The US Drought and Coccidioidomycosis

[RubiconDecision]

Over the last year, I've discussed in several of the D&D forums the danger of the Drought having medical effects. From history we know that during the Great Drought of the 1930's, that simultaneously we had Dustbowl condition in the Southwest. This resulted in a huge loss of the humus in the soil which makes it alive with multiple beneficial organisms. That also helps it retain water and makes it fertile.

However, during the Great Drought, persistent lack of rain led to a sterilization of the soil, and the great winds blowing across that corridor, the same ones that create Tornado Alley, resulted in removing the topsoil, and creating dust storms. Within this dust, which was aspirated by the people living in the region, are tiny particles of fungus and which produce something called Coccidioidomycosis. That results in a persistent infection, and causes multiple issues including breathing difficulties, skin rashes, malaise, etc. Many young children died of it, but what made things worse, the dust actually was transmitted as far as Washington DC.
Now there are reports of Coccidioidomycosis appearing in the current Drought region, as similar conditions have arisen. I believe we could see a lot of these cases, and that we can expect even worse drought conditions which will exacerbate the situation. Already there are many communities that could run out of water in the Southwest as local resevoirs have been drained at a much higher rate than normally would be drawn against by rain and snowmelt.

http://www.theatlantic.com/health/ar...thwest/375191/

Last fall, Kirt Emery was on his motorcycle, cruising up the 99 freeway over the mountains from Santa Barbara to Bakersfield, California, when he saw the dust storm materializing in front of him. Visibility was low, but he wanted to get through it as quickly as he could, so he held his breath and hammered his bike up to 100 miles per hour.As the head of epidemiology for the Bakersfield Public Health Services Department, Emery has spent the past two decades studying dust like this—and avoiding it at all costs. He knows all too well what could happen to him if he got sick: the expensive medications with their nasty side affects, the uncertainty of whether he could be ill for the rest of his life. It’s been more than 20 years since he moved to Bakersfield, and so far, he’s still healthy. That makes him one of the lucky ones. For many people living in places like Bakersfield, and throughout much of California’s Central Valley, dust can be deadly.Coccidioidomycosis, also known as cocci, or valley fever, is a fungal disease endemic to the soils of the Southwest, in places like Arizona, Nevada, New Mexico, Texas and Utah. In California, it’s rampant across the Central Valley, an area just slightly smaller than West Virginia that grows about a third of the country’s produce. About 30 percent of all valley fever cases nationwide occur in the Central Valley each year.
Valley fever has perplexed doctors and patients alike for more than a century. Symptoms range from mild fatigue to incapacitating, flesh-eating infections, and despite decades of research, advances in treatment and pushes to develop a vaccine have been painfully slow. There’s virtually no way to guard against inhaling the spores that cause valley fever, as most masks can’t filter out the microscopic dust particles that carry the spores through the air and into the lungs. Getting infected with valley fever can be as simple as driving through Bakersfield with the windows down—or in Emery’s case, on a motorcycle.

Here's a video showing what Coccidioidomycosis looks like.

[conon394]

The of jumping to conclusions you make the article in the Atlantic is profoundly absurd.

First the actual CDC report is quit a bit bit better than the sensationalism in the Atlantic article - note one that sources or references etc.

http://www.cdc.gov/mmwr/preview/mmwr...cid=mm6212a1_e

So let's see we a fugal vector that has been endemic in key areas forever. It mostly produces little to no significant illness outside of a few cases. And its nominal increase could well be attributed to the simple fact of increased mandated testing.

In any case the real issue would seem to be the insanity of the Ronald Regan and decades of anti tax Republicans that results in the gutting of what was once one of the best if not the best systems of research institutions in the western world and likely a well funded state public health infrastructure all for anti-tax free market economics. And now they can discover that the free market really does not care about obscure fungal problems that mostly hurt only the poor and other people who can't pay. The stupid drug to make your eyelashes bigger (*) likely gets far more funding than basic research on a fungus ever will.

* latisse its very existence is slap in the face of everyone who has ever died from an lack a cheap vaccine, or antibiotic or a new strain of a virus or bacteria or in this case a fungus. Yes good god I'm glad how many clever money men and scientists wasted money and time on giving my wife better eyelashes just before that new resistant strain of tuberculosis killed her... that's not true but the point stands.


In any case I not seeing the reason for panic in the OP. What's next panic about Henta virus?

[Gaidin]

There's nothing hilarious here. Drought. Not enough moisture here to hold down topsoil. There happens to be fungi in said topsoil that the human body doesn't well react to. Humans in area are breathing it in if they're unlucky. Move along. Move along.

[conon394]

Drought

Even that would not be much of a problem if water usage had been managed effectivly - so that LA would would be smaller, lawns would be fantastically expensive, public buildings would have no flush urinals, the aqueducts would be covered, etc.

[RubiconDecision]

http://www.cdc.gov/fungal/diseases/c...tatistics.html

The statistics rather speak from themselves from the CDC. Are we planning on discussing Science or my personality? It's interesting that your posts think the latter is an aspect of debate.

The data is still being compiled so we have none for 2013 and 2014 as yet, but it's a valid medical topic of concern right now, which is something I thought would be interesting versus some of the lighter scientific topics.


In highly endemic areas such as the Phoenix and Tucson metropolitan areas of Arizona, valley fever causes an estimated 15% to nearly 30% of community-acquired pneumonias, but low testing rates suggest that valley fever may be under-recognized.^2,3
This is a valid scientific medical topic given those percentages and given the history of Drought in the SW, as precisely the same thing resulted in the deaths of many folks in that region.

[Gaidin]

There's nothing fantastic to discuss. You want to talk about why it's there? Holy crap there's a drought and the wind is blowing the topsoil around. You want to talk about why research is going toward cosmetic medicine and not this, that's more for the mudpit and not here as that's politics. Oh and conon has pretty much covered what's happened with medical funding there anyway. What's new. All you're posting is that these cases are coinciding with the the escalation of dryness in the area. Big whup. Could've predicted that one.

[RubiconDecision]

Interesting, a genuine medical phenomena accounting for up to 30% of pneumonia in a region is a big whoop. Wow. Well, no one has to stay to discuss medicine, that's for sure, and if some post thinks it's unimportant, I would think the Internist trying to educate in the video doesn't think so. Nor would historians either as it was a phenomena back during the Dustbowl.

Gee maybe medicine is just a big whoop. Who knew? Maybe we should just warn those dedicated folks not to study medicine because epidemiology is a big whoop?

[Gaidin]

Gee, maybe I'm tired of your panic posts. Or your OP covered it.

Lack of rain led to sterilization of topsoil. Windstorms picked up topsoil in duststorms. Within this topsoil-dustorm was Coccidioidomycosis. Coccidioidomycosis can cause Valley Fever when breathed in.

I'm seeing a very simple trail of logical implications, all from two sentences in your OP. Why aren't you? THREAD MIGHT BE MORE INTERESTING IF YOU TALK ABOUT THE VALLEY FEVER INSTEAD OF THE CAUSE OF THE VALLEY FEVER, AND THE REGION. JUST A HINT.

[RubiconDecision]

Gee, maybe I'm tired of your panic posts. Or your OP covered it.

Lack of rain led to sterilization of topsoil. Windstorms picked up topsoil in duststorms. Within this topsoil-dustorm was Coccidioidomycosis. Coccidioidomycosis can cause Valley Fever when breathed in.

I'm seeing a very simple trail of logical implications, all from two sentences in your OP. Why aren't you? THREAD MIGHT BE MORE INTERESTING IF YOU TALK ABOUT THE VALLEY FEVER INSTEAD OF THE CAUSE OF THE VALLEY FEVER, AND THE REGION. JUST A HINT.

Hmmm, why would I bother to discuss Science about epidemiology, the microbiology of the fungus, the treatment in supportive care and pharmaceutical agents and things like percussive therapy done by a respiratory technician when I'm being insulted?

Who knew that Coccidioidomycosis can be summed up in a single post?!?! Wow! Gee, my Microbiology, Pathology, Pharmacology teacher(s) would have a field day with that kind of post.

When I read posts like this, I think, "Wow! We could revolutionize medicine. Just cut it down to maybe a week of training! There's no need to spend two years getting the pre-requisites, 2 years of Basic Science, 2 years of Clinical Science, at least 3 years of internship. We'll just have a brief bullet point presentation on something like Coccidioidomycosis and move right along. Who knew?"

Even better, it will be two sentences! That will be suffice!

[Gaidin]

Even better, it will be two sentences! That will be suffice!

Good for you, but you've got no statistics that tie it to anything but the drought. If the numbers keep climbing after the end of the agricultural mess is when I start worrying about an independent epidemic. You know why? Every damn statistic you've given me in this thread is tied to the drought in the region. Come back to me when that's over. See, what I'm doing now is I'm analyzing the data. Sheer numbers. And the data, the sheer numbers, says it started with the drought. The drought hasn't ended yet. So we don't have a clue what any of that means.

[RubiconDecision]

Well, that's an interesting post that points to the Drought as the culprit versus the fungus. When in fact, the drought helps to increase the aerosolization of the fungus species Coccidioides immitis and Coccidioides posadasii. Who knew that dry weather causes this kind of pneumonia alone. Wow. Brilliant post there.

Now if anyone was interested in the history of Coccidiodomycosis in terms of science and medicine, you might look here for a discussion of that, rather than ranting posts about personal observations.
http://cid.oxfordjournals.org/content/44/9/1202.long

The cases were broad based upon the migrations of folks from that region, affected war prisoners and internment camps later in WW2, resulted in the spread of the fungus all over the US during the Dust Bowl.

Here's some breakdown of affected population by age and sex:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6212a1.htm
During 1998–2011, a total of 111,717 coccidioidomycosis cases were reported to CDC from 28 states and the District of Columbia: 66% from Arizona, 31% from California, 1% from other endemic states, and <1% from nonendemic states. In Arizona, California, Nevada, New Mexico, and Utah combined, the number of cases increased from 2,265 in 1998 (aIR: 5.3 per 100,000 population) to 8,806 in 2006 (18.0 per 100,000); a decrease occurred in 2007 and 2008 before an increase in 2009 (12,868 cases; 25.3 per 100,000), which continued into 2010 and 2011 (42.6 per 100,000) (Table 1).
Incidence in endemic states increased among all age groups during 1998–2011 (Figure). During this period, incidence typically was highest among the 40–59 year age group in California but was consistently highest among persons aged ≥60 years in Arizona and other endemic states. Incidence during 2011 was 381.1 per 100,000 among persons aged 60–79 years and 385.2 per 100,000 among persons aged ≥80 years in Arizona (Table 2).
During 1999–2008, most (56%) Arizona cases occurred among males, but beginning in 2009, a higher proportion (55%) of cases occurred among females. Incidence in 2011 in Arizona was substantially higher among females (286.9 per 100,000) than males (215.7 per 100,000). In contrast, only 35% of California cases occurred among females during 1998–2011, and 2011 incidence among California males (20.5 per 100,000) was more than double that among females (9.7 per 100,000).

Here's a general article about it and the history and the locales where it happened.

http://www.newyorker.com/magazine/2014/01/20/death-dust
n 1977, the San Joaquin Valley—the swath of agricultural land that runs through central California—was designated a disaster area. Record-low runoff and scant rainfall had created drought conditions. At the beginning of Christmas week, the weather was normal in Bakersfield, the city at the Valley’s southern end, but in the early hours of December 20th a strong wind began to blow from the Great Basin through the Tehachapi Mountains. Hitting the ground on the downslope, it lofted a cloud of loose topsoil and mustard-colored dust into the sky. The plume rose to five thousand feet; dust blotted out the sun four counties away. Traffic on Highway 5, the state’s main artery, stopped. At a certain point, the anemometers failed; the U.S. Geological Survey estimated wind speeds as high as a hundred and ninety-two miles an hour. Windows on houses were sandblasted to paper thinness.
The Tempest from Tehachapi, as one researcher called it, spread dirt over an area the size of Maine. Twenty hours afterward, the dust reached Sacramento, four hundred miles north of Bakersfield, in the form of a murky haze that hung in the air for another day, stinging the eyes and noses of the residents. On the twenty-first, it started raining in Sacramento, which turned the dust to mud, coating the cars and sidewalks, and marked the end of the drought.
Over the next several weeks, Sacramento County recorded more than a hundred cases of coccidioidomycosis, otherwise known as valley fever, or cocci, a disease caused by inhaling the microscopic spores of Coccidioides immitis, a soil-dwelling fungus found in Bakersfield. (In the previous twenty years, there had never been more than half a dozen cases a year.) Six of the victims died.
In soil, C. immitis exists in chains of barrel-shaped units called arthroconidia; airborne, these fragment easily into lightweight spores. C. immitis is adapted to lodge deep: its spores are small enough to reach the end of the bronchioles at the bottom of the lungs. We can breathe them in, but we can’t breathe them out. Once in the lung, the spore circles up into a spherule, defined by a chitinous cell wall and filled with a hundred or so baby endospores. When the spherule is sufficiently full, it ruptures, releasing the endospores and stimulating an acute inflammatory response that disrupts blood flow to the tissue and can lead to necrosis. The endospores, each of which will become a new spherule, travel through the blood and lymph systems, allowing the cocci to spread, as one specialist told me, “anywhere it wants.” In people with weakened immune systems, cocci can take over.
Every year, there are some hundred and fifty thousand cases. Only forty per cent of people infected are symptomatic, and the signs—fever, cough, exhaustion—can be hard to distinguish from the flu. A small subset of patients will suffer long-term health problems; in fewer still, cocci will disseminate from the lungs into other tissue—skin, bones, and, often fatally, the meninges of the brain. For those with cocci meningitis, the treatment can be brutal. Three times a week, in the hospital, patients are administered an anti-fungal called amphotericin B—“amphoterrible” is how doctors refer to it—with a needle to the base of the skull. To prevent headaches, patients sometimes rest for several hours with their feet elevated above their heads. One patient, a twenty-six-year-old white woman who caught valley fever four years ago, told me that the medicine made her vomit non-stop on a negative incline. She was temporarily paralyzed, underwent three brain surgeries, and has had twenty-two spinal taps. Not long after her diagnosis, the doctors told her mother to make funeral arrangements. Now they tell her she will be on anti-fungals, funnelled through a shunt in her brain, for the rest of her life.

[conon394]

The fact remains however while this fungus is interesting what I was replying to was the indeed the nature of your OP.

You invoke the dust bowl (and note how far the dust could travel). and than this:

Within this dust, which was aspirated by the people living in the region, are tiny particles of fungus and which produce something called Coccidioidomycosis. That results in a persistent infection, and causes multiple issues including breathing difficulties, skin rashes, malaise, etc. Many young children died of it, but what made things worse, the dust actually was transmitted as far as Washington DC.

The fact is mostly does not produce a persistent infection outside of a tiny percentage of people (mostly older) does it produce any serious results.

Now there are reports of Coccidioidomycosis appearing in the current Drought region, as similar conditions have arisen

Which seems to make it sound like an emerging threat, rather than a localized issue in the places it has been known to endemic to for over 100 years. More importantly those locations have not changed during either the droughts of the 30s or 50s.

As the CDC own documents show that can't really say much about the increase especially since reporting factors/testing factors make it impossible to say it not simply increased awareness and reporting to the CDC that have produced an apparent increase. But beyond that there exists not any of the real long term longitudinal data to really say how drought might or might not impact the infection rate. Texas does supply data now and unfortunately certainly did not back when it was suffering under the 1950s era drought. Thus I not convinced any meaningful conclusions can be made really.

Under current conditions in a country that happily cuts the budgets of public health infrastructure at all levels on the alter of low taxes, it seems to me this is simply an minor risk and very rarely a major one for the population of its endemic areas. Its maybe possible that with national health care coming into existence up and if reporting and testing increase along with it some small biotech might take interest and or the CDC or NIH might be more able to coordinate a more stable and wide ranging and long term data gathering.

Also note that while the drought might allow more dust clouds its periods heavy moisture that may seem (note all the mights, may and seems in the CDC reports) to set up a better population of the fungus. Also lacking in the report is what might be a statistic that while adjusted for population growth I would think it would be critical to know the rate for agricultural workers and or construction workers vs the general public.

The statistics rather speak from themselves from the CDC. Are we planning on discussing Science or my personality? It's interesting that your posts think the latter is an aspect of debate.

If so why use the emotional Atlantic link in your OP vs all the links to the CDC and subsequent ones you could have used. The Atlantic piece is classic semi-science reporting. Just consider the opening bit about Kirt on his motorcycle - the most dangerous thing he did that day was not to drive into a dust cloud in a highly endemic area as an otherwise healthy person - it was getting on a motorcycle in the US (even assuming he was wearing a helmet and protective gear).

And than this:

"As the head of epidemiology for the Bakersfield Public Health Services Department, Emery has spent the past two decades studying dust like this—and avoiding it at all costs. He knows all too well what could happen to him if he got sick: the expensive medications with their nasty side affects, the uncertainty of whether he could be ill for the rest of his life. "

Again the article fails to show the actual numbers on any that and ignores that somebody who is immersed in the field can get paranoid. I worked at a biotech and one to the least popular people there was the head of the blood lab. She was a complete Nazi about running her lab up to beyond all recommended practices for a lab working with human and animal blood. That's a good thing - as IT guy I appreciated that she demanded we all get all hep shots and where gloves when doing work in her space and check in and out etc. But to be so rigorous she did sort of internalize that and then kinda annoyed every other lab tech and manger that ran other labs more easy because they did not need to be so worried - and by pontificating about about all their mistakes she added injury to insult. Again its the same as above the risk I faced driving to work was in fact worse than the risk I ever faced in a lab.

--------------------


So I guess I'm trying to understand what discussion you want to have?

Drought is bad - sure right true. But anyone with two brain cells to rub together could have also noticed water usage in California or Arizona or Nevada is insane and that the system in place neither rewards those who notice they live in a desert or penalizes those who don't. If you want a god damn lawn live in near the great lakes not in Arizona.

The failure of the US to fund and have more rigorous public health reporting and tracking so we could understate the the range and danger of this fugal issue?

The problem that a key state like Texas can more or less not report to the CDC? Maybe Rick Perry can't recall what the 3rd thing he was going to send to the CDC was?

Or is how do we fund research on minor local infections that promise to make Big Pharma no money at all so they don't give a damn. And likely not even help tiny Bio Tech either.

Or are you aiming to speculate that a persistent drought in California will move the fungus - even though previous persistent drought in high afflicted states have not?

[RubiconDecision]

So you're shooting the messenger then. That's an interesting tactic as whatever happened politically, or my manner of including an article that's not scientific, has little to do with there being science within it. The honest truth is that patients don't read science journals. If the only way this fungal infection was communicated was in an epidemiology report, or a Nature article, then that would only been seen by a tiny handful.

http://www.azdhs.gov/phs/oids/epi/va...ever/about.htm
While this fungal infection is endemic to certain regions, the patients are not, as they migrate and don't know they have the disease, as it make take years or decades to bloom. So a discussion of it is crucial for an internist may see an odd case in Michigan because someone formerly lived in an endemic region.

Not only this, but during the Dust Bowl, there were historic cases all over, where the surviving elderly family report the symptoms of the deceased that match "Valley Fever" one of the things that it's still called, and a common name for it then, but might only appear as pneumonia or unknown causes on the death certificate.

There's actually a lot of healthcare professionals repeating tired incorrect information about immunity after getting it, when it actually tends to dwell in the lungs and cause issues later. I would fully expect to see something similar to tuberculosis and granulomas due to this fungus being able to wall itself off in the lungs, and then when elderly might bloom again. All of which means a patient who relocated to Florida then later presents with the signs of it, even though she never had a case when younger.
http://www.valleyfeversurvivor.com/faq.html

We have to listen to the patients and see what they know, and encourage them to properly journal their symptoms so that a more thorough description is done, and then might find triggers to attacks. It's particularly important to understand the effects of this fungus in an already suffering asthma patient.

By no means is Coccidioidomycosis the only possible explanation, as there are several other things which could be the culprit like silicosis, lung cancers of diverse kinds, smoking, numerous infections of the lung, COPD, even an STD can cause similar presentation. If an internist has never heard of this fungus, they might do a bad patient history and totally forget to ask about where the patient was born, or lived before, and so fail to diagnose it.

[I WUB PUGS]

if water usage had been managed effectivly - so that LA would would be smaller, lawns would be fantastically expensive, public buildings would have no flush urinals, the aqueducts would be covered, etc.

Well to be fair, California is WELL ahead of the rest of the country when it comes to conservation, it just isn't enough. Sure stuff like the aqueducts should be addressed, but pretty much every new building is using no-flush urinals or at the very least, 2 different flushes for solid and liquid waste (requires competent user to pull up or push down the lever). How do you make LA smaller? And how does that address anything? Just move a few million people to where? And no one has a ing lawn in this state. As a Florida transplant I scoff at this notion of a "California lawn". Its a 10x10 patch of grass surrounded by succulents and mulch or just rows of lavender. Floridians have lawns. Californians have small patches of grass for their dogs to on.

What is needed and is always talked about in times of drought is the need for desal plants on the coast. These are always blocked by two groups of people:
A) Hippies who think sea lions will be sucked up into the plant.
B) Rich people, left or right of center, it makes no difference. They don't want an ugly desal plant making their view less spectacular.

Is desal expensive? Oh yes, but we already pay ridiculous amounts of money for water to be shipped over the mountains. Everyone lives on the coast. Build desal for them, let the mountain water go the Central Valley.

[Phier]

And now they can discover that the free market really does not care about obscure fungal problems that mostly hurt only the poor and other people who can't pay. The stupid drug to make your eyelashes bigger (*) likely gets far more funding than basic research on a fungus ever will.

Fungi hate poor people, its a proven fact.

* latisse its very existence is slap in the face of everyone who has ever died from an lack a cheap vaccine, or antibiotic or a new strain of a virus or bacteria or in this case a fungus. Yes good god I'm glad how many clever money men and scientists wasted money and time on giving my wife better eyelashes just before that new resistant strain of tuberculosis killed her... that's not true but the point stands.

Why do you hate eyelashes? But like most of your rants, they are just rants, if you bothered to do a wiki search...

Bimatoprost (marketed in the U.S., Canada and Europe by Allergan, under the trade name Lumigan) is a prostaglandin analog/prodrug used topically (as eye drops) to control the progression of glaucoma and in the management of ocular hypertension. It reduces intraocular pressure (IOP) by increasing the outflow of aqueous fluid from the eyes.^[1] In December 2008, the indication to lengthen eyelashes was approved by the U.S. Food and Drug Administration (FDA); the cosmetic formulation of bimatoprost is sold as Latisse /ləˈtiːs/.^[2] In 2008-2011, at least three case series suggested that bimatoprost has the ability to reduce adipose (fat) tissue

It was developed for glaucoma, you know, cure for a disease that leads to blindness. Odds are someone figured out the eyelashes of these people were getting longer, and BONUS!

Google then soapbox.
or maybe
Google than soapbox.

[Visna]

Longer eyelashes and reduced fat tissue? Sign me up, plz!

[Ludicus]

Odds are someone figured out the eyelashes of these people were getting longer, and BONUS!

Absolutely correct ´
Once daily bimatoprost treatment, applied dermally,

As an eye drop, for glaucoma, prostaglandin analogs ( bimatoprost, latanoprost, and travoprost) can cause side effects, including...darkening of the iris.

Spoiler Alert, click show to read: 

reduced fat tissue? Sign me up, plz!

Not exactly, it can be responsible for an iatrogenic orbital fat atrophy. It's not a good side effect.

[hellheaven1987]

Well, you can always move to Midwest then.