Riverside County not immune to valley fever

Mention of valley fever is liable to touch off quizzical looks or bad jokes, but to those who have it or are close to someone with it, it is no laughing matter.

Life for Lake Elsinore resident Araceli Jimenez underwent a drastic change after her husband came down with the disease, while former Escondido and Rancho Bernardo resident Robin Smith nearly lost his life twice and is confined to a wheelchair after being stricken with valley fever.

It’s scientific name is Coccidioidomycosis and is often called cocci (pronounced cox-see) for short.

It is spread by a fungus buried in the soil in arid regions of the Southwest and released into the atmosphere when the earth is disturbed, such as when digging or an earthquake occur. Symptoms could include fever, chest pain and coughing, though many experience no symptoms, according to medical researchers. To date, there is no antidote or vaccine for it, the researchers say.

On rare occasions, complications can occur that are life-threatening —- as happened with Jimenez’s husband.

A construction equipment operator working on sites in Riverside, San Bernardino and San Diego counties, he was diagnosed with the infection at the end of 2004, Araceli Jimenez said. After entering his bloodstream, the disease metamorphisized into coccimeningitis, and a shunt had to be implanted to drain fluid from the infection from his brain, she said.

“His life is dependent on antifungal medication and the shunt,” she said.

Jimenez prefers to maintain her husband’s and family’s privacy so she declined to offer more details, but her exposure to valley fever led her to campaign against a shopping center development proposed next to her property in Lake Elsinore. She fears the project’s grading could kick cocci into the atmosphere.

“He’s stable right now,” she said of her husband. “My worst fear is that he could become re-infected and there are no guarantees that he won’t become re-infected.”

Smith, who is now 52, said he became deathly ill not long after going on an archaeological dig in eastern San Diego County in 1995, when he must have struck a colony of the cocci fungi. As his symptoms evolved into pneumonia and coccimeningitis, and he fell into a coma, doctors were at a loss as to the cause, Smith said.

He said some friends were talking about his situation when one of them asked if any consideration had been given to valley fever as a cause. He was subsequently tested and doctors determined he had the disease and treated him with antifungal medication.

Though Smith improved and started working again, the medication he was taking failed to manage the infection and he again wound up in an intensive care unit, where doctors determined the infection had spread to six organs.

“I was admitted to ICU and again I was not expected to survive, and once again I somewhat miraculously did,” he said.

Like Jimenez’s husband, he was implanted with a shunt and now undergoes a painful draining procedure periodically. Though he lost the use of his legs, he has been able to recover sufficiently to work and go to school. Now a San Diego resident, he works for the Padres as director of disabled services and recently obtained a bachelor’s degree in fine arts from SDSU.

“My condition was extremely serious,” he said. “I am maybe one of the 1 percent of people who get affected like that. My experience was extreme, but it affects people in various and sundry ways. Most of the symptoms are not as serious and just bothersome, like achy joints and nodules on the lungs.”

In San Diego County, which has a population of about 3 million people, 120 cases of cocci were reported in 2008, while 50 were reported in Riverside County, which has about 2 million inhabitants.

The local numbers are dwarfed by those in Kern County, however, which had 1,085 verified cases in 2008, by far the largest number of any county among the state’s total of 2,513 cases for the year, according to statistics from the California Department of Public Health’s Center for Infectious Diseases.

The level of cases in Riverside County has remained steady in recent years. In 2007, there were 55 cases, 50 in 2006, 50 in 2005 and 48 in 2004, said public health department spokeswoman Barbara Cole. From 2005 through 2008, there were nine deaths related to cocci, health officials said.

Over the last three years, there have been more cases of valley fever in Riverside County than the highly publicized West Nile virus, of which 83 cases were reported; than encephalitis, 62 cases; and than whooping cough, 71 cases.

Still, those diseases are far less prevalent and take many fewer lives than such common illnesses as influenza and pneumonia, which kill several hundred people a year in Riverside County, said County Health Officer Dr. Eric Frykman.

“If there are 50 cases out of a population of two million, that’s a reasonably low risk,” Frykman said. “It’s a disease that people probably don’t need to worry about or fear, but people should recognize that if they’re in a windy or dusty environment, there is a risk. But then, there are areas that aren’t windy and dusty where there have been cases. So we don’t necessarily find a correlation.”

Jimenez’s battle against the shopping center to date has been unsuccessful as the Lake Elsinore City Council recently approved the proposal. While expressing empathy for her family’s situation, city officials were reluctant to factor in a risk that might not exist on the property and there would be no feasible way to test the dirt under the surface of the entire 4.3 acres.

Her family’s plight motivated Jimenez to take on the task of attempting to educate the city as well as residents to the fact that the disease is known to occur in this area and has taken lives, though the threat is much more pervasive in Kern County and Arizona, another area where the disease is more prevalent. For unknown reasons, those of Asian, Latino and African descent are more susceptible to the disease, according to the Centers for Disease Control and Prevention and the Mayo Clinic.

Jimenez said she believes the threat is being underpublicized to the general public, using her experience in Lake Elsinore as an example.

“I’m thinking it’s downplayed because of economics,” she said. “If it was reported that there was a spore in (a certain area), no one’s going to buy (a home there). To me, it has to be about money and economics.”

Smith also is concerned about the lack of awareness of valley fever.

“It blows my mind how unknown this syndrome is,” Smith said. “Arizona is the hot spot for valley fever. It only exists in the Southwest U.S. and it does exist here in San Diego.”

Their concern is shared by the authors of the book “Valley Fever Epidemic.”

Sharon Filip, a Seattle-area resident diagnosed with valley fever, said the experience led her to write the book, an effort joined by her son, David Filip, who contributed much of the research.

She as well as medical researchers say the disease is under-reported because a lot of people who become infected don’t realize the cause of the symptoms, while many of them are misdiagnosed by health care professionals.

“Even the CDC puts out that only 2 percent of the cases are identified as valley fever, meaning 98 percent are undiagnosed or misdiagnosed,” Filip said in a recent interview. “The future number of cases in California could far exceed what’s happened in Arizona. Because of the way they are reported or not reported, no one really knows.”

The disease has caught the attention of state legislators. At the request of state Sen. Roy Ashburn, whose district includes Kern County, the Senate in March voted to declare August as Valley Fever Awareness Month. And according to an article in Scientific American, the National Institutes of Health classified cocci as a bioterrorist weapon, though there is no evidence it has been cultivated for such use.

Yet, in Riverside and San Diego counties, it remains fairly low on the list of threats to public health.

“If there was a prevention program in place to make sure that no one was affected or died of coccidio, to the extent that it would be feasible, I’d be doing it,” Frykman said. “But to this point, there doesn’t seem to be a lot of prevention programs out there, so typically the advice is to avoid places where there’s a lot of dust and wind.”

© Copyright 2009, The North County Times