Drought conditions, travelers can spread Valley fever into California’s northern counties

08/02/2014 4:38 PM

10/07/2014 8:07 PM

Don Hopkins, a former Davis police officer and professional ballroom dancer, is having some trouble staying on his feet.

Hopkins, 67, is still physically drained from an early May trip to Mercy Hospital at Folsom, where doctors pumped him with pneumonia antibiotics for more than a week before accurately diagnosing his Valley fever.

As Hopkins’ temperature soared and he began to hallucinate, his wife, Lizette, insisted the doctors test for the disease, which is historically more prevalent in the southern Central Valley. Though Hopkins’ test results would surprise many in the Sacramento region, experts say the fever is not constrained to the south state and can be carried to other regions via travelers and drought conditions.

“When doctors see somebody with what they think is pneumonia, they immediately give them antibiotic,” said Hopkins, who lives in the El Dorado County foothills. “Often the patient gets worse and the doctors don’t think about Valley fever. It can basically disable a person for the rest of their life.”

Valley fever is caused by a species of fungus called coccidioides, which lives in the soil in Southern California, Arizona, Mexico and parts of Central America and can be brought to the surface by construction, agricultural work and other activities that disrupt the terrain, said Dr. George Thompson, director of the Coccidioidomycosis Serology Lab at the UC Davis Medical Center.

Once airborne, the spores can travel beyond these endemic regions on a mere gust of wind. Thompson called the assumption that the disease is only a Southern California problem a “total misconception.”

“The maps of where it is are well done, but those were in the ’40s,” Thompson said. “I think we’re going to see it all the way up through Oregon into Washington, maybe into Idaho and Nevada ... I think the region of it being endemic is going to expand a few hundred miles.”

In Sacramento and its surrounding counties, the mold occurs naturally but in small quantities, Thompson said.

There are four confirmed cases and 20 suspected cases of Valley fever for Sacramento County in 2014. There is one confirmed case in El Dorado County, one suspected case in Placer County and two confirmed cases in Yolo County.

Officials in northern counties believe the cases in their regions were acquired elsewhere, by people who traveled south and then returned home sick.

“Placer County is not really known for it so much as the southern Valley is, so we just make sure the local providers have information on what it is and how to treat it,” said Wesley Nicks, director of public health for Placer County. “But we don’t track it as really a very common disease in this area.”

Don and Lizette Hopkins said they have not recently traveled to any areas known for Valley fever. They did, however, remove some jasmine from a garden in Citrus Heights and replanted it in their home garden in Serrano shortly before Don Hopkins fell sick, which they suspect could have been the cause of his illness.

“Up here, we’re worried about the green rock and the asbestos,” Lizette Hopkins said. “We’re not thinking about Valley fever. Not up here in the foothills.”

The number of cases of Valley fever nationwide increased by about 15 percent each year between 1998 and 2011, according to the Centers for Disease Control and Prevention. Its prevalence in the future will depend on a number of factors, including drought, rainfall and temperature.

Coccidioides follows a “grow and blow” cycle, in which rain helps it grow beneath the soil and then exposure to dry, hot air breaks it down into spore form, which ultimately enters the lungs. Thompson said the fungus has the potential to spread further in a dry, dusty environment, much like it did in 1991, in California’s last major drought.

“This was a particularly bad drought year, so if we have a big windstorm we’re really in trouble,” he said. “When it dries out, the fungus doesn’t die.”

About 60 percent of people who contract Valley fever do not exhibit symptoms, and the rest develop mild to severe pulmonary infections, according to a study Thompson authored with two members of the CDC. About 1 percent of victims develop a more severe stage of the disease, which can affect the central nervous system and other organs, and is more common among people of African or Filipino descent, according to the study.

Jessica Einstein, executive director of the Valley Fever Americas Foundation in Bakersfield, said the disease can be difficult to diagnose because its symptoms are so close to those of flu and pneumonia and because doctors trained outside of California and Arizona are most likely unfamiliar with the disease. Promoting awareness among physicians across the state is one of the foundation’s main goals.

“Just because it’s not the center of prevalence doesn’t mean it can’t happen – doctors need to realize that,” she said. “And most people in California travel. Pretty much anytime you travel, you go through the Central Valley. It’s something everyone in California should be aware of.”

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