As Valley fever cases spike, experts say awareness is vital

In 2011, Renee Lascaux went to her doctor’s office in Tracy with a fever, cough and headache. Her doctor took an X-ray, said it was pneumonia and sent her home with antibiotics. Within a week, she was in an emergency room with worsening symptoms.

“I was losing hair – literally losing clumps of hair – and they tried to tell me it was because of age,” said Lascaux, 66.

Lascaux, an artist who now lives in Madera, said her doctors didn’t recognize that she had Valley fever, a fungal lung infection, when they first diagnosed her. She ended up spending 60 days in the hospital as doctors worked to identify and combat the disease. After she was discharged, she was prescribed an anti-fungal medication, Itraconazole, which likely will be part of her routine for the rest of her life.

Most commonly found in California’s Central Valley and Arizona, Valley fever cases, which had been decreasing in recent years, are on the rise again. In 2014, California reported 2,243 infections, according to the Centers for Disease Control and Prevention. By 2015, that number jumped to 3,053.

Locally, doctors at UC Davis also have seen seen an increase in Valley fever infections. In October 2015, UC Davis doctors identified five cases; last October they had more than 20.

“Essentially about four months ago we noticed a huge spike in positive samples,” said Dr. George Thompson, co-director of the Coccidioidomycosis Serology Lab at UC Davis Medical Center.

Difficult to diagnose because its symptoms can resemble the flu or pneumonia, Valley fever spreads through airborne spores from a fungus called coccidioides, Thompson said. The disease, which primarily lives in the soil in the West and Southwest, usually is brought to the surface by agricultural, construction and other outdoor work.

Most people’s immune systems are able to suppress the disease, and mild cases usually clear up on their own. However, bodies that can’t handle the infection face the risk of having it leave the lungs and turn into a more malignant illness such as meningitis. In extreme cases, Valley fever infections can be fatal.

The fungus thrives after a very wet period followed by a long dry period. Last year’s late rainy season and hot, dry summer and fall were prime conditions for the coccidioides to grow and spread, Thompson said.

 

According to Dr. Ian McHardy, co-director of the Coccidioidomycosis Serology Lab, almost a quarter of pneumonia cases in the Central Valley are caused by coccidioides fungal infection and not by bacteria. Because the disease manifests similarly to common bacterial and viral infections, misdiagnoses are common.

While there are inexpensive, generic fungal infection medicines that sometimes work for Valley fever, McHardy said, coccidioides-specific treatments tend to be expensive. One in three cases of Valley fever has a strain of the fungus that isn’t responsive to typical treatment, he said.

There isn’t much incentive for pharmaceutical companies to develop or mass produce Valley fever treatments because it is a “niche infection,” typically found in the West, McHardy said.

Because Valley fever spreads through airborne spores, avoiding the disease is difficult.

“Once it’s in the air, it can travel hundreds and hundreds of miles,” Thompson said.

The CDC recommends “common-sense methods” for discouraging Valley fever infections. They include avoiding dusty areas such as excavation or construction sites, and staying indoors during dust storms.

However, general awareness of the disease can go a long way in helping to fight it, Thompson said. Often, it takes months for doctors to correctly diagnose Valley fever, and then patients can have weeks or months of continuing symptoms even with effective therapy. Diagnosing people at the time of the infection and getting proper treatment for them would mean people aren’t sick for as long, and decrease the risk of the disease worsening.

Lascaux said she believes if she were diagnosed with Valley fever earlier, her treatment could have been more effective.

“It seems like if you’re going to get (Valley fever), you’re going to get it,” she said. “The best you can do is try to stay healthy and be aware of what Valley fever is in the first place. For doctors and people who are sick, if you go in for treatment, feeling like you have the flu with a fever, cough and headache, you can ask, ‘Could I have Valley fever?’ The sooner you get to it, the sooner your immune system can start dealing with it.”

This story was originally published March 8, 2017 at 2:46 PM with the headline "As Valley fever cases spike, experts say awareness is vital."