Valley Fever Is a Growing Fungal Threat to Outdoor Workers | Hacker News Reader

Valley Fever Is a Growing Fungal Threat to Outdoor Workers

scientificamerican.com

119 pointsBender32 comments

I've only diagnosed one case of coccidioidomycosis, and it was on a small tropical island. Black male in his early 20s. Looked for all the world like a cutaneous lymphoma. Biopsy was full of granulomas and I got a fungal stain reflexively. We were all flabbergasted. Turns out the young man was from the Central Valley.

I note the patient's sex and race because it seems this particular group either has a particular tolerance for the disease until it's metastatic, or has a particularly aggressive reaction to metastatic disease. In either case, my ID colleagues tell me that when they present, they seem to present with markedly worse systemic disease. Don't take my word for it, here's the Mayo Clinic, reviewing many other studies over decades:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012635/

A veterinarian I know has diagnosed multiple patients with valley fever, including one whose owner responded with "Oh, I had that!"

The most disturbing was the case where the dog's bones were very, very heavily eroded away -- to the extent that to me, a layperson, the bones weren't really recognizable anymore. As usual, the dog and one of the owners were recreating on trails near a dry lake bed.

Valley Fever was the least pleasant sickness I've had yet, would definitely recommend avoiding if you can. The fever and cough were both _very_ unpleasant, and it hurt to walk for weeks.

It's a disease that we run into in TB control programs in certain areas because it can resemble it on chest X-ray. Most people with it I've encountered did okay with modest or even no treatment, but I had one case who ended up with it chronically and all I could do was suppress it. Trying to control dust and reduce inhalation are right now the best options to prevent it, and everyone acknowledges it's nowhere near enough.

Yeah, it does not seem like an easy disease to do anything about. Not like we're going to be able to purge it from all the dust.

Absent work on a treatment/cure, best we can probably do is education and maybe get people to wear masks while doing dusty work outside?

It does seem like the medical community isn't really _that_ informed about it either. I basically had to diagnose myself and convince the doctor at the clinic I went to.

The only people who seem that informed about it are whoever writes that "places where certain fungal infections are common" warning in every advert for immunosuppressants.

It's definitely not top of mind for most physicians, no. Even in my hyperspecialized world I need to have a certain level of suspicion, and I've made the diagnosis not infrequently. VF is way underdiagnosed.

Do we not have effective anti fungals?

I grew up in Kern county where valley fever is prevalent and it is very serious. I've known many people that completely lost their summers from being so ill for months. The people who get chronic valley fever are the worst, just waisting away. They look like cancer/chemo patients.

Edit: the article neglected to mention the terrifying aspect that the infection can spread to your brain causing fungal meningitis

Fungal infections are generally nasty, ugly beasties.*

* "It's an industry term." -- Some movie

My mother contracted coccidioidal meningitis (CM) [1] around 1991, perhaps because her immune system was weakened from chronic lymphocytic leukemia (CLL). Apparently fluconazole was not widely used at this point, and they treated her with Amphotericin B via intrathecal delivery, but the treatment was unsuccessful and she died. Apparently treatment is now more successful.

[1] https://health.ucdavis.edu/valley-fever/about-valley-fever/c...

1/1000 who are infected die from it which is actually kind of terrifying to think about, especially since it also lives outside of the body in the soil.

LA County Public health has worthwhile information including:

- number of cases by area

- incidence rate per 100,000 from 2003 - 2022

http://publichealth.lacounty.gov/acd/diseases/cocci.htm

LA is not affected that badly fortunately. Look one county north and the incidence is an order of magnitude larger: https://kernpublichealth.com/valley-fever/

Valley fever's been around forever. It's a bad thing, and for sure we should develop a vaccine.

The SciAm article shows NO support for the assertion that the incidence is growing. You and the other comment about Kern are the only actual data.

Here is an all California survey of incidence data for 2019 compared to incidence from 2013-2018. The figures on page 8 suggest a northward shift to me:

https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20...

Not loading for me - any chance you could state the figures?

Doesn't it also infect pets, e.g., dogs? Anyway, something we're always mindful of here in the southwest US.

Yes. We lost our beloved family golden retriever to VF back in 2009. It was a painful experience to see her degenerate, and the cough was something else. I remember treatment costing a pretty penny.

Yes, it can theoretically infect any animal that inhales the arthroconidia (basically its spores), but there has been no documented spread from animals to humans or humans to humans.

I've seen dogs get valley fever unfortunately. Not sure about cats or other pets.

Masking with n95 or higher rated masks (95% efficacy or higher) is really important these days if you want to avoid COVID, mitigate air pollution from near constant wildfires, and now this.

However, I understand that not everyone can afford to keep buying good masks, or have a nice enough climate to be able to wear one outdoors. if the weather is too warm & humid, you’ll likely die from heat exhaustion instead.

> However, I understand that not everyone can afford to keep buying good masks

As a tip for fellow price-constrained folks out there: upgrading to an elastomeric respirator can help substantially with costs. Dentec's marketing copy suggests about a 90% reduction in costs compared to using disposable respirators [0]; given a pack of 50 duckbills on projectn95 [1] is roughly the same price as a new elastomeric w/ filters [2], seems to check out.

As an added benefit, going in on an elastomeric can help a bit with both mask fit and comfort.

[0] https://dentecsafety.com/usa/products/respiratory-protection... [1] https://www.projectn95.org/products/aci-surgical-n95-respira... [2] https://www.criticaltool.com/style/dentec-400nx-black-half-m...

Short us using a PAPR these are expensive with some P3-100's attached it is near impossible to use such masks working in a field as it just gets too hot and tiring. More common these days is to buy farm equipment that is enclosed and has a good cabin filter, ideally HEPA but unfortunately there are many tasks that must be done manually.

There are plenty of DIY PAPRs now, many of which need some refinement to be truly comfortable, but they're certainly affordable.

You've got my interest. I would love to see some articles if you have any handy. I found some cheaper off-brand PAPR's on Amazon but they have really bad reviews and look sketchy.

Is there any evidence of a sizeable effect from wearing masks outdoors, especially considering the risk of transmission outdoors is so much lower than indoors[0]? I thought this practice was debunked early in the pandemic. Even indoors, the effect is small at best[1], but outdoors the volume of air and other factors contribute to the near-impossibility of effectively transmitting any serious kind of live viral load.

0 https://academic.oup.com/jid/article/223/4/550/6009483 1 https://www.cochrane.org/CD006207/ARI_do-physical-measures-s...

Valley fever fungus survives outdoors, so the mask can help. COVID does not, so the mask is good indoors or in crowds.

If you’re referring to only COVID, you’re right. Wearing a mask outdoors is pointless. It only makes sense indoors, but I was also referring to air pollution from wildfires and Valley fever where both are still dangerous outdoors

It’s crazy to think about but we may soon be in the dystopian future where everyone has a rebreather system while they walk around in grungy neon lit cities. It’s preparing us for what colonizing other planets might look like I guess.

For those interested in researching mold a growing topic that may be of interest is Chronic Inflammatory Response Syndrome (CIRS). Most of the nih.gov papers are behind a paywall otherwise I would link a few. I personally find it interesting because I have been exposed to mold and have some of the symptoms.

Feel free to link them anyway; those who are interested can pull the DOIs and use scihub.

Here [1] is one of them. And this [2] is a protocol I have been loosely following using non-rx alternatives for ionophore biotoxin binders.

[1] - https://pubmed.ncbi.nlm.nih.gov/36069791/

[2] - https://richmondfunctionalmedicine.com/mold-related-biotoxin...

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