California valley fever

California valley fever is a ‘silent epidemic’ of airborne fungus in U.S. southwest

Patricia Leigh Brown, The New York Times, National Post Wire Services | 13/07/05 | Last Updated: 13/07/05 1:28 PM ET

John Walker/AP Photo files    Valley Fever, a little-known disease infecting more people nationwide every year, is especially prevalent in California’s San Joaquin Valley. Every day millions of residents in this agricultural region live with the threat of the disease, which is caused by a fungus in the soil. People who work in dusty fields or construction sites are most at risk, but visitors can contract the disease from passing through, too.

BAKERSFIELD, Calif. — In 36 years with the Los Angeles police, Sgt. Irwin “Joe” Klorman faced many dangerous situations, including one routine call that ended with Uzi fire and a bullet-riddled body sprawled on a living room floor.

But his most life-threatening encounter has been with coccidioidomycosis, or valley fever, for which he is being treated here. Coccidioidomycosis, known as “cocci,” is an insidious airborne fungal disease in which microscopic spores in the soil take flight on the wind or even a mild breeze to lodge in the moist habitat of the lungs and, in the most extreme instances, spread to the bones, the skin, the eyes or, in Klorman’s case, the brain.

The infection, which the Centers for Disease Control and Prevention has labelled “a silent epidemic,” is striking more people each year, with over 20,000 reported cases annually throughout the Southwest, especially in California and Arizona. Although most people exposed to the fungus do not fall ill, about 160 die from it each year, with thousands more facing years of disability and surgery. About 9% of those infected will contract pneumonia, and 1% will experience serious complications beyond the lungs.

A U.S. federal judge ordered the state to transfer about 2,600 vulnerable inmates

The disease is named for the San Joaquin Valley, a cocci hot spot, where the same soil that produces the state’s agricultural bounty can turn traitorous. The “silent epidemic” became less silent last week when a U.S. federal judge ordered the state to transfer about 2,600 vulnerable inmates — including some with HIV — out of two of the valley’s eight state prisons, about 90 miles north of here. In 2011, those prisons, Avenal and Pleasant Valley, produced 535 of the 640 reported inmate cocci cases, and throughout the system, yearly costs for hospitalization for cocci exceed US$23-million.

The pending transfer has underscored the complexities and mysteries of a disease that continues to baffle physicians and scientists. In Arizona, a study from the Department of Health Services showed a 25% risk of African-Americans with newly diagnosed valley fever developing complications, compared with 6% of whites.

“The working hypothesis has to do with genetic susceptibility, probably the interrelationships of genes involved in the immune system,” said Dr. John N. Galgiani, a professor at the University of Arizona and the director of the Valley Fever Center for Excellence, founded in 1996. “But which ones? We’re clueless.”

Kandis Watson, whose son Kaden, 8, almost died, had a gut feeling that “something was not right,” she said, when Kaden began feeling sick two years ago. The pediatrician prescribed antibiotics, but Kaden’s health deteriorated, with a golf ball-size mass developing at the base of his neck. The infection enveloped Kaden’s chest, narrowing his trachea. Kaden was essentially breathing through an opening the size of a straw, said Dr. James M. McCarty, the medical director of pediatric infectious diseases at Children’s Hospital Central California in Madera, where Kaden spent six months. Today the boy is back to his mischievous self, surreptitiously placing a green plastic lizard in his mother’s hair.

But how he contracted valley fever is still guesswork. “I think he got it being a boy, digging in the dirt,” Watson said.

Kern County, where Bakersfield is located, had over 1,800 reported cases last year. At the Kern Medical Center, Dr. Royce H. Johnson and his colleagues have a roster of nearly 2,000 patients. Many, like Joe Klorman, have life-threatening cocci meningitis.

“I got a bad break,” said Klorman, who preferred a squad car to a desk job until the illness forced his retirement. Now he travels four hours round-trip three times a week so that Johnson can inject a powerful anti-fungal drug into his spinal fluid. In other patients, the disease has been known to eat away ribs and vertebrae.

“It destroys lives,” said Johnson, whose daughter contracted a mild form. “Divorces, lost jobs and bankruptcy are incredibly common, not to mention psychological dislocation.”

Once athletic, Deandre Zillendor, 38, dropped from 220 to 145 pounds in two weeks, and lesions erupted on his face and body. “You keep it forever, like luggage,” he said of the disease.

Todd Schaefer, 48, who produces award-winning pinot noirs in Paso Robles, was told by his doctors that he had 10 years to live. That was 10 years ago. Valley fever has disseminated into his spinal column and brain, and his conversation is interrupted by grimaces of pain. Ruggedly handsome, he still outwardly resembles the archetype of the California good life.

But Schaefer has had a stroke, a hole in his lung, two serious heart incidents and relapses that “put me on the edge of life,” he said.

He believes he got infected with valley fever atop a tractor during the construction of Pacific Coast Vineyards, which he runs with his wife, Tammy. One doctor initially suggested bed rest, chicken soup and cranberry juice.

Today Schaefer can no longer drink wine, and he begins every morning retching. “I told her to leave me,” he said at one low point, of his wife, who is 37. “She’s too young, too beautiful.”

Dr. Benjamin Park, a medical officer with the CDC, said that the numbers of cases are underestimated because some states do not require public reporting. They include Texas, where valley fever is endemic along the Rio Grande. In New Mexico, a 2010 survey of doctors and clinics by the state’s public health department revealed that 69% of clinicians did not consider it in patients with respiratory problems.

Numbers spike when rainfall is followed by dry spells. Many scientists believe that the uptick in infections is related to changing climate patterns. Kenneth K. Komatsu, the state epidemiologist for Arizona, where 13,000 cases were reported last year, said that another factor may be urban sprawl: “digging up rural areas where valley fever is growing in the soil,” he said.

In Avenal, citizens have become activists, looking into possible environmental factors, including a regional landfill that accepts construction waste. Three of the four children of James McGee, a teacher, have contracted the disease, including Marivi, 17, who was found convulsing in the ladies’ room at school. McCarty of Children’s Hospital is seeing an increasing number of children from Avenal.

Valley fever was a familiar presence during the Dust Bowl and in Japanese internment camps throughout the arid West. Yet there is still no cure, and research on a fungicide and a potential vaccine have been stalled by financing issues. One company, Nielsen Biosciences Inc., has developed a skin test to identify cocci but has not yet been able to make it financially viable.

Part of the difficulty is that cocci is “a hundred different diseases,” Johnson said, depending on where in the body it nests. His patients include farm workers, oil field workers and construction workers.