
A Disease Without a Cure Spreads Quietly in the West - sgaither
http://www.nytimes.com/2013/07/05/health/a-disease-without-a-cure-spreads-quietly-in-the-west.html?hp&_r=0&pagewanted=all
======
tokenadult
I am very closely acquainted with a person who was found to have this
infection by culture of a biopsy sample during the 1980s. The person I know
has never been to the parts of the United States mentioned in this article.
The examination finding that prompted the biopsy was persistent cough and
general fatigue accompanied by an abnormal chest X-ray. (The chest X-ray, in
turn, was follow-up to a course of preventive treatment for tuberculosis,
medically indicated for a foreign person who arrived in the United States
Mantoux-positive for tuberculosis, perhaps from having had the BCG
tuberculosis vaccine overseas. The X-ray finding was nothing at all like the
chest X-ray of someone with a tuberculosis infection, but quite unusual,
prompting many other diagnostic tests, including repeated biopsies.)

The good news is that the patient I know recovered fully after surgery. The
bad news is that the patient had to have major surgery. Moreover, we are
unsure to this day what the actual diagnosis was. The surgery was curative, as
the patient's complaints and disabilities all went away after it was over, but
the lung infection was never definitively diagnosed. (Another infectious agent
was cultured after a different biopsy.) Slow-growing lung infections are very
hard to diagnose. Fortunately, most people have a lot of spare lung tissue, so
even removal of a whole lobe on one lung does not impair future aerobic
exercise.

Developing better diagnostic procedures for this illness will not be easy at
all, but seems well worth doing. Antifungal drugs are very hard to develop,
because fungi are very biologically similar to animals, and thus a drug that
works on fungi has a high probability of being toxic to human patients if
taken internally.

[http://www.mayoclinic.com/health/valley-
fever/DS00695/DSECTI...](http://www.mayoclinic.com/health/valley-
fever/DS00695/DSECTION=treatments-and-drugs)

------
healthenclave
The article is actually a little sensationalist. Because Coccidioidomycosis is
actually ENDEMIC to the western region of USA and Mexico.

The rates do usually go up after earthquakes and storms that can lift up large
amounts of dust up in the air.

In most people the infection resolves itself (much like TB in healthy people).
Some people might get pneumonia and rarely do healthy people get meningitis.
The disease is severe in immune-comprised but any disease can be severe in
that case (eg: simple thrush - candida albicans infection)

simple anti-fungals eg: fluconazole is effective is most cases

~~~
dclowd9901
You're correct that it's endemic, and it is usually associated with the fungus
getting kicked into the air, but being rid of it is hardly a walk in the park.
It usually downs its victims with the effectiveness of polio, there's no
vaccine, and no real "cure". Fungal infections don't work like that. It takes
a long, sustained treatment to be rid of it, and the meek/unhealthy
individuals you refer to usually die from the disease. Generally healthy
people merely suffer for a year or so.

~~~
douge
A year is a long time to suffer from invasive fungi, and if the toxicity of
your air is, in any way, threatening your health, then you can build a very
effective air purifier, which is better and cheaper than the store bought
kind, using simple parts.

The key is a MERV 13+ filter (MERV Rating System [0]), because it's 90%
effective for collecting particles 1-10 microns. TTBOMK, this is the size of
most spores and the arthroconidia that cause this coccidioidomycosis [1].

Take a a 20" box fan (like this Lasko one [2], or available at the hardware
store) and these 20x20x4 MERV 13 filters [3], $48, then either tape or bungee
cord the filters to the back of the fan. Run it on an elevated surface so that
it's not wasting the filter on cleaning up particles that have fallen from the
air and can be swept and mopped up. Assemble 1 unit per room.

This works really well. If you're looking for other methods to improve your
air quality, search for a UV A/C attachment (e.g. Calutech Blue-Ray), diffused
oils (e.g. "Thieve's Oil" in a cold-air diffuser), and ventilation practices.
For a wide rang of cases, these nasal screens [4] offer a great solution.

[0] [http://www.ontimeairfilters.com/air-filter-merv-
rating](http://www.ontimeairfilters.com/air-filter-merv-rating) [1]
[http://ci.vbi.vt.edu/pathinfo/pathogens/Coccidioides.html](http://ci.vbi.vt.edu/pathinfo/pathogens/Coccidioides.html)
[2] [http://www.amazon.com/Lasko-3723-20-Inch-
Premium-3-SPEED/dp/...](http://www.amazon.com/Lasko-3723-20-Inch-
Premium-3-SPEED/dp/B000HHJ2I2/) [3] [http://www.ushomefilter.com/products/air-
filters/SC80-20X20X...](http://www.ushomefilter.com/products/air-
filters/SC80-20X20X4) [4]
[http://www.filteryourlife.com/](http://www.filteryourlife.com/)

------
rwmj
Also, a new coronovirus in France and the middle east, which although it's
killed 50% of the people who've caught it so far is probably not going to kill
us all[1].

Also H7N9 (a new bird flu), although it's a bit of a lightweight having killed
a mere 20% of sufferers. It may not spread human to human, although we don't
know that, and this one hasn't yet reached "the West".

[1]
[http://www.bbc.co.uk/news/health-23179570](http://www.bbc.co.uk/news/health-23179570)

[2] [https://en.wikipedia.org/wiki/H7N9](https://en.wikipedia.org/wiki/H7N9)

~~~
skue
In med school I learned about a mailing list primarily for infectious disease
specialists tracking potential outbreaks worldwide. After a few months I
stopped reading it -- it was too terrifying.

Update: It was probably ProMED-mail[1]. The WHO also posts disease a outbreak
news[2].

[1] [http://www.promedmail.org/](http://www.promedmail.org/)

[2]
[http://www.who.int/csr/don/en/index.html](http://www.who.int/csr/don/en/index.html)

------
dclowd9901
As an Arizona native, both my best friend and one of my college professors
acquired the disease and became seriously ill. My professor had to miss most
of the year of the class I signed up for, and my best friend was down for an
entire year with weakened lung capacity, as well as not being able to drink an
ounce of any sort of liquor while taking the medication she needed to fight
it. These are probably 5s on a scale of 1-10 with how bad this disease is.

It's horrible, and I wouldn't wish it on anyone. I'd say be careful when you
visit AZ or CA, but there's not really anything you can do except avoid the
dusty areas entirely.

~~~
ttflee
This just reminds me that Prof. Fang Lizhi[1], who was a famous
astrophysicist, vice-president of the University of Science and Technology of
China, a prominent activist during the 1989 student uprising in China, later
hid in U.S. embassy in Beijing for months, exiled in U.S. and worked as
Professor of Physics in Univ. of Arizona also suffered from Valley Fever [2],
and was said to have died of it.

[1]
[https://en.wikipedia.org/wiki/Fang_Lizhi](https://en.wikipedia.org/wiki/Fang_Lizhi)

[2]
[http://www.csupomona.edu/~zywang/FLZ_NO6_2013-4-6.pdf](http://www.csupomona.edu/~zywang/FLZ_NO6_2013-4-6.pdf)

------
Alex3917
The problem also is that you have people who are constantly getting exposed to
anti-fungal medications without their knowledge. E.g. almost all supermarket
lemons/limes/oranges are coated in anti-fungal cream before being coated with
another thin layer of wax, so when you make zest from them (or order a drink
with zest at a bar) then you are probably reducing your body's ability to
fight off things like this. So much better to avoid things like that entirely
I think, as fungal infections are often not possible to cure.

~~~
tokenadult
There is utterly no epidemiological evidence that eating zest has anything to
do with any kind of fungal infection.

~~~
sliverstorm
Of course, that won't actually stop people from claiming there is.

~~~
Alex3917
Have you ever actually heard anyone mention the application of anti-fungals to
citrus fruit rinds in the first place? Because I've never even heard of it
outside of mycology circles, and there are virtually no Google results despite
the fact that the practice is ubiquitous.

~~~
sliverstorm
How does "There is virtually no evidence that this is even done" translate to
"This is a big problem"? At least in my book, lack of evidence doesn't count
as evidence.

~~~
Alex3917
Actually a Google Scholar search for 'citrus postharvest antifungal
treatments' does show that this is in fact the standard operating procedure.
E.g. this paper starts out with a summary of the current state of conventional
agriculture:

[http://ucce.ucdavis.edu/files/datastore/234-1524.pdf](http://ucce.ucdavis.edu/files/datastore/234-1524.pdf)

It's just that a more simple Google search like 'citrus antifungal' doesn't
turn up anything.

------
Roboprog
Swell. I write this from the Sacramento area (yeah, "the other valley" \-
Central, not Silicon) as somebody who was born by Bakersfield.

OTOH - doesn't every place have its own local diseases and parasites???

~~~
notatoad
>doesn't every place have its own local diseases and parasites?

Exactly. This whole article feels like the sort of ego piece you only get out
of places like LA or NYC. Every place on earth has diseases and other medical
problems caused by local environmental factors. To give it that a name like
"valley fever" is to trivialize the fact that the exact same phenomenon occurs
everywhere else in the world too.

~~~
kafkaesque
I agree that the article is too California-centric, but if you follow the link
to the Valley Fever Center, the first thing it says is "Two-thirds of all U.S.
Valley Fever infections are contracted in Arizona"[0]. I'm not saying this is
the next epidemic in the 'West', but I do feel a watchful eye is needed. I
live in LA, I'm a runner and don't live in a coastal city. My lungs are very
susceptible to bad air (particulates). I moved to LA from a city with much
cleaner air, and I've read LA residents tend to have more lung problems.
Sorry, I don't have a link/source handy.

[0] [https://www.vfce.arizona.edu/](https://www.vfce.arizona.edu/)

------
bink-lynch
We have recently been dealing with this not even knowing it existed prior. We
adopted a flat-coated retriever from Kingman, AZ and he was soon diagnosed
with a blown-out knee that required radical surgery. Luckily, my wife did some
research and cancelled the morning of the surgery as his behavior was not
consistent with a bad knee (lame sometimes, run like crazy others). Almost a
year later, still lame off and on, my wife felt odd swelling on his leg bone.
A new vet took more x-rays and found large lesions just above his ankle. We
are lucky it did not affect his lungs, but it settled in his bones which seems
painful. He has been on fluconazole for a couple of months and the masses on
his leg are shrinking. He has not limped for a couple of weeks now, but I
still have to carry him up and down the stairs because the weak leg could
break and it would not heal. Treatment will take at least one year.

Arizona was on the top of our list for our next home. Not anymore.

------
jylertones
Interesting to see this link about Bakersfield. I grew up there (15 years). I
remember every year knowing people that got sick from it. It was kind of like
the chicken pox where you'd just have to stay home for a week. From that
perspective, this article feels completely blown out of proportion. But maybe
we as locals all underestimated it.

------
ck2
Well that article makes you feel horrifyingly hopeless.

Somewhat related I've read that people who visit other countries for weeks at
a time can also get all kinds of illnesses their immune system isn't familiar
with, like Americans visiting Japan for a few weeks can catch all kinds of
stomach viruses.

~~~
mey
This is what I'd call sensationalist journalism. There are antifungal meds
that deal with these type of infections, which are mentioned directly in the
article.

A healthy immune system typically doesn't have an issue with this.

------
Falling3
This is very common where I currently reside - Phoenix. It happens most often
during dust storms, when soil is kicked up into the air. This is really
terrifying though; I had no idea it was so serious.

------
callmeed
My mom lives in Bakersfield and our family own a ranch in the valley (north of
Bakersfield). My mom's neighbor had a bad case last year and she said most
people know someone who has/had it.

Out where the ranches are, everything is dusty. Much more so than you see to
the west in the Salinas valley or where I live (Paso/San Luis/Santa Maria).
They built several prisons there years ago. It's pretty much the only lights
you can see at night.

------
ommunist
Looks like a hoax for me. Fungal infections are medically treated, even if
your lungs are affected with, say, Candida after sharing some shisha in a
dirty moroccan place.

~~~
voidlogic
While the human immune system does a good job with most fungal infections,
human medicine is very poor at treating all but the topical ones.

