Doctors couldn’t figure out what was wrong with Devin Buckley.
It was February 2018, and the previously healthy 18-year-old found he couldn’t walk to the bathroom without becoming short of breath. This was on top of the rapid weight loss, stomach issues and extreme fatigue that seemed to come out of nowhere.
The University of Arizona campus health center in Tucson, where Buckley was enrolled as a freshman, had no response. No one in the emergency room either.
Buckley was at home in Chicago for spring break when he found himself in the intensive care unit, struggling to breathe. It was there that he was finally diagnosed with valley fever, after a family friend suggested doctors test him.
“It blew my mind that something so serious could not be known,” Buckley, 24, said. “When I was first diagnosed, the word cancer was going around with some doctors – like they were testing me for it. So it shows you how serious a disease is if the doctors who see it think the first thing I have is cancer.
Valley fever is an infection caused by inhaling spores of the coccidioides fungus. The spores can survive heat and drought, persisting in the soil. When dirt is disturbed – by construction, wind or even walking – the spores can be thrown into the air.
The fungus is endemic to hot, dry soils in the southwest; 97% of all US cases of valley fever are reported in Arizona and California, according to the California Department of Public Health.
But that could change: Fungal infections, including Valley fever, are increasingly being diagnosed outside of their usual ranges. A study in the journal GeoHealth predicted that due to climate change, the Valley Fever Range could spread east across the Great Plains and north to the Canadian border before the end of the century.
“As temperatures warm up and the western half of the United States remains fairly dry, our desert soils will kind of expand and these drier conditions could allow coccidioids to live in new places,” Morgan said. Gorris, who led the GeoHealth study. at the University of California, Irvine, and is now a staff scientist at Los Alamos National Laboratory.
A “considerable spectrum” of diseases
About 20,000 cases of Valley fever were reported in 2019, but the Centers for Disease Control and Prevention say that’s likely an underestimate. Although easily diagnosed with a blood test, Valley fever has long been misdiagnosed or underdiagnosed due to lack of knowledge about the disease by both the public and doctors.
The majority of people with Valley fever may never know they have it. Its symptoms often resemble a viral respiratory infection: fatigue, cough, fever, shortness of breath and muscle aches.
“If you see a patient with pneumonia, who lives in the South West or has traveled to the South West, then Valley fever should be in what we call the differential diagnosis, which means it’s one of the things we need to think about,” said Dr. Royce Johnson, medical director of Kern Medical’s Valley Fever Institute in Bakersfield, Calif.
In 5 to 10 percent of cases, the infection can lead to serious long-term lung problems, according to the CDC.
“He definitely has a huge spectrum. You know, it goes from people breathing in the spores who really don’t have any symptoms but develop immunity,” said Dr. George Thompson, an infectious disease specialist at the University of California, Davis. spectrum is that of people with fulminant infection, meningitis, or multisite dissemination, that is, it is outside the lungs in several different sites of the body. A fulminant infection means that the disease occurs quickly and severely in an otherwise healthy person.
“The vast majority are somewhere in between, but they still have subacute disease,” he said. “They are sick for weeks, even months, you know, with cough, fatigue, fever, chills. So it’s still an important disease.
Valley fever can be difficult to treat. some patients have to take antifungal medication for months or years, which can lead to uncomfortable side effects such as hair loss, chapped lips, and dry skin.
In the years since Buckley’s diagnosis, the disease spread from his lungs to his spine and legs. He was placed on a ventilator three times. The last time, in 2021, was the longest – he was on a ventilator for two weeks.
“The fan was at 100% at one point. It was breathing for me,” he said. “They were saying to my mom, be prepared for me not to be here.”
Buckley has relearned to walk, feed himself and perform basic daily tasks, but he is still not out of the woods. His life is drastically different from what it was before he fell ill, filled with doctor’s appointments, surgeries, and hospital stays.
Hope on the horizon
Scientists have been trying to develop a vaccine for Valley fever since the 1960s, according to the CDC. In the 1980s, a candidate was finally tested on humans, but it didn’t work well.
But in recent years, researchers at the University of Arizona College of Medicine in Tucson have developed a very effective vaccine in dogs. Dogs, like humans, are susceptible to valley fever.
The two-dose vaccine uses a version of the coccidioides fungus that is genetically modified so that it cannot cause disease, but can still train the immune system to recognize and respond to future infections.
The vaccine could be approved by the US Department of Agriculture for use in dogs by early 2024. If so, it would be the first time the US has approved a vaccine to protect itself. against fungal infection in animals or humans.
Dr. John Galgiani, director of the Valley Fever Center for Excellence at the University of Arizona School of Medicine, has worked on vaccine research in dogs. He is now focused on getting the vaccine into clinical trials for humans.
“I’m really hopeful,” he said. “In my opinion, at this time, we have a candidate who is worth evaluating and I think he will probably be effective, and we will use him.”
Still, an approved valley fever vaccine for humans is years away. If all goes according to plan — which doesn’t always happen in the scientific process, Galgiani noted — the earliest he sees this vaccine available to humans is eight years.
But experts say now is the time to build on the research momentum to advance vaccine development, before Valley fever reaches even more people in the country.
“I think fungi really are the next superbug. I think they’re really the ones that will be the problem over the next decade. And valley fever will be a key part of that,” said Thompson of UC Davis. “They are definitely here to stay. This battle has only just begun.
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