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Valley Fever Cases Increase

2/21/2011 

Children’s Hospital, along with other areas of the Valley, has seen a significant increase in the number and severity of cases of valley fever – a flu-like and potentially deadly illness caused by inhaling airborne spores of a soil-dwelling fungus.

Since summer 2010, about 15 pediatric cases have been admitted to Children’s for serious infection. Many of these patients are under age 4 and mostly come from areas south of Fresno. Currently Children’s has eight inpatients with the non-contagious disease that affects people of all ages, including several new cases. Normally Children’s has only about one or two valley fever inpatients this time of year. Kern County – a hot spot for valley fever – is experiencing a spike as well, jumping from an average of 1,237 annual cases between 2001 and 2008, to 2,000 cases in 2010, according to a Kern County Public Health Department spokesman.

“Beginning in October, we started seeing kids that became infected with valley fever in late summer or early fall,” said Dr. James McCarty, a pediatric infectious disease subspecialist at Children’s who has cared for children with valley fever for the past 25 years. “We treat this every year but it seems particularly bad this year. We are seeing a number of children with severe disease including one fatal case.”

Dr. Demosthenes Pappagianis, an infectious disease expert at University of California, Davis, where Children’s sends its valley fever antibody tests for confirmation, agrees. He says that while all the statistics are not available yet, he called the apparent increase in pediatric valley fever cases “an unusual observation.”

“Experience has shown us that children under 5 are particularly vulnerable to valley fever,” said Dr. Pappagianis. “We think kids after age 5 and into their teens may be more resistant than adults to the disease but the data isn’t clear at this point.”

Adults in the Valley randomly selected for a skin test will often test positive for valley fever even if they have no symptoms or recollection of being seriously ill. “People exposed to valley fever during childhood seem to develop an immunity that protects them from further infection,” said Dr. Pappagianis.

Valley fever is an illness that usually affects the lungs. Sometimes other parts of the body are impacted, such as the brain, bone, skin or other organs. This is called disseminated valley fever. Less than 1 percent of those infected develop disseminated valley fever. Without proper treatment, the disease can lead to severe pneumonia, meningitis and even death.

People at risk for severe disease include:

  • Those with weakened immune systems
  • Persons of African or Filipino descent
  • Women in the third trimester of pregnancy

Valley fever is primarily caused by a fungus called Coccidioides immitis, most commonly found in the deserts of the southwestern United States and Central and South America. The disease spreads through spores in the air when contaminated soil is disturbed such as by construction, dust storms and earthquakes.

“The best thing people can do is avoid inhaling excessive amounts of dust – especially in the South Valley,” advised Dr. McCarty.

Researchers notice that heavy winter rainfall may also be a factor. During years of abundant rain, an increase in valley fever cases typically follows in the dry season. “This is an observation since World War II when extensive studies were done in the San Joaquin Valley on military personnel,” said Dr. Pappagianis. “When there’s less rain we don’t see as many valley fever cases, either. The rain probably provides an environment in the soil in which the fungus can grow better and produce more spores.”

About 60 percent of those infected never show symptoms. The others develop the following that can last a month:

  • Cough
  • Fever
  • Chest pain
  • Headache
  • Muscle aches
  • Fatigue
  • Rash

When valley fever is suspected, a doctor can order an antibody blood test or culture.
There is no vaccine to prevent valley fever but efforts are ongoing to develop one. Treatment usually includes an oral or injected anti-fungal medicine. Treatment can range from three to six months for simple cases, to years for more serious cases.

“We have patients we’ve been treating for about 10 years,” said Dr. McCarty. “Valley fever is a chronic illness that can be very difficult to manage. Some people are on medications for life.”