Reports of Valley Fever on the Rise

San Francisco Chronicle (CA)-­March 31, 2013
Author: Erin Allday

Large swaths of California, as far north as Redding and down to San Diego, have seen a dramatic
spike in Valley Fever, a fungal infection that causes flu-­‐like symptoms and can be deadly.

Cases of the illness in California rose about 13 percent per year every year from 1998 to 2011,
according to a new report by the U.S. Centers for Disease Control and Prevention. There were 719
cases in 1998 and 5,697 in 2011.

Nationwide, the total number of cases increased tenfold over that period, from 2,265 in 1998 to
22,401 in 2011.

It's likely that most of that increase is due to more awareness of the disease and doctors doing a
better job diagnosing and reporting cases, and not because more people are actually getting sick,
say Valley Fever experts.

But that means public health authorities are only now beginning to understand the scope of the
illness -­‐ and the number of reported cases will probably keep increasing over the next few years.

"One of the problems with the disease is people don't recognize it. Even doctors aren't very good
at it," said Dr. David Stevens, Chief of Infectious Disease at Santa Clara Valley Medical Center,
San Jose, President of California Institute of Medical Research, San Jose, which has a laboratory
designed specifically to study Valley Fever, and Professor of Medicine at Stanford.

"The true magnitude of Valley Fever is just being appreciated now," he said. "We may end up with
more than 150,000 people a year, once we get a handle on this number."

Valley Fever is caused by the Coccidioides fungus, which lives in the soil in the southwestern
United States. In California, the fungus most commonly is found in the Central Valley, but there
are colonies of it throughout the state. Stevens believes there are pockets of the fungus in Contra
Costa County.

People become infected with the fungus by inhaling its spores, which are released when the soil is
disturbed, such as from dust storms or construction projects. Stevens said he's heard of entire
archaeological teams becoming infected after digging up sites in the Central Valley. In 2006, more
than 500 inmates at Pleasant Valley State Prison near Coalinga developed Valley Fever during construction on a nearby state hospital.

Not everyone who inhales the spores will get sick, and many of those who develop symptoms never
seek treatment. Symptoms include fever, coughing, chest pain, fatigue and headaches, and often are
confused for the flu.

Complicating the diagnosis is the fact that symptoms usually take several weeks to show up. Most
people recover without any treatment, and antifungal drugs usually are effective for those who need

But the fungus can be tricky and will sometimes lurk in the body long after a person seems to have
recovered, only to reactivate months or even years later. In these patients, the fungus can spread
beyond the lungs and cause spotty rashes on the skin and swollen, achy joints. It also can cause
meningitis, a deadly condition in which the fluid around the brain or spinal cord becomes infected.

Early treatment of the infection can help prevent the onset of later, more serious symptoms,
Stevens said.

The California Department of Public Health recommends that people with weakened immune systems
avoid inhaling dust, and that people who work in dusty conditions, especially in parts of the state
where the fungus is found, use respiratory protection.

Eradicating the fungus from the soil isn't possible, so infections are always going to occur.
Stevens said he and other scientists are working on a vaccine, along with more effective
treatments, although progress has been slow.

"If you could vaccinate people and make them immune to the fungus before they get infected, that
would be the best way to protect and prevent infections," Stevens said. "Otherwise, there's not
much you can do about prevention -­‐ you have to breathe."

Erin Allday is a San Francisco Chronicle staff writer. E-­‐mail: [email protected]