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Tuesday, July 30, 2013

Valley Fever Strikes Hard In California Towns

Arthroconidia of Coccidioides immitis. (Centers for Disease Control and Prevention)

Arthroconidia of Coccidioides immitis. (Centers for Disease Control and Prevention)

Often considered a “silent epidemic,” valley fever officially infected 22,000 Americans in 2011 — most of them in California and Arizona — but some think the numbers are much higher.

It’s an infection that can wreak havoc on the lungs, heart, bones and in some cases the brain. At its worst, its fatal.

Valley fever is prevalent in hot, dry climates and it’s thought to spread through contact with soil.

In the past two decades, about 2,000 people have died from it. And in one town, the prevalence is so high that a judge ordered 26 prisoners moved from the local jail because they were deemed to be at too high a risk of infection.

Three sick siblings

Jim McGee is a parent of four in the small town of Avenal, Calif. Three of his four children have contracted valley fever. Two of them presented flu-like symptoms, but it was worse for his older daughter.

“One day at school, she didn’t come back from the restroom. One of her friends came to check on her and found her in the middle of the bathroom floor, unconscious and convulsing,” McGee told Here & Now.

There is a need for more attention, for more resources to try to develop a prevention for this disease.
– Dr. Jim McCarty

McGee had no idea what was wrong at first.

“They checked her for many, many things,” he said. “She went to a neurologist. She also went, you know, to our family doctor, and he immediately suspected she had Valley Fever.”

His daughter had to miss six weeks of school while she recovered, and all three children have lingering effects of the disease.

Cases on the rise

Dr. Jim McCarty, a pediatrician who specializes in infectious diseases at Children’s Hospital Central California, treated McGee’s children.

“If patients have these flu-like symptoms — with fever and cough and joint pain and muscle aches and rashes — and weeks have gone by, then I think it’s important that they and also their healthcare provider consider valley fever as a possibility,” McCarty said.

For reasons that aren’t yet understood, the incidence of valley fever is rising. McCarty expects it’s due to a combination of weather, more human activity that disrupts dust and more susceptible people moving to the area.

A need for more research

“There is a need for more attention, for more resources to try to develop a prevention for this disease,” McCarty said, noting that valley fever is not well understood — despite being endemic in the Southwest — because there isn’t much funding for research, controlled trials or the development of a vaccine.

For McGee’s family, the children’s health problems have caused the family to think seriously about moving.

“We’re up in the air about what we are going to do, but we’re certain we’re going to have to do something,” McGee said.

Guest

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New York Times “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.”

Transcript

ROBIN YOUNG, HOST:

And we have this news: Bradley Manning has been found not guilty of aiding the enemy. He's been convicted of violating espionage, the Espionage Act and other charges. We will have more for you later in the program. But right now we want to take a look at Valley Fever. This is a fungal infection that's so bad in some towns in Central California, Arizona and New Mexico that in one vulnerable prisoners have been moved out of prisons, and some families have sent children out of town.

In mild cases, it simply causes fever and malaise, but it can escalate and affect the lungs, heart, bones and in some cases brains. At its worst, Valley Fever can be fatal. In the last 20 years, some 2,000 people have died from it. In a moment, Dr. James McCarty, director of pediatric infectious disease at Children's Hospital Central Florida, but first one of his families.

Jim McGee is a father of four and a teacher in a small town in central California. He joins us from the studios of Capital Public Radio in Sacramento. And Jim, I understand that three of your four children have Valley Fever. How did it start?

JIM MCGEE: The first one was my youngest, and she was nine years old at the time. Two years ago in the month of May, she was very, very ill. She had flu-like symptoms, and she didn't respond to treatment or medication. And finally she developed pneumonia and was so bad that she had to be taken by ambulance to Children's Hospital, just outside of Fresno.

There, Dr. McCarty discovered that she not only had pneumonia, but she also had Valley Fever, which he treated her for both. She was in the hospital for about a week and a half and then released home.

YOUNG: So that's the first child in your family. Did you know what Valley Fever was? Was this a shock to you, or did you think, oh...

MCGEE: No, it was not a shock to me. In fact my wife had been after me for some time that she thought it might be a good idea if we actually left the area because we have such a high incidence of Valley Fever in the town that we live in. It's a little town called Avenal. We seem to have a disproportionately large number of cases of Valley Fever there, so much so that the state prison that's located there has been ordered to move out a large percentage of their population due to the high incidence of Valley Fever.

YOUNG: Yeah, 2,600 high-risk prisoners were moved, replaced by inmates from elsewhere in the state, at least that's the plan. This was just last month. You know, we immediately think, wow, even the prisoners were able to get out, but, you know, some families have to stay there for different reasons. You have this one daughter who was sick. Who was the next child?

MCGEE: The next one was my son, and his symptoms were very much the same, however his was caught rather quickly by our local doctor. He was started on medication, and he missed about six weeks of school.

YOUNG: Wow.

MCGEE: It was - it made a very difficult situation for him in his school year. Both my youngest, Ariana(ph), and my son Marcos(ph) had the more traditional kind of Valley Fever, which is, you know, respiratory. However, Valley Fever can affect, you know, the tissues, and it can even affect the brain.

YOUNG: Well, that brings us to your oldest daughter. She had different symptoms. She was dizzy and, well, was found on the bathroom floor convulsing.

MCGEE: Right. For over a month, perhaps two months or more, she had headaches, fatigue, dizziness, and she went to several different doctors and was tested in many different ways. No one had the slightest idea what was the matter with her. On two occasions at home, she fell, and it was like a momentary faint, and then one day at school she didn't come back from the restroom.

One of her friends came to check on her and found her in the middle of the bathroom floor on the ground, unconscious and convulsing. At this point we had no idea what it was. They checked her for many, many things. She went to a neurologist. She also went, you know, to our family doctor, and he immediately suspected that she had Valley Fever. He was absolutely correct. It was Valley Fever.

YOUNG: So she's being cared for. You have a diagnosis. But, you know, it did go into her brain. So what is her prognosis?

MCGEE: Well, she seems to have recovered rather well. She too missed six weeks of school, but she is still plagued with a certain level of fatigue. She has difficulty in the heat. We have a rather warm, dry climate here, and when the temperatures go up, she pretty much melts. And so she has to stay in and quiet. All three kids, when they exert themselves excessively, become tired, and it takes them a while to recover.

YOUNG: Well, I mentioned this in passing, and some people might be thinking what are you doing there? I mean, it's thought that Valley Fever is from this fungus that is in the soil. It gets airborne. It can't go from person to person, but it gets into the air, and people inhale it. So why not get out of there? What has this done to your family?

MCGEE: We had been talking about getting out of there even before the first child came down with Valley Fever. Before we were able to make a move, the other two came down with Valley Fever. Neither my wife nor I have had it. And our oldest daughter has not had it, either. She's married and out of the house and has her own family.

I teach school there, and I particularly like my job. I've been there for over 18 years now. Now we're faced with this dilemma. Does a person who has had Valley Fever and has it in their system, is that it? Do they have it and they're over it or do they get it again? We don't know. As a consequence, my son is going to be going to school in Stockton. He's going to be actually out of Avenal.

My older daughter is in her senior year in high school, and, you know, she's going to be going away to college. And the other three of us are talking very seriously of leaving.

YOUNG: You're looking for new work?

MCGEE: Yeah, I haven't decided exactly what I'm going to do. I'm near retirement age, and, you know, we're up in the air about what we're going to do, but we're certain that we're going to have to do something.

YOUNG: Jim McGee, three of his four children contracted Valley Fever. Jim, stay right there because we're going to bring in the physician who treated your children and look at how to diagnose this infection. Meanwhile, Jeremy, you've been keeping an eye on the news.

JEREMY HOBSON, HOST:

Yeah, as we mentioned, Army Private Bradley Manning has been acquitted of aiding the enemy, for giving secrets to WikiLeaks, but he was convicted of five espionage counts. We're going to have more on that story with a law professor later in the show. You're listening to HERE AND NOW.

(SOUNDBITE OF MUSIC)

YOUNG: I'm Robin Young; it's HERE AND NOW. We've been talking about Valley Fever, that's a potentially fatal disease caused by a fungus that lives in dry soil in the West and Southwest. In mild cases it causes fever, malaise. In more serious forms, it can damage organs and tissue, even lead to meningitis. Cases are on the rise. According to the Centers for Disease Control, they've risen tenfold since 1998. and no one has pinpointed exactly why.

We've been speaking with Jim McGee of Avenal, California. Three of his four children came down with Valley Fever. Let's bring in their doctor, James McCarty, director of the pediatric infectious disease at Children's Hospital Central California. He's at the studies of KALW in San Francisco. And Dr. McCarty, for you this is not just numbers on paper. What are you seeing at the hospital?

JAMES MCCARTY: From 2010 through 2012, we saw a very dramatic increase in the number of children that we hospitalized with Valley Fever. March of 2012, we had 16 children in the hospital who were in-patients with Valley Fever, most of them very sick. So we've seen a big run-up in the incidence of this disease.

YOUNG: Well, this isn't a new problem. We read about how on military bases in the past in the West, lawns were planted to try to tamp down this spore that's in the ground. But why do you think there's an increase now?

MCCARTY: Well, I'm not sure anybody really knows why there is an increase. It may be a function of an increased number of susceptible people that have moved into the area, possibly some increased detection, although I think we're clearly seeing more patients with this.

Is there increased human activity that's generating more dust? And lastly, is this a function of weather? I mean, are we seeing weather patterns that are promoting the growth of the organism, and there's just more of it out there to spread around?

YOUNG: Yeah, you talk about susceptibility, and we understand that some are far more susceptible than others - blacks, for instance, and Asians. Do we know why that is?

MCCARTY: We don't. There's probably some genetic explanation for that, but I don't think anybody really has a good handle on why specifically African-Americans, people of Filipino ancestry and other groups are at higher risk for getting severe disease.

YOUNG: What would you want people to know about this?

MCCARTY: Well, it's difficult to avoid exposure if you live in an area where this is endemic because dust is everywhere. It's just part of the environment that we live in in the Central Valley of California. When I'm asked this by parents, I recommend that people, particularly high-risk people, should avoid large amounts of dust exposure in endemic areas.

So, if there's construction going on nearby, they should avoid that dust. On dusty, windy days, it's probably better to stay indoors than to go outside. And I think it's also important that people, and also their health care providers, are more aware of Valley Fever so that they can pick up the signs and symptoms more quickly and make a diagnosis more quickly.

YOUNG: That counts, right?

MCCARTY: It does. In our experience, the longer it takes to diagnose a patient, often the more severe their disease and the more difficult their treatment.

YOUNG: Well, it's so funny you say stay out of dust. We're talking about the valley, you know, between the ocean and the mountains in California in this case.

MCCARTY: That's why I'm saying, it's difficult to limit exposure, and we can just do what's prudent and try to avoid excessive or intense dust exposure.

YOUNG: Here on the East Coast, people wrestle with Lyme disease and have it in varying severity. You know, some feel they have it in a recurring way. Is that the same with Valley Fever, that some people get over it after some treatment, others feel that it comes back, or that it lingers?

MCCARTY: I think all those situations are true. Most people who get Valley Fever never even become clinically ill with it, and then others get a mild illness, which runs a self-limited course. And then some will develop a pneumonia, which sometimes requires treatment, sometimes requires very extensive treatment. And then some people develop severe disease, which can be life-altering, can result in permanent disability, or it can even be fatal.

YOUNG: Can you cure it completely once you have it?

MCCARTY: Well, most patients with Valley Fever we're able to cure. The organisms probably do reside in your body for the rest of your life, and there's also the possibility that later in life you might have some reactivation disease. But certainly in our experience most of the patients that we treat we send them on their way and they do well.

The patients who develop Valley Fever meningitis, however, that's a lifelong disease. There's no cure for that. You can suppress the disease, and many patients can live a normal life, but many cannot. And they all require lifelong therapy with antifungal drugs.

YOUNG: Well, I was reading an article about a man who traveled to the West from Britain and went home and had terrible respiratory problems, and it wasn't until they went in that they realized that the fungus had actually grown. It was golf-ball-size. Is that part of what happens when there are respiratory problems?

MCCARTY: We'll frequently see patients that will come in with very large and extensive pneumonias. Often we'll see patients with cavities, we'll see lung abscesses, we'll see what are called pleural empyemas with this. Now, there are a variety of lung manifestations of this.

YOUNG: But if it presents as a severe flu in the beginning, in most cases, how do you? How did you know that Jim McGee's daughters had it?

MCCARTY: Well partly because of where they're from. So he's from a highly endemic area. So we always consider Valley Fever in any patient we see from Avenal, California. The thing that differentiates this from, let's say, a simple flu is that this goes on longer. So if patients have these flu-like symptoms, with fever and cough and joint pain and muscle aches and rashes, and weeks have gone by, then I think it's important that they and also the health care providers consider Valley Fever as a possibility.

YOUNG: Is there any - I mean, we hear there's a vaccine, might be incredibly expensive. I mean, there isn't one right now. Is this just the way it is, that people just have to suffer?

MCCARTY: No, I think there is a big need for a vaccine and for vaccine development. I think there's not funding available for this. And so I think there is a need for more attention with resources to try to develop a prevention for this disease and also to better understand the treatment. There's really not much out there in terms of well-controlled trials that have evaluated the treatment of Valley Fever.

YOUNG: Well, and as we said, we've heard from Jim McGee, who had three children in his family who have it. I want to bring Jim back in. Jim, are you there?

MCGEE: Yes, I am.

YOUNG: Well, this must be dispiriting to hear a lot of this, although you're living it. I just wonder how you feel because we're reading in some articles that there are people in other parts of California who have never heard of it, and here it has completely disrupted your family.

MCGEE: That's true. I talk to people in Stockton, which only a two-and-a-half-hour drive from Avenal, who are just completely unaware of Valley Fever and others who have just only remotely heard about it and have had no contact with anybody who's ever had it. And - but you go just slightly south, and it's a huge problem.

YOUNG: Well, you're - in your town in particular. What would you want people to know?

MCGEE: Where we live, you know, it's something that we're coping with, and I think when anybody is choosing a place to live that they should very carefully consider this as one of the major factors.

YOUNG: That can't be good for Avenal. I hear it's a small town anyway.

MCGEE: The town is, you know, 90 to 95 percent Hispanic. There are a lot of people who work in agriculture. They would have to completely change their lives in order to go someplace else. And so it's something that they cope with.

YOUNG: That's Jim McGee. He lives in Avenal, California. His three kids contracted Valley Fever there. And their doctor, James McCarty, head of the Pediatric Infectious Diseases Division at Children's Hospital Central California. Gentlemen, thank you both.

MCCARTY: Thank you.

MCGEE: Thank you for having us.

YOUNG: So do you live in these affected areas? Have you had experience with Valley Fever? What would you want people to know? Go to hereandnow.org. We'd love your thoughts. While there, your thoughts on the Bradley Manning verdict, not guilty of aiding the enemy, although five charges of espionage. In the next half-hour we're going to ask what does that mean for Bradley Manning, for Edward Snowden, also charged with leaking secrets. And we'll speak with a law professor, but we'd love your reaction to the verdict, as well, hereandnow.org. Latest news is next, HERE AND NOW. Transcript provided by NPR, Copyright NPR.


Please follow our community rules when engaging in comment discussion on this site.
  • Eve

    How about ceasing the use of gas/electric blowers? This would cut down on much of the dust in crowded cities and neighborhoods and possibly cut down on the airborne dispersal of Valley Fever fungus.

  • Jackie

    My 31 year old husband has been battling this disease for almost 5 months now, which has resulted in four hospital stays, three surgeries, and endless medical bills. Unfortunately, he has contracted disseminated cocci, which affects only about 1% of those infected. We were unaware of this disease prior to moving to Phoenix, Arizona. Thank you for doing this story and getting the word out there about the severity of this disease.

  • Ginny

    My mother died of Valley Fever in 2008. It was diagnosed conclusively in
    her post mortem exam. She and my father had spent 30 winters in the desert
    Southwest. Spots were noticed in a chest x-ray which lead to lung
    biopsies (inconclusive) and eventually because of her fear of possible lung
    cancer, to the removal of part of a lung. She never fully recovered. We were
    told that the biopsy and surgery actually broke through the capsule that had
    naturally surrounded the nodule of coccidiomycosis in her lung. We were told that
    if they’d been left alone, she probably would have survived.

    Ginny

    • andic_epipedon

      That sound horrible. It speaks to the fact we need better diagnostics.

  • Heyhootie

    My dog had this disease. It took over 9 months for the vet to figure out what was making him so sick. He had lost a third of his body weight and we were about to out him down. As a last resort the vet tried anti-fungals and within a week we saw a difference. It has now been over two years and he will forever be on medication. Thankfully he is a happy, healthy dog otherwise.

  • andic_epipedon

    More political pressure needs to be placed on the government and pharmaceutical companies to deal with this problem.

    After working in the Central Valley in California for three years as a soil scientist I wouldn’t doubt that as much as 90% of the population in the Central Valley has been exposed to the fungus and overcame the illness on their own. I think it’s obvious that there is a lot of man-made soil disturbance and natural disturbance (i.e. wind) and there is no prevention. Whoever mentioned prevention by not going outside is unrealistic. Who wants and is able to live in a box indoors 24/7.

    Most of the population that is exposed to Valley Fever is never diagnosed and only gets flu symptoms. I have been aware of this occupational hazard for almost 20 years. My doctors have never taken into consideration the possibility that I could have Valley Fever being in a high risk group for exposure. And once I left the Central Valley none of the doctors even knew what it was.

    I was unaware that it was anywhere but the Central Valley of California until just recently. It was once thought to be contained to a specific geologic formation, but now it is obvious that is not the case. No one has studied treatments and diagnostic tests very well. The best that they can come up with is that the fungus likes arid climates. It’s part of life and it should be studied and the diseases that come from it should be treated.

Robin and Jeremy

Robin Young and Jeremy Hobson host Here & Now, a live two-hour production of NPR and WBUR Boston.

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