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HEALTHWATCH / VALLEY FEVER : Cases of Deadly Illness on Rise in County

April 29, 1993|LEO SMITH | TIMES STAFF WRITER

Here's a good test of your paranoia:

For the overwhelming majority of people who contract valley fever (or coccidiodomycosis), the symptoms are so mild the victims don't take particular notice.

For one in 1,000 people who contract it, the illness is fatal.

Valley fever, which primarily affects the lungs, is caused by inhaling a fungus (coccidioides immitis) found in dirt. When dirt spores are blown into the air, people breathe them in.

The illness has been in recent headlines because of its prevalence in Kern County. There were 3,342 cases reported in Kern County in 1992, and more than 600 this year. Valley fever is a much greater problem to Kern County residents, but there is a risk of valley fever anywhere there are fields and soil. And that means Ventura County.

"So many people in the county are probably infected and they don't know it," said Debbie Gorey, a registered infection control nurse at Santa Paula Memorial Hospital. "Anytime the wind is blowing and there is dust in the air, you are more prone. Dust is a layer of soil, so fungus is being spread throughout the air."

Certain areas of the county, particularly Fillmore, Santa Paula, and parts of Oxnard, will likely have more soil spores in the air. People who work in fields are more susceptible to valley fever.

In 1991, there were seven cases of valley fever reported in Ventura County. Larry Dodds, county public health director, said the number jumped to 60 in 1992. There have been 24 cases reported to date in 1993, as compared with 18 in the same period in 1992.

"The big thing that started (the increase) was the big dust storm around Thanksgiving in 1991. It set off cases all over Southern California," Dodds said. "Then we had east winds last summer, so we had another bump in cases in September and October."

Oxnard physician Cary Savitch, an infectious disease specialist, credited a series of environmental factors for the surge.

"Rain causes a lot more fungus to grow in the soil," he said. "Spores germinate and if you get a wind storm, a dust storm, the dust is inhaled" Savitch compared the incidence of valley fever in 1992 (and early 1993) to what he saw in 1978 following a major December dust storm. "Those have been the two big years for cocci in my practice," he said.

The most common cases of valley fever have the symptoms of a common cold or flu. It may be accompanied with a cough or some mild upper-respiratory problem.

Sometimes the illness can be more severe, causing symptoms of a bad cold: a cough that won't go away, a low-grade fever and chills. In these cases, either an intravenous drug called amphotericin or a new oral drug called fluconazole can be prescribed.

With mild and somewhat more severe cases, the illness remains in the lungs. It's when it moves out of the lungs and into the central nervous system that it can be deadly. Gorey said about 90% of the cases in which the infection hits the central nervous system are fatal.

"We can give (intravenous) therapy, sometimes directly in the head through a reservoir," Savitch said. "But usually at that point there's a reasonable chance the patient may not survive." Savitch said valley fever usually doesn't show up in blood or skin tests in its early stages, so treatment doesn't begin until the illness is well-developed.

How people react to valley fever depends on their immune systems.

"There's a genetic difference in people that we don't fully understand. All Asians, particularly Filipinos, have a higher risk of it spreading," Savitch said.

Savitch said African-Americans, Native Americans, Latinos and pregnant women also are at somewhat increased risk. So are people with AIDS, cancer and other immune deficiencies.

Gorey said there's not much one can do to prevent contracting the infection, but there are some precautions that might lessen the risk. "People say to wet down soil, so it doesn't get dusty," she said. "If you're driving through an area known to be endemic, it's much better to have air conditioning on than to have the windows down."

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