Long Read: “Death Dust”

Special for our Southwestern/Californian correspondents. Dana Goodyear in the New Yorker on “The Menace of Valley Fever“:

…In soil, Coccidioides immitis exists in chains of barrel-shaped units called arthroconidia; airborne, these fragment easily into lightweight spores. C. immitis is adapted to lodge deep: its spores are small enough to reach the end of the bronchioles at the bottom of the lungs. We can breathe them in, but we can’t breathe them out. Once in the lung, the spore circles up into a spherule, defined by a chitinous cell wall and filled with a hundred or so baby endospores. When the spherule is sufficiently full, it ruptures, releasing the endospores and stimulating an acute inflammatory response that disrupts blood flow to the tissue and can lead to necrosis. The endospores, each of which will become a new spherule, travel through the blood and lymph systems, allowing the cocci to spread, as one specialist told me, “anywhere it wants.” In people with weakened immune systems, cocci can take over.

Every year, there are some hundred and fifty thousand cases. Only forty per cent of people infected are symptomatic, and the signs—fever, cough, exhaustion—can be hard to distinguish from the flu. A small subset of patients will suffer long-term health problems; in fewer still, cocci will disseminate from the lungs into other tissue—skin, bones, and, often fatally, the meninges of the brain. For those with cocci meningitis, the treatment can be brutal. Three times a week, in the hospital, patients are administered an anti-fungal called amphotericin B—“amphoterrible” is how doctors refer to it—with a needle to the base of the skull. To prevent headaches, patients sometimes rest for several hours with their feet elevated above their heads. One patient, a twenty-six-year-old white woman who caught valley fever four years ago, told me that the medicine made her vomit non-stop on a negative incline. She was temporarily paralyzed, underwent three brain surgeries, and has had twenty-two spinal taps. Not long after her diagnosis, the doctors told her mother to make funeral arrangements. Now they tell her she will be on anti-fungals, funnelled through a shunt in her brain, for the rest of her life.

Cocci is endemic to the desert Southwest—California, Arizona, New Mexico, Nevada, Texas—and to the semi-arid parts of Central and South America. Digging—building, drilling, tilling, clearing—stirs it up, and dry, hot, windy conditions, a regional feature intensified by climate change, disperse it. In recent years, infections have risen dramatically. According to the Centers for Disease Control, from 1998 to 2011 there was a tenfold increase in reported cases; officials there call it a “silent epidemic,” far more destructive than had been previously recognized. Its circumscribed range has made it easy for policymakers to ignore. Though it sickens many times more people than West Nile virus, which affects much of the country, including the Northeast, it has received only a small fraction of the funding for research. “The impact of valley fever on its endemic populations is equal to the impact of polio or chicken pox before the vaccines,” John Galgiani, an infectious-disease physician who directs the Valley Fever Center for Excellence, at the University of Arizona in Tucson, says. “But chicken pox and polio were worldwide.”

In 2012, valley fever was the second-most-reported disease in Arizona; two-thirds of the country’s cases occur in the state. There is no vaccine to protect against it and, in the most severe cases, no cure. The population of Phoenix has grown by ten per cent in the past decade, and newcomers have no acquired immunity. The elderly and the immune-compromised—including pregnant women—are most susceptible; for unknown reasons, otherwise healthy African-Americans and Filipinos are disproportionately vulnerable to severe and life-threatening forms of the disease. (In one early study, Filipino men were estimated to be a hundred and seventy-five times as likely as white men to get sick from cocci, and a hundred and ninety-two times as likely to die from it.) But, as one specialist told me, “if you breathe and you’re warm-blooded, you can get this.”…

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34 replies
  1. 1
    BGinCHI says:

    “if you breathe and you’re warm-blooded, you can get this.”

    It’s a shame AZ Republicans are immune.

  2. 2
    tybee says:

    i think i’ll stay here in the swamp and risk the west nile and malaria.

  3. 3
    Mary G says:

    Eight or nine years ago, my rheumatologist told me not to ever go to Bakersfield or Fresno, not even to pass through on I-5 with the doors and windows tightly shut in the car with the non-circulating air conditioning on, because I am on a lot of immune suppresants for RA. She was very vehement about it. Now I know why. Guess I should stay out of Arizona, too.

    I won’t give up Joshua Tree, though. Fortunately, it is nationally protected from digging and building.

  4. 4
    MomSense says:

    I thought our struggles with Lyme were bad but his sounds horrific.

  5. 5
    BGinCHI says:

    @Mary G: That’s pretty good advice about B’field and Fresno even if you are perfectly healthy.

  6. 6
    Roger Moore says:

    There may be no vaccine today, but some of my coworkers are working on one*. Fungal infections are different from most of the diseases we vaccinate against because our bodies’ main defense against them is the innate immune system rather than the adaptive immune system. Since vaccines work by priming the adaptive immune system- basically teaching the body about a disease before it encounters it naturally, so it is ready if the disease ever shows up- they’re much less effective against things like fungal infections that are mostly fought by the innate immune system. There still some hope because the adaptive immune system still plays a supporting role in defense against fungi, but it’s a major challenge.

    *They’re more interested in vaccines against secondary fungal infections in immunocompromised patients, but one of their goals is a vaccine that protect against a broad spectrum of fungi, including Coccidioidies species.

  7. 7
    Roger Moore says:

    @Mary G:

    I won’t give up Joshua Tree, though. Fortunately, it is nationally protected from digging and building.

    That doesn’t protect it from blowing dust from outside the Park.

  8. 8
    Linnaeus says:

    Think I’ll stay in the cold parts of the country. I can deal with that.

  9. 9
    Ben Franklin says:

    “There is no vaccine to protect against it and, in the most severe cases, no cure”

    But there is prevention. Keeping your immune system vibrant is the key to fending off inflammation. Chronic inflammation is key to disease.

    It is becoming more and more apparent that the gut is immune central, and this is about what you ingest nutritionally. Live garlic, and ginger root along with supplemental pro-biotics keep the beneficial florae healthy wealthy and wise. There is a cornucopia of toxins ready to take advantage of your junk food diet. Being young is some defense, but those youthful habits will catch up with you. A word to the wise should be sufficient.

  10. 10
    BGinCHI says:

    @Ben Franklin: Plus exercise. And kindness towards others.

  11. 11
    kindness says:

    They call it Valley Fever out where I live. You typically get it once and then have an immunity to it. I got it years ago when I first moved out to the Central Valley. It isn’t bad for most folks. An annoying flu like thingy. That’s how mine was. But I’m not immune compromised.

  12. 12
    Ben Franklin says:

    @BGinCHI:

    I get my exercise while kicking some ass, kindly of course.

  13. 13
    BGinCHI says:

    @Ben Franklin: That’s not only healthy, then, but practical too.

  14. 14
    Omnes Omnibus says:

    @BGinCHI: Cold showers?

  15. 15
    BGinCHI says:

    @Omnes Omnibus: As long as your water hasn’t been poisoned by Freedom Industries.

  16. 16
    Comrade Colette Collaboratrice says:

    Yikes. I’m never going to AZ again, and I’m gonna roll up the windows and crank the AC on the rare occasions I have to pass through the Central Valley in CA.

    The Earth is Pandora’s box, and we have found the key. And then used it, and then thrown it away.

  17. 17
    LanceThruster says:

    F#ck!

    It includes my region (Antelope Valley).

    Oh well…guess my plans to live forever are on hold.

  18. 18
    the Conster says:

    @Mary G:

    I’ve wanted to mention for a long time that I think what you did for HBM was unbelievably wonderful. You’re a mensch.

  19. 19
    StringOnAStick says:

    I remember being a kid in the Central Valley, then moving back to CO while my best neighborhood friend, the original Trekkie, was sick with Valley Fever so I couldn’t say goodbye. I was happy to get back to CO, and even happier when I got older and learned about this disease.

    The fact that the infectious bits can lodge so deep in the lungs because of their small size is what makes it, and asbestos, so dangerous. Too small to cough up but big enough and toxic enough to cause serious damage. Considering how many people Valley Fever is affecting now, you’d think there’d be an outcry and some money to research it. Oh, right. The gubmit is broke and can’t do stuff like protect public health or respond to disease anymore; thanks, rethugs!

  20. 20
    Aji says:

    Twenty-two spinal taps?!

    Ho.Lee. Shit.

    I’ve had one spinal tap on my life, and that was one way too many. Horrible reaction to it. I cannot imagine undergoing 22 of those suckers. Much less all the rest.

    And sadly, with climate change, we can expect stories like these to grow by leaps and bounds in the next few years.

  21. 21
    🎂 Martin says:

    Valley fever can be nasty shit. No worries though, the Silicon Valley billionaire is planning on parceling out all of those countries into Respiratorydeathistan.

  22. 22
    AnotherBruce says:

    @Comrade Colette Collaboratrice: Don’t fear the planet, fear how we abuse the planet.

  23. 23
    Dead Ernest (Thought Wrangler) says:

    @Aji:

    Aji, hopefully not, but just in case you ever have to get one again, the best known problem / undesirable consequence of spinal taps is a most horrific headache (HA).
    These headaches are not a ‘reaction’ or a necessary consequence. The HA’s happen if/when spinal fluid leaks out due to the tap – which, again, isn’t supposed to happen.
    If you do ever have to get another spinal tap, and you get the HA, there’s a very fast fix. It’s called a ‘blood patch’ because a tiny amount of your own blood is injected into the spine – and presto! the blood plugs the leak.
    – but if you’re not still at the place that did the tap, once one has the HA, any position besides lying flat on your back makes the HA so painful that a person is likely gonna want to lay still for 12 hours (leak stops) rather than go back to the hospital.
    ::for The More You Know…::

  24. 24
    Roger Moore says:

    @AnotherBruce:
    There’s plenty to fear about the planet. Where the natural conditions aren’t enough to be a severe danger, the inhabitants will be. A lot of the ways we abuse the planet are to make it less dangerous in the short term.

  25. 25
    cckids says:

    @Roger Moore: This. And the wind blows there ALL THE TIME. The ground looks scoured.

  26. 26
    Aji says:

    @Dead Ernest (Thought Wrangler): I had two reactions: One was the monstrous headache, which lasted longer than the remainder of the day as they told me it would. They told me it was unavoidable, and I had to go home and lie flat on my back (yeah, nearly an hour’s drive away), and if I didn’t, it would get worse – but they told me it was inevitable. This at a supposedly higher-end hospital in Westchester County [haven’t lived in NY for more than a decade now].

    The other reaction was to the local they used before doing the actual LP. Of course, the asshole doc (and he was an asshole, it turned out) told me that it was a stress reaction and all in my head. It wasn’t – I’d had reactions to locals before, and I knew exactly what it was.

    I hope I never have to undergo one again, but with my autoimmune issues, who knows? And you mean to tell me that all that shit could’ve been avoided? Christ.

  27. 27
    Dead Ernest (Thought Wrangler) says:

    @BGinCHI:

    And kindness towards others.

    Kindness to ‘others’?

    Isn’t that where infectious diseases come from, from those ‘others’?

    Goes to show ya, kindness is best practiced from a distance.

    ::for, The More You Fear👺 …::

  28. 28
    Dead Ernest (Thought Wrangler) says:

    @Aji:

    Damn! You’re right – they were assholes; the doc, and whoever said it was unavoidable.

    I’m curious (nosy) to learn what the reaction to the local was… if you’re so inclined.

    Truly hope you don’t ever need one again, but if one has an immune system that’s problematic, there is a higher possibility that if you fall ill, and simpler, less invasive tests fail to get to a good diagnosis, there are diseases (infectious and others) which require an LP in order to make the diagnosis.

    Reckon that in that (hopefully never happen) case: get a better doctor (anesthesiologists and neurologists will be most adept), have them observe you after and be ready w blood patch IF a HA comes on.

  29. 29
    mai naem says:

    I have a friend whose elderly mom, over several months, was losing a lot of weight, had some kind of upper respiratory stuff going on and appeared that she may have dementia. She wasn’t eating all that well. She’d gone to her doctor several times and the thought was that she may have lung cancer(ex-smoker) or some other kind of malignancy. Anyhow, she went to the hospital for a work up and a smart doc checked her out for Valley Fever. She got treated for it and everything started resolving relatively quickly.

  30. 30
    Aji says:

    @Dead Ernest (Thought Wrangler): This one was a neurologist. He was supposedly one of the top guys in the area, and part of my insurance network at the time.

    The anesthetic reaction was one I’ve had before – and I have no fear of needles or anything like that; it’s nothing psychosomatic, but more allergic. Sudden overall flushing, both heat and color, feeling of irritation all over my body (skin, etc.), massive dizziness with this feeling of disconnection, and massive shakiness, and then the nausea hits. Once when it happened to me, someone told me thereafter that I was given too much, but I’ve always been hypersensitive to them, which makes me wonder whether it was too big a dose, or simply that I react badly to an ordinary dose.

  31. 31
    Anne Laurie says:

    @Aji: Huh. I had that kind of reaction, secondary to a kidney scan, back in the early 1980s — and was, of course, told it was ‘all in my head’. Two days later, I developed huge red peeling bumps on my elbows & knees, obviously an allergic reaction, and the urgent care doctor said it meant I was allergic to the contrast dye used for the scan. Ever since, when a new healthcare provider asks about allergies, I’ve always included ‘contrast dyes’ and nobody’s raised an eyebrow beyond one or two nurses who assured me that the dyes have ‘improved a LOT’ since those days…

  32. 32
    Aji says:

    @Anne Laurie: Oh, yes, the contrast media. Had the same thing happen with a CAT scan in the early ’80s. Guy says, “Are you allergic to iodine?” Me: “Not that I know of.” After an hour of sheer unrelieved hell, they pull me out of the tube, and I’m covered head to toe in three-inch hives. Doc asks about allergies, I tell him what the tech asked, tech says, “I said it was LIKE iodine!” which of course he did not.

    IV Benadryl in the elbow, and five weeks before I could unbend my arm.

    And, yes, the “all in your head” thing. Gah. Come live in our moccasins for a week, right? Hell, they wouldn’t last a day.

  33. 33
    ixnay says:

    @BGinCHI:

    Well, being cold-blooded and all … .

  34. 34
    gaderson says:

    My brother got it at a family wedding in the Central Valley. Was misdiagnosed by the ‘doc in a box’, but, finally got a doctor that was familiar with the disease at home, in Silicon Valley. Had to drain his lungs from the first infection. Then…it spread to his brain ‘cocci meningitis’, and after multiple failures of the shunt reservoir (placed in his lower back — has back issues from that) they were able to bring down the infection to a manageable level (he also had multiple LPs). Now he takes a handful of anti-fungals (i.e. ONE pill will cure a woman’s yeast infection) every day.
    Kern county in California is a major research center, for obvious reasons. The initial research came from the 1940s when troops were stationed in the Central Valley for the Pacific Theater — can’t imagine what amphotericin-A was like (his nurses called amphotericin-B it ‘shake-and-bake’ because of the constant fever and chills).
    He’s been lucky that insurance hasn’t rejected him for ‘existing condition’.

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