LAS CRUCES, N.M. — Lorenzo Fernandez installs fences for a living. Travis Hart worked as a landscaper. Richard Myers ripped out bushes so he could widen his driveway.
Those simple, everyday activities caused all three men to contract a potentially deadly disease called valley fever that the Centers for Disease Control called a “silent epidemic.”
All three activities disrupt the soil, exposing the men to a spore that lives in the soils of southern New Mexico and causes the disease. They inhaled the spore when the soil was disturbed, and the spore became airborne.
All three recovered, mostly, but a poor farmworker who came from another New Mexico city to Las Cruces to be treated for the disease died from it last year. Two others in Las Cruces’ county have died from it in recent years.
“I feel lucky that I’m alive,” said Fernandez, who suffered two collapsed lungs, was hospitalized for 11 months, underwent a five-hour surgery, and lost 76 pounds as his health deteriorated.
200 deaths each year. Who is at risk?
There are about 14,000 reported cases of valley fever in the United States each year and roughly 200 people die from it.
Doctors say symptoms are similar to other illnesses and many doctors don’t know much about it. A New Mexico Department of Health survey in 2011 found two-thirds of the state’s doctors did not feel confident in diagnosing valley fever.
“It’s not terribly common, but it’s not rare,” said Dr. Obi Okoli, a Las Cruces physician who specializes in valley fever.
Most who acquire valley fever never show symptoms or have symptoms so common that they don’t go to a doctor. Young people are more likely to overcome it on their own. Severe cases are more common among older people and those with weakened immune systems.
Pregnant women and people with diabetes have a higher risk. Blacks and Filipinos are more likely to get the disease than those of other groups. Pets, especially dogs, can also get it. It is not contagious.
Valley fever is most common among older people. Okoli noticed that many of his patients are elderly people who have retired to New Mexico from somewhere else. He thinks those who grow up in the desert, exposed to the spores that cause the disease all their lives, develop a degree of immunity.
A multi-state threat
Valley fever, or coccidioidomycosis, is a fungal infection caused by a spore that grows in soils in areas of low rainfall, high summer temperatures and moderate winter temperatures.
Spores stay in soil until disturbed. Those who work in occupations that disrupt soil, such as farming or construction, are especially vulnerable. But gardeners and those spending significant time outdoors, like mountain bikers and ATV riders, also face elevated risk.
Wind also stirs up the soil, picking up spores and blowing them around, increasing exposure. Dust storms, common in New Mexico, are especially hazardous.
The infection is most prevalent in southern Arizona — about 70 percent of reported cases in the country are detected in the state — but is also endemic to parts of California, southern New Mexico, and southwest Texas. It is also found in Central and South America.
What are the specific symptoms?
Symptoms of valley fever are common: fatigue, cough, fever, shortness of breath, headache, night sweats, muscle aches and joint pains.
Valley fever is mistaken for pneumonia, tuberculosis, chronic fatigue syndrome, even cancer. Because it is frequently misdiagnosed, the disease is often not detected until treatments for other illnesses fail and the person ends up in the hospital.
Symptoms take one to three weeks to develop after a person inhales the fungal spores. Three-quarters of people known to have valley fever miss work or school. About 40 percent are hospitalized.
The disease is most commonly diagnosed with a blood test. It can be treated with antifungal medications, but antibiotics have no effect. Those with the most severe cases may take medication for life.
Valley fever usually begins in the lungs, but it can spread elsewhere including the skin, bones, and, most hazardously, the brain.
Two collapsed lungs: ‘I’d never be the same’
Fernandez, 61, has been installing fences and disrupting soil for 41 years. But that didn’t cause any health problems until he moved to Las Cruces in 1990.
Health problems began after he was diagnosed with diabetes in 2017. Fernandez began feeling weak. He had dizziness and night sweats.
“I just didn’t feel normal,” he said.
His primary care doctor discovered a collapsed lung. Doctors put a tube in his chest. His lung was re-inflated. The doctor soon discovered Fernandez’s other lung had collapsed.
Finally, in November 2017, Fernandez was diagnosed with valley fever. A five-hour surgery in Albuquerque fixed his problems. He spent 11 months in hospitals, all told.
Fernandez, who lives in Old Picacho, is recovering. He can’t install fences yet or lift heavy loads, and he lost 76 pounds because of health difficulties. He’s gained back some weight, but still weighs 46 pounds less than before.
“They told me I’d never be the same,” he said.
Rash, aches and a 103-degree fever
Richard Myers, 74, moved to Las Cruces last year. He and his partner, Lorry Hoksch, relocated from Iowa. They own an RV, so they set out to widen the driveway leading to their home for the vehicle.
To do that, they had to remove some desert vegetation. That disturbed the soil.
In April 2018, Myers got a rash on his back. His joints were achy. Then he started feeling sick. He went to MountainView Regional Medical Center’s urgent care center and was diagnosed with pneumonia.
A week later his condition had not improved, so he went to the emergency room.
He spent seven days in the hospital. He had a 103-degree fever. He was still being treated for pneumonia, but doctors gave him stronger medication. He went home, but again he didn’t get better.
Two weeks later, he went back to the emergency room. On his third day in the hospital, Okoli told him he thought he had valley fever. He took Myers off antibiotics and put him on antifungal medication.
“I started to improve almost immediately,” Myers said.
Nine months later, Myers is back to normal, though he’s still taking antifungal medication. He has gained back all the weight he lost.
Stroke-like symptoms at age 19
Travis Hart was 19 years old when he became infected, just a year out of Las Cruces High School.
At the time, he worked as a landscaper. One day a big job required him to shovel large amounts of dirt. A few days later, he developed a lung infection.
Not long after, he was riding in a car when he suddenly developed stroke-like symptoms. The left side of his tongue went numb. His stepdad rushed him to the hospital.
“I couldn’t hardly speak,” said Hart, now 27. “I couldn’t remember where I was born. I couldn’t remember my mom’s name.”
Doctors decided he suffered from migraines. They sent him home.
Not long after, Hart blacked out at a friend’s house. His friend rushed him to MountainView Regional Medical Center. He was unconscious for 10 minutes.
Tests revealed that Hart had valley fever.
The disease had spread to his brain. When it spreads to the brain, it produces meningitis. They immediately gave him antifungal medication, which eventually relieved the worst of his symptoms.
Now a Las Cruces firefighter, Hart will deal with consequences of the disease for the rest of his life. Though he feels normal, the meningitis has impacted his short-term memory. Learning is difficult. He must take the antifungal medication permanently.
All valley fever victims who develop cocci meningitis, like Hart, must take antifungal medication the rest of their lives if they want to stay healthy. That creates another problem for those patients who don’t have good health insurance or any insurance at all.
Some insurance companies balk at paying for the medication indefinitely. That’s what happened in the case of the 49-year-old farmworker who died from valley fever. He was a patient of Okoli’s.
Okoli learned that the man had died when he called his home recently. He wasn’t surprised.
“If you don’t get the medicine and it’s in the brain,” he said, “you’re going to die.”
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