Valley Fever

By Marguerite Johnson

LORI CROWN THOUGHT she was doing the right thing last year when she moved to a dryer climate in Bakersfield, California, after being plagued by asthma attacks during her six years in Hawaii. A few months later, Crown, 35, was suffering from severe headaches, a prolonged fever of 102 degreesF, swollen feet and painful bumps on her hands and legs. The diagnosis: "valley fever," or coccidioidomycosis, a dust-borne disease caused by the microscopic spores of a fungus, Coccidioides immitis.

As a newcomer to the San Joaquin Valley, Crown was stunned to learn that the same rich topsoil that makes the region an agricultural Mecca also harbors this deadly microbe. She has become a statistic in the worst epidemic of valley fever ever recorded. From 1986 to 1990, doctors reported an average of 450 cases a year to state authorities. In 1991 the number nearly tripled, to 1,208. Last year it soared to 4,54l, with an estimated death toll exceeding 50.

The worst-afflicted area is the San Joaquin's Kern County, which has reported nearly 2,000 cases since October. Valley fever is also on the rise in the Tucson and Phoenix areas, where reported cases jumped from 287 in 1991 to 438 last year. But statistics tell just part of the story: only about 10% of those infected ever come to a doctor's attention. The rest have either no noticeable symptoms or mild cases that they mistake for a cold or flu. Though . valley fever, which has been known for a hundred years, has received scant attention outside the Southwest, the current epidemic is changing that. Last week the U.S. Centers for Disease Control and Prevention in Atlanta issued a warning to physicians nationwide to be on the alert for the disease in patients who may have become infected while traveling.

Valley fever does not spread from person to person but is contracted by inhaling airborne spores from the fungus, which is endemic to dry areas of the American West and Southwest as well as parts of northern Mexico and Central and South America. Face masks offer only limited protection against the infinitesimal spores, and efforts to design a vaccine have yet to succeed. The fungus multiplies dramatically whenever the soil becomes damp after a protracted dry spell. Swept into the air by winds, construction equipment, even the passing feet of farm workers, the spores can travel up to hundreds of miles on the surface of dust particles. Central California's six-year drought, which has been interspersed with warm, heavy rains, as well as the region's construction boom, provided the ideal conditions for fungal proliferation.

Those lucky enough to ingest the spores without becoming seriously ill seem to acquire immunity. More serious cases are often mistaken for pneumonia, since the fungus flourishes in the moist, warm environment of the lungs. In about 1% of victims, the disease spreads beyond the lungs through the bloodstream -- typically to the skin, bones and the membranes surrounding the brain, causing meningitis. "There was a time when I saw three new cases of cocci meningitis a year," says Dr. Royce Johnson, chief of infectious diseases at Bakersfield's Kern Medical Center. "Not long ago, I saw three new cases in one day." Johnson is now treating 51 cases of cocci meningitis and an additional 300 patients with severe valley fever.

Latinos, African Americans and Asians are at much greater risk than Caucasians of developing a severe case. "We don't know why," says Dr. Demosthenes Pappagianis, a professor of microbiology at the University of California at Davis, "and it is a very important question because it goes to the ability of humans to respond to this organism." Others who are especially susceptible are the elderly, asthma sufferers and people with suppressed immune systems. The California health department advises such individuals not to take car trips through the Central Valley on windy days.

The disease is easily detected with a blood test, but since most cases are mild and self-limiting, there's no consensus on how aggressively it should be treated. However, once serious symptoms appear -- including skin rashes, labored breathing and achy joints -- treatment must be prompt. Unfortunately, all four antifungal drugs in use are disagreeable and often toxic. The worst, victims agree, is amphotericin B, known as "Ampho the Terrible" to those who have to have it injected into the base of their skull for meningitis. The side effects include nausea, fever and kidney damage. In severe cases, where the fungus has permanently damaged lung or bone tissue, surgical repair may be needed. Since the drugs serve only to suppress the fungus, not to kill it, those who develop a severe case of valley fever may require treatment for years and can never be sure that it will not flare up again.

Ronald Sanders, 50, of Bakersfield, came down with valley fever in 1988. It spread into his brain membranes, causing a stroke. Today, although his paralysis is gone, he is still fighting the disease. Every Friday, Sanders has to go to his doctor's office for a cisternal tap, in which spinal fluid is removed, tested and mixed with amphotericin B for reinjection. There is no end in sight to the painful procedure.

Thanks to fluconazole, an expensive antifungal drug ($685 for a one-month supply of pills), Lori Crown's condition has improved. Her feet are no longer swollen and the sores on her skin have vanished, but she still gets painful headaches, frequent fevers, arthritic pain and debilitating fatigue. "It's so frustrating," she says. "One day I'll feel fine, then I'll be in bed for the next three." Most days she wishes she could have stayed in Hawaii.

With reporting by Dan Cray/Los Angeles and Andrea Dorfman/New York