A Disease Without a Cure Spreads Quietly in the West / Valley Fever

BAKERSFIELD, Calif. — In 36 years with the Los Angeles police, Sgt. Irwin Klorman faced many dangerous situations, including one routine call that ended with Uzi fire and a bullet-riddled body sprawled on the living room floor

But his most life-threatening encounter has been with coccidioidomycosis, or valley fever, for which he is being treated here. Coccidioidomycosis, known as “cocci,” is an insidious airborne fungal disease in which microscopic spores in the soil take flight on the wind or even a mild breeze to lodge in the moist habitat of the lungs and, in the most extreme instances, spread to the bones, the skin, the eyes or, in Mr. Klorman’s case, the brain.

The infection, which the Centers for Disease Control and Prevention has labeled “a silent epidemic,” is striking more people each year, with more than 20,000 reported cases annually throughout the Southwest, especially in California and Arizona. Although most people exposed to the fungus do not fall ill, about 160 die from it each year, with thousands more facing years of disability and surgery. About 9 percent of those infected will contract pneumonia and 1 percent will experience serious complications beyond the lungs.

The disease is named for the San Joaquin Valley, a cocci hot spot, where the same soil that produces the state’s agricultural bounty can turn traitorous. The “silent epidemic” became less silent last week when a federal judge ordered the state to transfer about 2,600 vulnerable inmates — including some with H.I.V. — out of two of the valley’s eight state prisons, about 90 miles north of here. In 2011, those prisons, Avenal and Pleasant Valley, produced 535 of the 640 reported inmate cocci cases, and throughout the system, yearly costs for hospitalization for cocci exceed $23 million.

The transfer, affecting about a third of the two prisons’ combined population, is to be completed in 90 days, a challenge to a prison system already contending with a federal mandate to reduce overcrowding. Jose Antonio Diaz, 44, who has diabetes and was recently relocated to Avenal, is feeling “very scared of catching it,” said his wife, Suzanne Moreno.

Advocates for prisoners have criticized state agencies for not moving the inmates sooner. “If this were a factory, a public university or a hotel — anything except a prison — they would shut these two places down,” said Donald Specter, the executive director of the Prison Law Office, which provides free legal assistance to inmates.

The pending transfer has underscored the complexities and mysteries of a disease that continues to baffle physicians and scientists. In Arizona, a study from the Department of Health Services showed a 25 percent risk of African-Americans with newly diagnosed valley fever developing complications, compared with 6 percent of whites.

“The working hypothesis has to do with genetic susceptibility, probably the interrelationships of genes involved in the immune system,” said Dr. John N. Galgiani, a professor at the University of Arizona and the director of the Valley Fever Center for Excellence, founded in 1996. “But which ones? We’re clueless.”

Read More:
http://www.nytimes.com/2013/07/05/health…=all&_r=1&