LORI CROWN THOUGHT she was doing the right thing last year when she moved to a dryer climate in Bakersfield, California, after being plagued by asthma attacks during her six years in Hawaii. A few months later, Crown, 35, was suffering from severe headaches, a prolonged fever of 102 degreesF, swollen feet and painful bumps on her hands and legs. The diagnosis: “valley fever,” or coccidioidomycosis, a dust-borne disease caused by the microscopic spores of a fungus, Coccidioides immitis. As a newcomer to the San Joaquin Valley, Crown was stunned to learn that the same rich topsoil that makes the region an agricultural Mecca also harbors this deadly microbe. She has become a statistic in the worst epidemic of valley fever ever recorded. From 1986 to 1990, doctors reported an average of 450 cases a year to state authorities. In 1991 the number nearly tripled, to 1,208. Last year it soared to 4,54l, with an estimated death toll exceeding 50. The worst-afflicted area is the San Joaquin’s Kern County, which has reported nearly 2,000 cases since October. Valley fever is also on the rise in the Tucson and Phoenix areas, where reported cases jumped from 287 in 1991 to 438 last year. But statistics tell just part of the story: only about 10% of those infected ever come to a doctor’s attention. The rest have either no noticeable symptoms or mild cases that they mistake for a cold or flu. Though . valley fever, which has been known for a hundred years, has received scant attention outside the Southwest, the current epidemic is changing that. Last week the U.S. Centers for Disease Control and Prevention in Atlanta issued a warning to physicians nationwide to be on the alert for the disease in patients who may have become infected while traveling. Valley fever does not spread from person to person but is contracted by inhaling airborne spores from the fungus, which is endemic to dry areas of the American West and Southwest as well as parts of northern Mexico and Central and South America. Face masks offer only limited protection against the infinitesimal spores, and efforts to design a vaccine have yet to succeed. The fungus multiplies dramatically whenever the soil becomes damp after a protracted dry spell. Swept into the air by winds, construction equipment, even the passing feet of farm workers, the spores can travel up to hundreds of miles on the surface of dust particles. Central California’s six-year drought, which has been interspersed with warm, heavy rains, as well as the region’s construction boom, provided the ideal conditions for fungal proliferation. Those lucky enough to ingest the spores without becoming seriously ill seem to acquire immunity. More serious cases are often mistaken for pneumonia, since the fungus flourishes in the moist, warm environment of the lungs. In about 1% of victims, the disease spreads beyond the lungs through the bloodstream — typically to the skin, bones and the membranes surrounding the brain, causing meningitis. “There was a time when I saw three new cases of cocci meningitis a year,” says Dr. Royce Johnson, chief of infectious diseases at Bakersfield’s Kern Medical Center. “Not long ago, I saw three new cases in one day.” Johnson is now treating 51 cases of cocci meningitis and an additional 300 patients with severe valley fever.
