More Spores?

Confirmed valley fever cases are on the rise--and a drug that could help has been delayed

About 15 years after being infected with valley fever, a Kansas man is still feeling the effects of the fungal disease, and is now being treated in Arizona—where the number of confirmed cases continues to rise.

Joseph Couture of Wichita contracted the disease between 1996 and 1997 while he was stationed in Lamar, Calif., during a stint in the Navy. He first noticed a problem when he began coughing up blood. He was eventually diagnosed with the disease while serving in Okinawa, Japan. Symptoms progressed to extreme fatigue, fever, night sweats and a 25-pound weight loss.

"I've had two surgeries where they removed a portion of my left lung because of this," he said. "If I'm doing something, it feels like I'm ripping my scar tissue. I get a lot of pain in my left side from where they did the surgeries. It's making it difficult to do shifts at work. Sometimes I just don't have the energy to give it my all at work and home. The biggest thing is feeling like I'm letting everyone down."

Couture, now 37, still requires medicine for his symptoms. Because the disease is not prevalent in Kansas, and information is limited there, the Cessna avionics technician eventually contacted Dr. John Galgiani, director of the University of Arizona-based Valley Fever Center for Excellence.

Galgiani, also a professor of medicine at the university, is treating Couture at the center's office in Phoenix, which opened in June. The Valley Fever Center is a partnership between St. Joseph's Medical Center, the UA College of Medicine in Phoenix, and the Valley Fever Alliance of Arizona Clinicians.

Exposure to valley fever occurs after a spore from a fungus, which grows in dirt, becomes airborne and is inhaled. About a third of human exposures eventually require medical care, Galgiani said. The fungus also can infect dogs, cattle, horses, skunks, javelina and other species.

Although Galgiani is treating Couture for a case contracted many years ago, the number of new cases of valley fever in Arizona continues to skyrocket. Citing statistics compiled by the Arizona Department of Health Services, Galgiani said there was about a 38 percent increase in cases last year, from 11,888 in 2010 to 16,436 in 2011.

Even though the number of reported cases is growing, Galgiani can't say for certain that there actually are more infections. Doctors are testing for the disease more often, and a state lab recently changed to a newer type of blood test that yields more positive tests, he said.

But the increase doesn't seem to indicate that the giant dust storms, or haboobs, that hit the Phoenix area over the last couple of years were a factor. "The increase was every week, all year long. It was not a big bump for a couple of months after the dust storm(s)," Galgiani said.

Because valley fever can have a lengthy incubation period, it's difficult to pinpoint exactly when a person contracted valley fever, Galgiani said.

While nobody knows a definitive reason for the recent spike in cases, Galgiani and other researchers believe climate is having an effect on the disease.

Rain causes the fungus to flourish in the dirt, Galgiani said. And when conditions dry out, and the soil is disturbed by wind, construction or digging, the spores become airborne. That cycle is sometimes known as "grow and blow," a phrase coined by Andrew Comrie, a climatologist at the University of Arizona's School of Geography and Development. It doesn't take inhaling a lot of them to become infected.

Comrie, who is also the university's senior vice president for academic affairs and provost, co-authored a 2011 study detailing climate's relation to valley fever.

"It seems that climate can make the number of valley fever cases go up or down maybe 10 to 20 percent a year, depending on the baseline you're looking at," he said.

He concurs with Galgiani that last year's dust storms weren't significant in terms of the disease.

"The dust in dust storms does not come from those (infected) environments," he said; the spores live primarily in undisturbed areas of the Sonoran Desert. Much of the dust that kicks up in a quick dust storm is from agricultural fields and construction sites, he said.

While we know how people become infected with valley fever, efforts to prevent the disease have been challenging, Comrie said, because the condition is not one of national significance. That makes it hard to acquire federal resources and support.

Galgiani agrees, blaming a lack of money for stalling further research on a vaccine in pre-clinical trial discovery.

"There's no business model for this, because it's an orphan disease. No company would see this as an investment opportunity," he said.

However, one can make a case that the disease costs the country about $200 million a year, he said.

A drug to treat those already infected with valley fever also is on hold for financial reasons. Nikkomycin Z is under development by a company led by Galgiani, but more of the drug is needed for study.

Valley fever is endemic to parts of Arizona and California, but the fungal spore that causes the disease also has been found in New Mexico, Utah, Texas and southern Nevada. Two-thirds of all valley fever cases occur in Arizona, with 80 percent of the infections being found in Maricopa County, Galgiani said. Most of the other cases in the state are in Pima and Pinal counties.

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