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Fungi are nature’s great garbage disposals. Some species of fungi are saprophytes—Sapros in Greek means rotten—so they thrive off of dead or rotting materials, like wood or mammals. Cocci, a particularly virulent saprophyte, lives just as well in the soil as it does in humans, where the lung seems to be a favorite habitat.
Cocci’s life cycle begins in the dirt. Its spores break apart easily when airborne, and when carried on the breeze, either settle in new soils to reproduce, or, if a human happens to breathe them in, in the warm, moist environments of our lungs. When inhaled, the spores head straight to the tiny, hollow sacs located at the ends of the air passageways where they start to multiply, feeding off the body’s flesh.
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Adan Barragan was just 17 when he left his home in Colima, a beach town on Mexico’s Pacific coast, for California. He settled in Delano, Kern County’s second largest city after Bakersfield, as a farmworker. Now 29, he lives in a modest home with his wife and four young children, and works for a local grower, digging irrigation lines and spraying pesticides. He’s often in the fields six days a week, working 10- to 12-hour shifts.
Last October, Barragan noticed a tiny bump in the middle of his chest. It looked like a pimple, he says, so he didn’t think much of it at first. Before long, it was the size of a bright red baseball, hard to the touch and oozing pus. The bigger it grew, the harder it became for him to breathe, and to lift and carry the heavy machinery he operates in the fields. His wife, Alma Ramos, worried it was cancerous, urged Barragan to seek medical attention at Kern Medical Center. He was diagnosed immediately with valley fever.
Barragan’s extensive exposure to the soil as a farmworker puts him at a higher risk of developing valley fever, but Ramos says they had never heard of the disease before.
“If we knew more about it, he probably would have been more careful,” Ramos says, translating for Barragan, who only speaks Spanish. “I hear ‘valley fever’ and all I think is ‘fever.’ So I’m thinking a cold. He probably had symptoms before and we didn’t know.” Barragan still works as a farm laborer, but his health scare was enough to convince him to start considering other work. “He’s learning English,” Ramos says. “He’s going to get a high school diploma, because he doesn’t want to be out in the fields anymore.”
While hospitalized, Barragan underwent a strict regimen of the antifungal fluconazole, delivered intravenously three days a week for three months. The medicine gave him seizures, and caused him to shed weight, about 50 pounds over the course of his stay. Because antifungals are rarely administered directly to the infection site—with the exception of shunts that convey them directly into the brain to combat meningitis—the hope is that enough can be pumped throughout the body to target wherever the fungus has spread. Sustained use of antifungals, whether orally or intravenously, can cause permanent kidney damage, however. “With the oral medications, why it gets scary is that they see how much the patient can tolerate,” Emery says. “It’s not like with other drugs when they say, ‘OK, we know this body weight and we give them this specific amount of medication.’”
Barragan’s symptoms eventually cleared, but he is still supposed to take up to 10 pills of fluconazole daily for the next three years. He’s wary of experiencing any more side effects, like the fatigue that put him out of work for four months, but he considers himself fortunate—of the 10 other patients also in treatment for valley fever during his stay in the hospital, four of them died from “disseminated” disease, he says.
Disseminated valley fever might be one of the greatest conundrums surrounding the disease. It only occurs in 1 percent or less of infections, but if a patient is black or Filipino, the risk of developing valley fever is much higher. Its damage to the skeletal system, joints, lungs or meninges—the delicate membranes that enclose the brain and spinal cord—is vicious, as the fungus can decompose the vertebrae, skull, long bones, like the femur and tibia, or the joints of the knees, wrists, ankles, and elbows. Meningitis, the most serious manifestation of disseminated cocci, happens if the fungus manages reach the protective membranes of the brain and spinal cord. To keep a patient alive, treatment must last a lifetime.
“The fact of the matter is that [getting infected] is a game changer,” Emery says. “Your life has to revolve around getting these drugs or you die. No one will take their patients off of medication believing that they’ll survive. We’ve tried. Everything looks healthy, everything looks normal, and then we try taking them off the medication and they go back to disease state.”
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Kern County’s first great epidemic of valley fever began in 1991 and lasted for three years, the result of a particularly rainy spring following a five-year drought. In just one year—from 1991 to 1992—cases jumped from 959 to more than 3,000. Counting asymptomatic patients, however, some doctors think up to 8,000 people may have been infected.