The "Silent" Epidemic of America's Southwest

 Nodules caused by Coccidioides immitis fungus.

There is a serious epidemic going on in the American Southwest which has been remarkably overlooked by the rest of the country.  A fungal disease termed "Valley Fever" is currently endemic to several southwestern states, prominently Arizona, New Mexico, and Southern California.  However, while endemic, this disease is ruthless and has very little funding to aid treatment due to its apparent obscurity.  Here is a quote that really caught my attention:

" The impact of valley fever on its endemic populations is equal to the impact of polio or chicken pox before the vaccines”

-John Galgiani, an infectious-disease physician who directs the Valley Fever Center for Excellence at the University of Arizona in Tucson

 

A nodule of Coccidioides immitis filled with infected spores.

It is crucial to understand the confusing severity of the Valley Fever fungal disease.  The way that it enters our bodies is through breathing in its spores.  The spores are the small spherical whitish objects within the nodule pictured above.  The fungus has adapted in a way such that when humans breathe in the spores, they latch onto the inner lining of the lungs and cannot be breathed back out.  Therefore, if you happen to live in an area that the fungus is endemic, and you can walk down the street and breathe these into your lungs, you are at risk of a serious condition.  Once breathed in, the spores multiply within a protective nodule, which then breaks open and allows the spores to spread throughout your body.  In many unfortunate cases they reach the brain and cause large amounts of damage.  

The disease is hard to combat because in the least severe cases symptoms appear to be much like the flu: cough, fever and exhaustion that eventually go away by themselves.  However, in more severe cases, the spores spread to other tissues inside the body including the skin, bones, and brain. The fungus has even been linked to a form of meningitis, termed "Cocci meningitis", which can be treated, but the treatment includes extremely painful injections into the skull of amphotericin B (an antifungal medication).

One case study of a young woman who started with a seemingly mild case of Valley Fever is described here:

"One patient, a twenty-six-year-old white woman who caught valley fever four years ago, told me that the medicine made her vomit non-stop on a negative incline. She was temporarily paralyzed, underwent three brain surgeries, and has had twenty-two spinal taps. Not long after her diagnosis, the doctors told her mother to make funeral arrangements. Now they tell her she will be on anti-fungals, funnelled through a shunt in her brain, for the rest of her life."

 

-Dana Goodyear, Author of Article discussing a previously conducted interview. 

Overall, Valley Fever is a huge problem in the desert southwest that is being ignored due to its endemic state.  This is concerning because there is no vaccine against it, and when cases become potentially fatal there is usually no way to cure them without significant pain for the patient.  In addition, this disease is non-discriminating in its victims; anyone can breathe in the fungi if they are in an infected area.  

I chose this article because it brings up the ideas of ethics and governmental involvement in epidemics that we've been talking about in class.  Should the government not fund research and treatment surrounding a disease just because it isn't a "big name" infection that we hear about every day in social media?  Should patients be subjected to harsh treatments such as cranial injections if they barely know anything about the disease that they have? What if someone went to Arizona and brought the fungus back to the northeastern US, how would the CDC and the government react if at all?  All big questions that apparently are yet to be answered.  It will be interesting to see how (and if) this disease makes it into the news as we approach the warmer vacationing summer months.  

Link to the Main Article:

http://www.newyorker.com/reporting/2014/01/20/140120fa_fact_goodyear

Picture Links:

http://www.virginmedia.com/images/rift-vallery-fever-431x300.jpg

http://en.wikipedia.org/wiki/File:Mature_spherule_with_endospores_of_Coccidioides_immitis_PHIL_480_lores.jpg