A young man fell ill with fever, cough, and fatigue, all nonspecific symptoms that could easily suggest the flu or pneumonia. But the cause was neither a virus nor a bacterium. It was a fungus carried through the air from the soil beneath his feet in California’s Central Valley, causing a disease known as Valley fever.
Valley fever (coccidioidomycosis) is caused by the Coccidioides fungus found in soil across the Western Hemisphere, but especially endemic in the Central Valley and parts of the American Southwest. When soil is disturbed, tiny fungal spores can become airborne and inhaled. Many people who are infected experience mild symptoms or recover without ever knowing they had it.
But in some cases, the infection can spread beyond the lungs to the brain, bones, or other parts of the body and cause life-long disability and even death. At the Stanford Valley Fever Clinic, medical director Shanthi Kappagoda, MD, and Dean Winslow, MD, professor of medicine and pediatrics, care for patients facing the disease’s most difficult forms.
Watch the latest MedStory, featuring, Kappagoda and Winslow.
One such case involves a Central Valley man whose initial infection turned into meningitis requiring specialized care at the clinic, under the watchful eyes of Drs. Kappagoda and Winslow. Though he is no longer able to work, “I don’t think that he would be alive, honestly, if it weren’t for the efforts of Dr. Kappagoda and all of our colleagues here at Stanford,” Winslow says.
Many patients arrive at the clinic after a long and frustrating search for answers, with delayed diagnoses, recurring illness or complications. The Stanford clinic expands access for people in Northern California who might otherwise need to travel long distances for expertise. Its team works with patients to develop individualized treatment and long-term management plans.
“I hope patients feel a sense of relief and hope when they arrive at our clinic,” Kappagoda says. “They’ve often faced a long journey.”
Cases have been rising across California, potentially fueled by weather patterns such as wet winters followed by hot, dry summers, as well as climate change. Yet the disease remains understudied, despite the disease being discovered in the 1890s.
The lack of research around Valley Fever and its ability to mimic other respiratory illnesses are the main reasons why Valley fever can be so difficult to diagnose. “It’s a disease that you have to think of in order to diagnose,” says Winslow. If clinicians do not consider it as a possible cause and order the right tests, it can be easily overlooked.
People who are pregnant, those who are taking medicines that weaken the immune system, or those working outside in affected areas, such as construction or farm workers, may be at higher risk for serious disease. Some people of Filipino, African American, and other backgrounds also appear to be more likely to develop infection that spreads through the body, though researchers are still working to understand why.
The clinic also represents a commitment to answering the many questions that remain: Which treatments work best for different forms of the disease? How long should treatment last? Could a vaccine one day prevent infection?
For now, Kappagoda says, “meaningful progress would start with more public awareness.”. If you live in an area where Valley fever is common and develop persistent fever, cough, or fatigue, ask your clinician whether testing is appropriate. Recognizing the disease early can help patients get the care they need. And possibly change the course of a life.
