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Another Busy Year for Valley Fever

5/24/2012 

Valley fever patientAt first it was a mystery why Malissa Phonasa wasn’t feeling well. Last fall the high school freshman from Clovis began experiencing unusually high fevers, fatigue, weight loss, headaches and a dry cough. Despite numerous visits to her primary care doctor, several blood tests and various antibiotics, she saw no improvement.

After undergoing a chest X-ray at a local adult hospital, Malissa was referred to the Children’s Hospital Central California Emergency Department where pediatric specialists soon diagnosed her condition. Malissa had valley fever – a flu-like and potentially deadly illness caused by inhaling airborne spores of a dirt-dwelling fungus.

Valley fever patient and family“It was very frustrating not knowing what was wrong,” said Sinhprasong Thongreuang, Malissa’s dad. “Finally we got an answer.”

Children’s Hospital, along with other areas of the Central Valley, has seen a significant increase in valley fever. In March the number of valley fever inpatients at Children’s peaked at 16. Normally Children’s has only about one or two inpatient cases at any one time. Currently there are 11 inpatients being treated with valley fever, eight admitted in the month of May. 

“While last year was a huge year for valley fever, we’ve been just as busy if not busier this year,” said Dr. Dr. McCarty with patientJames McCarty, Children’s Hospital medical director, pediatric infectious disease. Dr. McCarty has more than 25 years’ experience treating the non-contagious disease that is endemic to our region and affects people of all ages.

Kern County, a hotspot for valley fever, has experienced a spike in cases as well. “In 2011 we had the second highest number of valley fever cases ever,” said Kirt Emery, epidemiologist, Kern County Public Health Services Department.

In 2011, Kern County saw 2,734 cases, of which 222 were under age 15. This compares to 2010 when Kern County saw 2,051 cases, of which 170 were under age 15, according to Emery.

Late rainy season may lead to more cases

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. Valley fever fungusThe disease spreads through spores in the air when contaminated soil is disturbed such as by construction, dust storms and earthquakes.

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.

Children’s Hospital began seeing children in the fall and winter who became infected with valley fever in late summer or early fall.

“This year’s late rain, however, may mean we start picking up cases earlier this year, like May, June, July, and into the fall,” cautioned Emery.

Dr. McCarty agreed, noting that large dust storms several months ago may have also contributed to the recent increase.

Be aware of persistent symptoms that don’t improve

“The best thing people can do is avoid inhaling excessive amounts of dust – especially in the South Valley,” said Dr. McCarty. “If parents have a child with flu-like symptoms that persist and don’t improve, it’s a good idea to take the child to their pediatrician or primary care doctor.”

Since last summer Children’s Hospital has admitted about 20 children for valley fever ranging in age from 5 months to teenage, with about half under age 5. While most of these cases come from the South Valley, including six from Avenal alone, Children’s also has affected patients from Fresno, Clovis and Los Banos.

Valley fever patientAs in Malissa’s case, 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.

“This year we’re seeing mostly lung disease, not as much bone disease, but some meningitis,” said Dr. McCarty. “We’re still seeing prolonged illnesses, with patients spending an average of six months in the hospital.”

An inpatient since mid-December, Malissa was looking forward to going home. “I’m feeling much better than when I first came,” said the 14-year-old while in her hospital room.

Malissa and her parents are thankful for Children’s Hospital and Dr. McCarty. “He has a lot of experience,” said Malissa’s dad. “And he’s very funny!” added Malissa with a smile. In late April, Malissa was smiling even more when she was well enough to be discharged from the Hospital. She continues to receive medication for valley fever and follows up regularly with Dr. McCarty.

Those most at risk

People at risk for severe valley fever disease include:

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

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 antifungal medicine. Treatment can range from three to six months for simple cases, to years for more serious cases.

“Children’s Hospital currently treats more than 100 children on an outpatient basis for valley fever,” said Dr. McCarty. “Valley fever is a chronic illness that can be difficult to manage. Some people are on medications for a very long time.”