At the outset of a dusty day in the American Southwest, Erik McIntyre, a former U.S. Navy electrician, unknowingly inhaled microscopic fungal spores while driving through Phoenix. Unbeknownst to him, this moment marked the beginning of his struggle with Valley fever—a battle that led to paralysis and a life confined to a nursing home at the age of 53. Erik’s harrowing story is not an isolated incident. The number of cases has increased by about four times in the last twenty years, as reported by the Centers for Disease Control and Prevention.
Recent figures from the Centers for Disease Control and Prevention (CDC) indicate that Valley fever, also known as coccidioidomycosis, has been haunting the American Southwest and is now marching northwards. Public health officials warn that a much larger area of the United States could become vulnerable in the coming decades. A stark illustration of this is the emergence of the fungus in the arid hills of Eastern Washington state, previously not known to be an endemic area.
“I cannot think of any other infection that is so closely entwined with climate change,” expressed Rasha Kuran, an infectious-disease specialist at the University of California at Los Angeles, reflecting the concerns of many front-line health workers grappling with the disease. According to scientists, the fungus thrives in dry soils and proliferates after periods of extreme drought—conditions that are intensifying across the West due to climate change.
Furthermore, as Morgan Gorris, a staff scientist at Los Alamos National Laboratory, warns, “What was once a disease that was primarily limited to the Southwestern United States would become a disease of the Western United States.” Such predictions are grounded in sophisticated models projecting the potential spread of Valley fever as the climate warms.
Economically, the toll is hefty as well. According to an approach described in a recent economic evaluation, the average total cost of Valley fever in the United States was estimated at $3.9 billion per year for the 2000-15 baseline period. With projections based on climate change and population trends, these costs could escalate dramatically, potentially reaching $18.5 billion per year by the end of the twenty-first century.
The complexity of this fungal threat is further underscored by the difficulty in diagnosing and treating it. Valley fever is often misdiagnosed because its symptoms closely mirror those of other respiratory illnesses such as pneumonia or flu. As detailed by the CDC, early diagnosis and treatment are crucial, yet often delayed, contributing to the disease’s severity.
In terms of treatment, coccidioidal meningitis (CM), a severe form of Valley fever where the fungus spreads to the central nervous system, is particularly daunting. Despite the availability of antifungal drugs like fluconazole and amphotericin B deoxycholate (AmB), morbidity remains significant due to the disease’s complications, the devices used for treatment management, and side effects of the medications.
This situation calls for heightened awareness and improved public health strategies. The CDC, alongside state and local health departments, is working to raise awareness and educate healthcare providers to reduce delays in diagnosis and treatment. New tools for faster and easier detection of Coccidioides in the environment are also being developed. In addition, research into new laboratory tests and treatment approaches is ongoing.
Relevant articles:
– An invisible killer, Washington Post, Nov 13, 2023
– Valley Fever (Coccidiomycosis) Awareness, Centers for Disease Control and Prevention (.gov)
– Economic Valuation of Coccidioidomycosis (Valley Fever) Projections in the United States in Response to Climate Change, nih.gov
– UC Davis Center for Valley Fever, ucdavis.edu