, helping reduce treatment delays.
"Too many Arizona patients spend weeks being treated for the wrong illness because Valley Fever isn't considered early enough," Estrada said. "My goal is to shorten the time from a patient's first visit to an accurate diagnosis, reduce unnecessary antibiotic use, and improve patient outcomes."
"Preparing nurse practitioners to recognize conditions such as Valley Fever is part of our responsibility to Arizona," said Sarah J. Locke, DNP, MBA, FNP-BC, RNC-OB, NE-BC, Family Nurse Practitioner specialty coordinator in the DNP Program. "Faculty scholarship, such as Dr. Estrada's, ensures our students graduate with the latest evidence-based knowledge, enabling them to provide better care for patients from their very first day in practice."
"Having our study published is an exciting achievement," Estrada said. "It allows me to share information I am passionate about with other nurse practitioners and healthcare providers."
Having joined the College of Nursing faculty in January 2025, Estrada brings a unique perspective as also being a three-time alumna. She completed the college's accelerated nursing program and later returned to earn her FNP credential and DNP degree. Estrada credits the college community with supporting her growth as an educator and scholar.
"Our faculty are not only generating new knowledge but also bringing it directly into the classroom," said Lauren Acosta, PhD, RN, SANE-A, CPH, division chair of Nursing and Health Education. "By preparing nurse practitioners to recognize Valley Fever earlier, the College of Nursing is helping strengthen Arizona's healthcare workforce and improve care for communities across our state."
Through faculty education and research, the College of Nursing is helping strengthen Arizona's healthcare workforce by preparing nurse practitioners to recognize Valley Fever sooner, resulting in earlier diagnoses, more appropriate treatment, and better patient outcomes for communities across Arizona.