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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.
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.”
Kaden was essentially breathing through an opening the size of a straw, said Dr. James M. McCarty, the medical director of pediatric infectious diseases atChildren’s Hospital Central California in Madera, where Kaden spent six months. Today the boy is back to his mischievous self, surreptitiously placing a green plastic lizard in his mother’s hair.
But how he contracted valley fever is still guesswork. “I think he got it being a boy, digging in the dirt,” Mrs. Watson said.
Kern County, where Bakersfield is located, had more than 1,800 reported cases last year. At Kern Medical Center, Dr. Royce H. Johnson and his colleagues have a roster of nearly 2,000 patients. Many, like Mr. Klorman, have life-threatening cocci meningitis.
“It destroys lives,” said Dr. Johnson, whose daughter contracted a mild form. “Divorces, lost jobs and bankruptcy are incredibly common, not to mention psychological dislocation.”
Once athletic, Deandre Zillendor, 38, dropped to 145 pounds from 220 in two weeks, and lesions erupted on his face and body. “You keep it forever, like luggage,” he said of the disease.
Todd Schaefer, 48, who produces award-winning pinot noirs in Paso Robles, was told by his doctors that he had 10 years to live. That was 10 years ago. But valley fever has disseminated into his spinal column and brain, and his conversation is interrupted by grimaces of pain. Ruggedly handsome, he still outwardly resembles the archetype of the California good life. But Mr. Schaefer has had a stroke, a hole in his lung, two serious heart episodes and relapses that “put me on the edge of life,” he said.
Today Mr. Schaefer can no longer can drink wine, and he begins every morning retching. “I told her to leave me,” he said at one low point, of his wife, who is 37. “She’s too young, too beautiful.”
Dr. Benjamin Park, a medical officer with the C.D.C., said that the numbers of cases are “under-estimates” because some states do not require public reporting. They include Texas, where valley fever is endemic along the Rio Grande. In New Mexico, a 2010 survey of doctors and clinics by the state’s public health department revealed that 69 percent of clinicians did not consider it in patients with respiratory problems.
Numbers spike when rainfall is followed by dry spells. Many scientists believe that the uptick in infections is related to changing climate patterns. Kenneth K. Komatsu, the state epidemiologist for Arizona, where 13,000 cases were reported last year, said that another factor may be urban sprawl: “digging up rural areas where valley fever is growing in the soil,” he said.
Valley fever was a familiar presence during the Dust Bowl, and in Japanese internment camps throughout the arid West. Yet there is still no cure, and research on a fungicide and a potential vaccine have been stalled by financing issues. One company, Nielsen Biosciences Inc., has developed a skin test to identify cocci but has not yet been able to make it financially viable.
Part of the difficulty is that cocci is “a hundred different diseases,” Dr. Johnson said, depending on where in the body it nests. His patients include farm workers, oil field workers and construction workers.
One of his patients, Barbara Ludy, 61, had a job that involved taking care of a man who is quadriplegic. She was strong enough to lift his 175-pound frame, plus his wheelchair, into a van. Cocci meningitis affected her ability to think, to remember, to walk, to live independently. When her weight dropped to 71 pounds, her distraught daughters went to Goodwill to buy their mother size zero clothes.
Wednesday, December 12, 2012
Tuesday, November 20, 2012
Updated: Tuesday, 20 Nov 2012, 6:47 PM EST
Published : Tuesday, 20 Nov 2012, 6:47 PM EST
SHELBYVILLE, Ind. (WISH) - A dangerous infection is causing concern in Shelbyville.
Some high school students are undergoing treatment for what heath officials think may be Histoplasmosis.
It's an infection caused by breathing in spores from bird or bat droppings.
It's an infection you may have never heard of, but health investigators in Shelby County believe Histoplasmosis is responsible for making some Shelbyville High School Student Council and National Honor Society students sick.
Robert Lewis with the Shelby County Health Department says the fungus grows in large amounts of bird or bat droppings.
In this case, Lewis believes the students were exposed when they were clearing out an old barn for a school fundraiser
“They were probably sweeping it out so that stuff got into the air and its unfortunate very unfortunate that these children breathed it,” said Lewis.
Lewis says most of the time, Histoplasmosis effects the respiratory system, but can also cause fever, chills, joint pain, mouth sores, and red bumps on the lower part of the leg. More serious cases involve swelling near the heart, brain, or spine.
While Lewis suspects the infection in these cases, it has to be confirmed by the CDC.
24-Hour-News 8's John Laberge reached out to school officials to confirm the number of students affected and the location of the barn in question. Our calls have not been returned.
One child is being treated at Riley Hospital for Children.