A Disease Without a Cure Spreads Quietly in the West | Hacker News Reader

A Disease Without a Cure Spreads Quietly in the West

nytimes.com

177 pointssgaither59 comments

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...

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

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.

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

Not only storms or earthquakes...I would imagine Santa Ana winds would help this spread to the coastal regions.

Not very familiar with US geography but looks like your are correct :

(A) http://en.wikipedia.org/wiki/Santa_Ana_winds#Health%20effect...

(B) http://publichealth.lacounty.gov/acd/diseases/Cocci.pdf - Check the comments section

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

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

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/

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

For the coronovirus, people tend to check the type of infection only when the infection is bad. The people who have died all had comorbidities, meaning they were already sick with something else, so that 50% death rate is a result of a very strong observation bias and unlikely to be a characteristic of the disease.

I remember hearing that the bird flu (during the original outbreak) was called H1N1 so I got curious to find out how many substrains have been identified thus far.

I was surprised to find that there are currently 35 strains of bird flu listed! https://en.wikipedia.org/wiki/Avian_influenza_virus#Contract...

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.

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

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

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.

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

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

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.

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.

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

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

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

No, but there is plenty of evidence that fungi develop resistance to anti-fungal drugs. If I really liked zest I might keep eating it, but since I actually don't like it in the first place I don't find that I lose anything by leaving it out of recipes and cocktails.

I certainly wouldn't say that it's definitely harmful, but when you're eating all these fungicides that have never been tested for longterm safety on humans then that's a risk one should be at least cognizant of.

Actually unlike antibiotics, there is limited evidence of rrsidtence to antifungals. Amphotericin and fluconazole have been around forever and still useful.

Almost all fungal (few exceptions) infections are 100 % curable and treatable in most healthy individuals !!

Lethal fungal infections (such as Aspergillous and Mucormycosis - flesh eating fungus) are common in immune-comprimised individuals (Diabetics, HIV+ , Organ Transplant Recipients, etc) and very un-common in healthy individuals.

"Almost all fungal (few exceptions) infections are 100 % curable and treatable in most healthy individuals !!"

I mean some of them are curable, but anti-fungals are extremely toxic since human cells and fungi cells are very similar. And unlike with bacteria you can't just use antibiotics, since antibiotics mostly come from fungi to begin with. Also, you're not going to be young and healthy forever. At some point you are going to reach an age where you are highly vulnerable to fungal infections, unless you've already died from something else.

Well Fungal cells walls have ergosterol which we humans don't and that is a particular target site for many anti-fungals.

In some cases the fungal treatment is longer than usual eg: Nail infection, because it takes very long for the drug to reach the site. The treatment is around 3 months +

In most common opportunist fungal infections a few doses of anti-fungal does cure and treat the infection.

Also most Healthy individuals don't get infected with Fungus in the First Place even if they eat what ever crap with Anti-fungal substances (in your case lemon with pesticides)

Because our body defense is usually good enough to ward off fungal infections in the first place. Actually a very handful of fungal species are able to infect Healthy people.

And the article is a little Sensationalist as the disease is endemic and common to SW USA.

> In some cases the fungal treatment is longer than usual eg: Nail infection, ...

I believe I got that and roughly beat it! It only took a few years!

Doing some rough carpentry, I dropped a 2 x 4 on my left big toe. No big pain. But later it appeared that I had cracked the nail. Later the nail began to crumble -- likely a fungus among us!

Eventually the nail crumbled its way nearly all the way back to the white part.

I got some anti-fungus cream, generic, big tubes, from Wal-Mart. So, I'd put a tablespoon of this cream on the nail, wrap up the toe with a piece of paper towel, secure it with whatever tape was handy, and f'get about it until after a shower, etc. and then repeat the procedure.

More than once the nail grew out again but was infected with the fungus. We're talking years here!

Finally I got lucky and the nail grew out apparently healthy.

Then there was another problem: The inside edge of the nail was a long way from growing out so grew against flesh giving me an ingrown toenail. Okay, been there; done that! So, slathered on some Wal-Mart generic triple anti-biotic cream, wrapped it up, and waited months until the end of the nail grew out past the flesh. Yes, the end of the nail was ugly with blood and dead flesh! Ah, soap and water! But there was no bacterial infection from the ingrown nail, and no fungus infection.

Now the nail is nicely grown out with little or no evidence of crumbling from a fungus infection.

So, I killed the fungus with just topical medicine and not some internal medicine that might damage my liver.

But, given the slow rate of nail growth, a case can take years!

The anti-biotic cream seems to be strong stuff: Once got some on my socks, washed my socks, and too soon saw sewage bubbling up in my backyard. Yup, the anti-biotic cream had sterilized my septic tank! So, flush a box of Rid-X or whatever, and the septic tank has been healthy ever since.

LOL glad you have your toe nail back. The treatment would have been much faster had you taken Oral Anti-Fungal Meds.

I understand your concern but if you read the side effects even Aspirin has a TRUCK LOAD of 'em. But most of the serious side effects are extremely rare.

On a related note people complain about Side effects of Meds all the time (and Rightly so) but continue to live un-healthy lifestyles (smoke, loads of Alcohol, Trans Fat, etc) which is a little Ironic :)

> On a related note people complain about Side effects of Meds all the time (and Rightly so) but continue to live un-healthy lifestyles (smoke, loads of Alcohol, Trans Fat, etc) which is a little Ironic :)

I really hate this argument. Life is not binary. That statement is not ironic.

I might want to be a healthy individual, but I'm not required to go on a raw food vegan or paleo diet in order to do. Griseofulvin or it's friends, however, is designed to cure an infection, and taking it does not require me to quit eating sugars, carbs and alcohols or stop smoking, rock climbing or breaking the speed limit on the highway.

Aren't topicals that are absorbed through the skin also broken down by the liver?

I don't know.

Or maybe after all the topical I used, enough was absorbed that in effect I had internal medication. Or, I used enough topical to kill all the fungus in my shoes, socks, etc. so that the next time the nail grew out there wasn't any fungus. It does appear that there was some infection on other nails on the same foot. I never put topical on those other nails, but they have cleaned up, as they have grown out, along with the nail on the big toe that finally grew out healthy.

For a liver, supposedly one of its main roles is to get rid of molecules it doesn't like to see, possibly including anti-fungus molecules.

> anti-fungals are extremely toxic since human cells and fungi cells are very similar

Anti-fun gals tend to be toxic, not so much because of cell similarity. Ergosterol biosynthesis is not performed by humans.

Come on, do you have any references or sources for any of these claims? That seems a very flimsy inference.

Do you have any more information about that?

I zest the peels often and enjoy a gin and tonic with lime, would buying organic or from a specific producer help avoid it? The cost should be minimal for these items.

http://www.whatsonmyfood.org/pesticide.jsp?pesticide=604

http://en.wikipedia.org/wiki/Enilconazole

http://en.wikipedia.org/wiki/Tiabendazole

At what dosage are those antifungals effective?

It appears that the highest amount of Tiabendazole found is 0.79mg/kg so I would guess on an individual rind it would be roughly 0.1mg if that. Given dosage amounts seem to be about 25mg/kg/day I would guess it would take an obscene amount of it to cause any sort of bodily reaction. Wouldn't this concern be on par with consuming things that contain deadly things but in ppb or ppt quantities?

"Wouldn't this concern be on par with consuming things that contain deadly things but in ppb or ppt quantities?"

It's not going to be enough to be toxic to humans. The issue is whether it's either introducing antifungal resistant fungi into your body, or causing fungi already in your body to become antifungal resistant.

Drinks at a bar would be using unwaxed lemons.

It's possible to buy organic unwaxed lemons, so people who worry about what's put on lemons and sealed in with wax can still enjoy zest.

For this post let's assume that all lemons are sprayed with pesticides and fungicides, and then they're waxed. And that the wax is removed by alcohol, allowing the pesticide and fungicide to come off into the drink.

A slice of lemon in a gin and tonic is going to give you a tiny dose. I'd be interested to see if there's any evidence that the pesticides and fungicides are doing any harm. (Especially in comparison to the alcohol.)

Any authoritative reference on the type of antifungals that are used? Do they inhibit fungi specific to citrus fruits or also fungi that infect humans?

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???

>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.

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/

In fairness, it's causing genuine suffering and is so far incurable for many people.

They call it "valley fever" in the Valley of the Sun (i.e. Phoenix metro area) as well.

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

You're right. I live in the mid-Atlantic region of the country. Two months ago, we went hiking in the woods and my wife and I forgot to check our three kids for ticks until the next day. My 4 year old son had two ticks on him. A week later, bulls-eye rash about 5 inches in diameter appeared on his back around one of the tick bites.

Three weeks of antibiotics later, he was fine but there are a lot of people that get Lyme's Disease without even knowing that they had a tick bite, or the rash that appears in the majority (but not all) is in their hairline so they don't see it. Untreated, it can have a lot of the same effects the article attributes to this fungal infection.

Quite right .. Untreated Borrellia (Lyme's Disease) can actually be very severe (cardiac, large joint and cns involvement). You should always has some kind of pest-repellent on yourself in case you plan to camp.

Good thing you son had very TYPICAL presentation and history - H/o Hike in the woods , followed by rash with central clearing (bull's eye).

Lyme's disease is Endemic in the NE USA and some part of central US as well.

The article is a little sensationalist like I mentioned in another comment. Many parts of US (and the world) have their own set of Endemic Diseases to the Geo-location.

ps: It's untreated Borrellia infection that leas to lyme's disease.

If only the crazy people hadn't won I would be able to get a Borrellia vaccine, where I live I assume I will get Lyme's Disease before I die of old age.

What really gets me angry is I can vaccinate my dog... I've been looking into vaccine compatibility...

Where I grew up (Darwin, Australia), gardening can kill you with a flesh-eating bacteria.

http://en.wikipedia.org/wiki/Melioidosis

Luckily, it's treatable with very high doses of antibiotics. It mostly kills the already infirm or elderly.

Swimming in a lake here in Florida can kill you:

http://en.wikipedia.org/wiki/Naegleria_fowleri

Personally, I prefer springs and oceans. So not too worried about that. Lakes around here are murky and full of gators any way.

Oh that disease due to a kind of Amoeba (Naegleria) is very bad because it actually almost always leads to death (post to meningo-encephalitis). 97-99% mortality unlike coccidioidomycosis (which is a little hyped in the article).

They tried Amphotericin B in some case with limited success but the disease is always fatal :(

On the plus side, it's extremely rare. About three cases a year in the U.S. on average.

Darwin wins again -- Saltwater crocodiles are bigger than alligators :D

A similar virus killed Steve Frasier, founder of Internet Mortgage Exchange (IMX), who also contracted it gardening at his home in Walnut Creek.

He had a fever and complained of pain in his arms for a week before going to see a doctor, but by then there was little they code do as the bacteria had spread to his heart.

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.

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.

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.

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.

That's true, but I picking up a few minor infections here and there that your body can shrug off is no big deal. In fact it's useful for our immune systems get a minor workout from time to time.

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.

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.

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.

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.

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