Most people never even know they’ve been exposed. Although once introduced cocci never truly leaves the body, about 60 percent of infections present no symptoms. Even then, however, there’s no guarantee of immunity. An infected patient will test positive for it for the rest of their lives, even if they never get sick. And severe stresses on the immune system, like cancer treatment or organ transplants, can cause symptoms to flare up decades after exposure.
The remaining 40 percent of infections resemble the flu, or result in painful boils that typically clear up following a few months of treatment. But for reasons still mysterious to doctors, a very small percentage of valley fever infections become brutal lifelong illnesses. There’s little understanding of why cocci targets some people more harshly than others, but the amount of spores inhaled, the strength of the patient’s immune system, and genetic predisposition all play a role. “It means something to the Central Valley,” Emery says, “but it’s an orphan disease.”
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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.