- An increase in droughts and dust storms on the west coast is spreading valley fever, a fungal infection that can cause permanent lung damage and, in rare cases, death.
- Reported cases of valley fever have reached an all-time high in California, and new cases of valley fever have been reported as far north as Washington state.
- As climate change worsens, researchers suspect wind-borne fungal infections like valley fever could become more and more dangerous to public health.
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As droughts and dust storms become more common in the Southwest U.S., a fungal infection that can cause pneumonia and fatal meningitis is infecting more people than ever before. In recent years, infectious spores have travelled far beyond what scientists thought were the limits of the endemic.
Valley fever (also called Coccidioidomycosis) is caused by inhaling spores of fungus (called coccidioides) found in dry soil. Not everyone exposed to the spores will get infected, but in rare cases, the disease can cause permanent lung damage and, in rare cases, spread to other areas of the body such as the spinal cord, joints, and skin. If left untreated in some of these situations, it can be fatal.
Dust storms, which can spread Coccidioides spores, have increased by 240% in recent years
Drought, dry soil, and rising ocean temperatures have led to more dust storms in California and the surrounding area, according to research from George Mason University air quality scientist Daniel Tong. Fungus spores that thrive in the arid climate are easily carried by wind-blown soil and spread in what scientists call the “grow and blow” effect.
Dermatologists from University of California Irvine, and epidemiologists from the CDC and California Department of Public Health, theorise that this may be contributing to an increase in valley fever cases that will only continue in the future. In California, valley fever cases last year reached an all-time high since the disease was recorded, surpassing the previous records set in 2016 and 2011 (after a brief period of decline in cases between 2012 and 2014), according to the California Department of Public Health. The department recorded 7,466 confirmed cases of valley fever by the end of 2018, a 137% increase since 2015.
Places previously thought to be out of the natural range of Coccidioides are now seeing cases of valley fever
In 2014, after three people in eastern Washington state were diagnosesd with valley fever, researchers found Coccidioides spores in the local soil, 700 miles north of the San Joaquin Valley where the fungus is endemic. Since valley fever emerged in Washington state, two people have died and eight more have been hospitalized from Coccidioides infection. More spores were found in Central Oregon in 2016.
Cases of valley fever have been found as far away as New York City, according to the CDC, though they weren’t due to spores travelling across the country. Rather, students on a community service trip in Baja, California, presumably inhaled the spores while there but didn’t realise they were infected until they were back in the Empire State. Symptoms of valley fever don’t appear until one to three weeks after exposure.
When valley fever strikes in new places, people are especially likely to be misdiagnosed
Fortunately, valley fever isn’t contagious – it is only caused through direct contact with the spores, so people who bring valley fever home from their travels can’t spread it. However, getting valley fever far from the valley has its own set of risks, namely that geographical distance can make it even harder to correctly diagnose.
While clinics know to test for the fungus in Arizona, where valley fever is related to 1 in 3 pneumonia cases, doctors and patients in, say, Washington state or New York City are likely to mistake it for pneumonia or the flu.
One woman, who shared her story with CALIFORNIA magazine, for example, was sick for over a month with a fever, difficulty breathing and an itchy, oozing rash before doctors realised it wasn’t pneumonia or the flu. She is believed to have inhaled the spores while doing yard work on her property in Santa Margarita, west of where valley fever is usually found.
This is problem isn’t isolated to places where valley fever is unusual. Recent data shows that in the vast majority of cases, valley fever is misdiagnosed or never reported. In fact, researchers suspect the actual number of cases may be six to 14 times the number reported.
Treatment, when needed, can include anti-fungal medication
Most people will recover from valley fever without treatment within weeks or months. About two-thirds of people will never even show symptoms of infection. Severe cases, however, require anti-fungal medication and possible hospitalisation.
A blood sample or skin test can confirm a valley fever diagnosis within a few days of going to the doctor. The sooner the disease is correctly identified, the more effectively it can be treated, said Dr. Tom Chiller, chief of the Mycotic Diseases Branch at the Centres for Disease Control and Prevention.
“Making an early and accurate diagnosis is essential,” Chiller said in a 2016 presentation to medical professionals. “It eliminates the need for unnecessary antibacterial use, reduces the need for additional diagnostic tests, and helps you decide on an early management strategy, including how to deal with complications.”
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