VALLEY FEVER (COCCI)
Valley Fever (coccidioidomycosis, or "cocci" for short) is a fungal disease caused by the organism Coccidioides immitis, which lives in our soil here in an encapsulated, spore form. Although the disease is present in many of the dry, warm areas of the Southwestern United States, the spore concentration is particularly heavy in the soil of Bakersfield. Cocci cases were up drastically in 1991-1992, possibly due to proliferation of the spores in the soil after the "March Miracle" rains of 1990.
How do you get Valley Fever? Essentially, the only way to get cocci is to directly inhale dust-containing spores. There are no reported cases of human-to-human transmission (in other words, cocci is not contagious). The spores initially cause a lung illness one to four weeks after exposure. Most patients either have no symptoms or have a mild, brief flu-like illness, often not serious enough to seek medical attention. On occasion, "primary" (or new) cocci can be more severe, with fever, aches, fatigue, and a dry cough. A variety of skin rashes, some painful and quite spectacular in appearance (including erythema nodosum, a painful nodular rash on the shins and legs), can occur. The chest x-ray may be abnormal, with pneumonias and/or nodules. Even in mild cases, cocci may cause prolonged, mild to moderate fatigue (like mono often does).
Unfortunately, a small percentage of patients can have a much more severe illness. The disease can be prolonged, with lung nodules and cavities, often complicated by significant pneumonia. In the most severe cases (less than 1%) the disease can spread throughout the body (disseminate) to virtually any body organ. This dissemination is much more common in people of color, especially Filipinos. There may also be increased risk of dissemination in pregnant women, diabetics, and patients with cancer or AIDS. If the physician suspects active cocci, blood tests are often necessary to confirm the diagnosis.
Fortunately, most patients with cocci have mild courses with full recovery and do not require any treatment. There are medications available for patients with moderate cocci and severe cocci (intravenous anti-fungal medicines). Treatment decisions are made on a combination of blood test results and severity of clinical symptoms/illness. Often, several blood tests are necessary (at 2 to 6 week intervals) to evaluate a cocci patient, even those who never require treatment. These tests are done at an off campus lab, and we therefore must charge for them.
At this point, there is not a great deal that can be done to prevent cocci. Avoiding close exposure to areas known to be high risk and staying inside on windy, dusty days may be the only way to reduce the risk of cocci.
CSUB STUDENT HEALTH SERVICES 661/654-2394 mjh 11-92 updated 8/96, 2/06 ck