Infection Hits a California Prison Hard

NY Times ^ | December 30, 2007 | JESSE McKINLEY

[neverdem]

COALINGA, Calif. — When any of the 5,300 inmates at Pleasant Valley State Prison begin coughing and running a fever, doctors do not think flu, bronchitis or even the common cold.

They think valley fever; and, more often than they would like, they are right.

In the past three years, more than 900 inmates at the prison have contracted the fever, a fungal infection that has been both widespread and lethal.

At least a dozen inmates here in Central California have died from the disease, which is on the rise in other Western states, including Arizona, where the health department declared an epidemic after more than 5,500 cases were reported in 2006, including 33 deaths.

Endemic to parts of the Southwest, valley fever has been reported in recent years in a widening belt from South Texas to Northern California. The disease has infected archaeologists digging at the Dinosaur National Monument in Utah and dogs that have inhaled the spores while sniffing for illegal drugs along the Mexican border.

In most cases, the infection starts in the lungs and is usually handled by the body without permanent damage. But serious complications can arise, including meningitis; and, at Pleasant Valley, the scope of the outbreak has left some inmates permanently disabled, confined to wheelchairs and interned in expensive long-term hospital stays.

About 80 prison employees have also contracted the fever, Pleasant Valley officials say, including a corrections officer who died of the disease in 2005.

What makes the disease all the more troubling is that its cause is literally underfoot: the spores that cause the infection reside in the region’s soil. When that soil is disturbed, something that happens regularly where houses are being built, crops are being sown and a steady wind churns, those spores are inhaled. The spores can also...

[neverdem]

C. COCCIDIOIDOMYCOSIS (Coccidioides immitis)

Scroll down about halfway. I believe coccidiomycosis is another acceptable variant, IMHO.

[neverdem]

micro ping

[CedarDave]

At least a dozen inmates here in Central California have died from the disease, which is on the rise in other Western states, including Arizona, where the health department declared an epidemic after more than 5,500 cases were reported in 2006, including 33 deaths.

This is really nothing new. Long time residents of the southwest probably have contacted a mild form of the disease at one time or another and developed antibodies and immunity to future espisodes. However, with the population explosion and several millions of people in an area originally containing a few hundred thousand, the numbers add up. I suspect the actual percentage of the population who contact serious cases is quite low as it always has been.

[devane617]

“Camp Fever” hit Ft Hood earlier this year. When you get that many people in a confined space it is hard to get rid of an infection.

[swmobuffalo]

Wow, I’d never heard of this before until yesterday talking to a coworker who used to live in Arizona. She was talking about having to treat her dog for it.

[Myrddin]

Shortly after I started graduate school in pathogenic bacteriology, the department head insisted that all new students be screened for TB and Valley Fever. The department head lost a lung to Valley Fever. I complied with the request. It was the typical skin test. TB on one arm, Valley Fever on the other. The TB faded as usual, but the Valley Fever prick raised a red circle of inflammation that nearly wrapped around my arm. It wasn't surprising as I spent many happy hours on my dirt bike in the canyons of southern California. A lung X-ray confirmed the Valley Fever was inactive by the characteristic amorphous blobs of calcium in my lungs. Over the next few years, my lungs were assaulted by 7 cases of pneumonia. That was finally halted when pneumonia vaccines were offered along with flu vaccines.

Suffice to say, my lungs are in bad shape after all that battering from Valley Fever and pneuomonia. It is imperative to maintain my health and good calcium levels. Valley Fever can strike again if the calcium is drawn off the nodules in the lungs. The preferred antibiotic, amphotericin B, is nearly as hard on the patient as it is on my fungi.

[Myrddin]

There was a spike in new cases of Valley Fever in Southern California following the Northridge quakes. The aftershocks raised lots of dust into the air.

[neverdem]

Health professionals ruefully refer to this highly toxic yet very effective drug as "amphoterrible."

[Myrddin]

Nice article. The tools available for molecular biology have improved vastly since I graduated in 1976. Fluorescent tagged antibodies were just becoming common at that time. The monoclonal antibodies were leading edge stuff at that time.

[neverdem]

Nice article.

Thanks for the tip. The Dr. Fungus link leads to free CME (Continuing Medical Education) credits. I was just looking for a credible quote using "amphoterrible."

[panaxanax]

I contracted Valley Fever as a kid while living outside Phoenix (Luke AFB) back in 1959. It wasn’t diagnosed until a couple of years later following a chest X-Ray that showed scarring.

We were tested in school every year for TB (Schick Test?). Mine always turned red and swollen and I was rushed to the nurse’s office and hid in the corner like a mad dog with rabies. My parents were called immediately to come and remove the infectious plague-spreader from the school grounds. They wouldn’t let me back until I was cleared by the base doctors. The scarring is there to this day.

[Myrddin]

The Dr. Fungus link leads to free CME (Continuing Medical Education) credits.

Good catch. I switched to computer science and electrical engineering after grad school. You don't find formal requirements for continuing education in my field. The penalty for failing to keep abreast is technical obsolescence. Technical dinosaurs are unemployed dinosaurs. That's sufficient incentive to stay on top of the field.

[VOA]

“The preferred antibiotic, amphotericin B, is nearly as hard on
the patient as it is on my fungi.”

Yep.
Some years back, my microbiology prof said that with amphotericin B,
the cure is just about as bad as the disease.

[srmorton]

I have been teaching Mycology (the study of fungi) for over 20 years. Coccidiomycosis is just the name for the fungal disease that results from infection with the systemic fungus Coccidioides imitis. In my part of the country (NC), we have a fungal disease called Blastomycosis which is caused by the systemic fungus Blastomyces dermatitidis. They just take the first part of the genus name and add the suffix -mycosis which literally means "fungal infection".

Coccidioides is endemic in the San Joaquin Valley (hence the common name "valley fever"). Most natives of that region have a positive skin test showing that they have been exposed to the organism, yet have never been diagnosed with clinical infection. These people are generally immune. Non-natives, such as those who might end up being sentenced to prison there, or those who are immunocompromised are the most likely to be susceptible, especially the elderly (whose immune systems are starting to fail) and infants (whose immune systems are not yet fully developed).

[Myrddin]

My TB test has always been negative. Once the TB skin test returns a positive, it will usually do that for the rest of your life. The follow up is a lung X-ray. Inactive TB appears as nicely formed circular spots. Almost like a hole punch, but of varying sizes dependent on the size of the lesion. The Valley Fever lesions appear amorphous. Just as with Valley Fever, the walled off TB lesions are wrapped in a calcium shell. It is important to maintain calcium levels so that calcium isn't used by the body. I've never seen the lung X-ray of an active case of TB. BTW, TB can also infect the digestive tract. In that case, the lungs might look just fine.

I spent a little time reading about TB because it killed my great-great grandparents in Wales. If not for a TB outbreak, my great grandfather might never have emigrated to the U.S.

[Myrddin]

In the final days before my dad passed on, his doctor indicated that they had resorted to Vancomycin to deal with what appeared to be a lung infection. Nothing worked. Frankly, I think his problem was due to inhaling ash from the fires in the Fall of 2003. It was a chemical irritation, not an infection. His doctor labeled the problem as ARDS.

I still have an interest in my original training in molecular biology and pathogenic bacteriology, but that training has never paid the bills.

[VOA]

Frankly, I think his problem was due to inhaling ash from the
fires in the Fall of 2003. It was a chemical irritation,
not an infection.

I'm not an MD...but given the examples of silicosis and black lung
disease, it's not a far stretch to see microparticulates from
prolonged smoke exposure causing serious problems.

[panaxanax]

It’s been more years than I wish to count since I’ve had the test. I do remember the next day the nurse would come into the class with a clear plastic card with rings marked on it and place it over the site on our forearm. I was always off the chart. That was 45+ years ago.

[vetvetdoug]

I deal with Blastomycosis about once a month in dogs. Years ago we used Amphoteracin B but the damage to the kidneys and veins were terrible. Now, itraconizole is used almost exclusively and has nowhere near the side effects that Amphoterrible had. Itraconizole is also used for those infected in Histoplasmosis and San Juaquin Valley Fever cases.

[az_gila]

When I got it (mildly, luckily) after I moved to Tucson, the doctor said “Welcome to Arizona”...:^)

The Valley Fever “Center of Excellence” is at the VA hospital/University of Arizona in Tucson...

http://www.vfce.arizona.edu/

The home page has a clear map showing the likely areas for Valley Fever in the US.