Beware the air you breathe may be deadly.  In Southern California and the American Southwest, the air is filled with dust churned up by bulldozers and held aloft by the hot wind. But dust isn't the only problem in these overheated regions. Another is a lung disease, called valley fever, known medically as coccidioidomycosis, or cocci.

Remember the heat spell in California last year?  Well, Coccidioides, dormant during long dry spells, "blooms" when it rains and is swept into the air by anything that disturbs the soil: earthquakes, storms, farming, construction.  It can be carried hundreds if not thousands of mile away.  With the increase of global warming and population, cases of “Vally Fever” have gone up more than three fold in California and Arizona since1993. 

Most people who inhale the valley fever fungus have few, if any, problems. But some, especially pregnant women, people with weakened immune systems, and those of Asian, Hispanic and African descent, may develop a serious or even fatal illness from valley fever.  I know because my nephew is now sitting in Mission Hospital here in Asheville, North Carolina in a coma after visiting California in November and December 2006, where he probably came into contact with the fungus.

Mild cases of valley fever usually go away, but when valley fever is more serious, doctors prescribe antifungal medications that can treat the underlying infection.  In my nephew’s case, the problem is so serious that the doctors in Asheville, NC, started administering the antifungal medication directly into his spinal fluid and now through a catheter inserted through his skull.

Because Valley Fever is more common in California, the doctors at Mission Hospital in Asheville, NC, were so concerned by Thanh Le’s worsening condition, they (Doctor H. McClain, M.D. heading a team of five doctors with the Asheville Infectious Disease Consultant Center), called California for advice.  (Something they never do.  After all they are experts in their field.) The advice they received was shocking, jam it into his spinal fluid (Anphotericin B Liposomal (Ambisome); an anti-fungal medication).  This procedure was something they had never come across and one that has the entire medical community there talking.

Thanh le, 24 years of age, moved to North Carolina in 2006 from California.  He made a return trip to California to visit his wife’s relatives in San Jose, California in November and in December 2006 he started coughing.  At first he thought nothing of it.  He returned home to North Carolina, where his condition worsened. 

In January 2007 Thanh admitted himself to Highlands/Cashiers Hospital emergency, where the doctors thought he had pneumonia.  Although TB (Tuberculosis) and Histoplasmosis, (a fungal infection), were cited as possible reason for his illness. But skin tests were never performed.  Highlands/Cashiers Hospital prescribed antibiotics and sent him home.  After 2 days Le’s body broke out with a rash.  After six days Thanh returned to the hospital, but the doctors assumed it was a reaction to the medication and changed meds. During one of Thanh’s visit to Highlands/Cashiers Hospital the emergency doctor on duty told Thanh that his headaches were not an emergency and sent him away to see a family doctor.  

A month later, in February 21, 2007, Thanh Le returned to Highlands/Cashiers Hospital with his uncle, where TB (Tuberculosis) and Histoplasmosis, were cited again as a possible causes of his illness.  On February 23rd and 28th Thanh Le and his wife went to a Western Pulmonary and Critical Care, PLLC in Sylva where he was x-rayed by both Carolina West Radiology, and WestCare Health Service, to check his lungs.  Evidence of something growing in Thanh’s lungs was present, but no further testing was performed for Histoplasmosis or TB (Tuberculosis). 

Along with the cough, fever, and rash, Thanh experienced more and more sever headaches until finally he started hallucinating Tuesday March 13th, 2007.  (Problems Thanh had reported to the doctors, all of which are indications of Histoplasmosis.)  Wednesday morning, March 14th, 2007, Thanh’s wife called his aunt, (my wife), and we took him again to the Highlands/Cashiers Hospital Emergency Room where Doctor Wheeler made a call to Mission Hospital in Asheville to Doctor McClain who asked that Thanh be sent immediately to them. 

I received a call from Doctor Wheeler that same night to pick up Thanh and transport him to Asheville.  As we left, Doctor Wheeler gave copies of the x-rays and reports for us to take to Missions Hospital to insure the doctors in Asheville were kept abreast of the history of Thanh’s case.  While we were waiting to be admitted at Missions Hospital, my wife and I read the reports Doctor Wheeler had given us.  We were both surprised to read that Histoplasmosis and TB (Tuberculosis) had been indicated as possible causes of Thanh Le’s illness in January and again in February 2007. 

At Missions Hospital, Thanh Le was immediately put in a room where red tape was put on the door, “Don’t Not Enter, Isolation”.  Nurses donned air-filtered masks and clean room suits.  His wife was not allowed to see him.  His aunt and I were required to wear the same uniforms to visit.  After consulting with me by phone Thursday morning, Dr. McClain started Thanh on a regimen of drugs for TB, (Tuberculosis) and ordered a biopsy of Thanh’s lungs to confirm his suspicion.   Friday a biopsy was performed.  Saturday the tape came down, the doors opened to the hallway, the suits were put away, and Thanh’s wife was allowed to see him. 

That same evening, with his wife and aunt present, Thanh quietly slipped into a coma.  The pressure from the inflammation causing Thanh’s increasing headaches choked off the blood supply to Thanh’s brain stem and Thanh suffered two infarcts, (strokes) that resulted from the growth of the fungal infection Thanh was carrying all along.

Evidence of these events is now documented by the medical bills Thanh Le’s pregnant wife and two children are starting to receive by mail.  Thanh Le’s wife, Phoung, goes faithfully to Mission Hospital with hope and a prayer to sit by his side.  She can’t explain to Kang, Thanh’s three year old son, why his father can’t get up and take him to Chucky-Cheese.

The first case of valley fever was recognized more than a century ago. Since then, doctors have diagnosed upward of 100,000 cases a year in endemic areas.

Climate change.

In Arizona, most outbreaks occur in June, July, August, October and November. In California, the risk of infection is highest during the summer months, usually June through August.

Valley fever isn't limited to humans; dogs, horses, cattle, bats, snakes, coyotes and most other animals also are susceptible to the disease. Even house cats can catch valley fever when dust seeps in around windows and doors during storms.

The acute form of valley fever is often mild, with few, if any, symptoms. When symptoms do occur, they tend to resemble those of the flu, and can range from minor to severe:

• Fever.
• Cough.
• Chest pain, which can vary from a mild feeling of constriction to intense pressure resembling a heart attack.
• Chills.
• Night sweats.
• Headache.
• Fatigue.
• Shortness of breath.
• Joint aches.
• Rash. Some people develop painful red bumps that may later turn brown — mainly on the lower legs but sometimes on the chest, arms and back. Others may have a raised red rash with blisters or eruptions that look like pimples.

If you don't become ill from valley fever, you may only learn that you've been infected when you later have a positive skin or blood test or when small areas of residual infection (nodules) show up on a routine chest X-ray. Although they don't cause problems in and of themselves, nodules can look like cancer on X-ray, leading to unnecessary biopsies.

If you do develop symptoms, especially severe ones, the course of the disease is uncertain. It can take from six months to a year to fully recover, and fatigue and joint aches can last even longer. The severity of the disease depends on several factors, including your overall health and the number of fungus spores you inhale.  There is a simple skin test available like the one conducted for Tuberculosis that can be done.  Although not one hundred percent accurate at least it’s a start.

For more information about Valley Fever consult www.mayoclinic.com