Doctors couldn’t figure out what was wrong with Devin Buckley.
It was February 2018 and the previously healthy 18-year-old discovered he couldn’t walk to the bathroom without getting out of breath. That was on top of the rapid weight loss, stomach problems and extreme fatigue that seemed to come out of nowhere.
The on-campus health center at the University of Arizona in Tucson, where Buckley was enrolled as a freshman, had no answers. No one from the emergency room either.
Buckley was home in Chicago over spring break when he ended up in intensive care with difficulty breathing. It was there that he was finally diagnosed with valley fever, after a family friend suggested the doctor’s test for it.
“It surprised me that something so serious couldn’t be known,” said 24-year-old Buckley. “When I was first diagnosed, the word cancer was circulating among some doctors – as if they were screening me for it. So it just shows you how serious a disease is when doctors who see it think the first thing I have is cancer.
Valley fever is an infection caused by breathing in spores of the fungus coccidioides. The spores can survive through heat and drought and remain in the soil. When the dirt is disturbed — by construction, wind, or even hiking — the spores can become airborne.
The fungus is endemic to the hot, dry soils of the Southwest; According to the California Department of Public Health, 97% of all U.S. Valley Fever cases are reported in Arizona and California.
But that could be changing: Fungal infections, including valley fever, are increasingly being diagnosed outside of their usual range. A study in the journal GeoHealth predicted that, due to climate change, Valley Fever’s range could spread eastward through the Great Plains and north to the Canadian border before the end of the century.
“As temperatures rise and the western half of the US remains quite dry, our desert soil will expand a bit and these drier conditions will allow coccidioides to live in new places,” said Morgan Gorris, who led the GeoHealth study. while at the University of California, Irvine, and is now a staff scientist at Los Alamos National Laboratory.
A “huge spectrum” of diseases
About 20,000 valley fever cases were reported in 2019, but the Centers for Disease Control and Prevention say this is likely an underestimate. While Valley Fever can be easily diagnosed with a blood test, it has long been misdiagnosed or underdiagnosed due to a lack of knowledge about the disease among both the public and physicians.
The majority of people with valley fever may never know they have it. The symptoms often resemble a respiratory infection: fatigue, cough, fever, shortness of breath and muscle aches.
“If you see a patient with pneumonia, who either lives in the Southwest or has traveled to the Southwest, valley fever should be part of what we call the differential diagnosis, which means it’s one of the things that we need to think about,” said dr. Royce Johnson, the medical director of the Valley Fever Institute at Kern Medical in Bakersfield, California.
In 5% to 10% of cases, the infection can lead to serious, long-term problems in the lungs, according to the CDC.
“It definitely has a huge spectrum. You know, it ranges from people breathing in the spores really having no symptoms but developing immunity,” said Dr. George Thompson, an infectious disease specialist at the University of California, Davis. “The other end of the spectrum is people with fulminant infection, meningitis, or spread to multiple sites, that is, it’s outside the lungs to multiple different sites in the body.” Fulminant infection means the illness comes on quickly and severely in an otherwise healthy person.
“The vast majority are somewhere in between, but they still have subacute illness,” he said. “They’re sick for weeks to months, you know, with coughs, fatigue, fever, chills. So it is still a significant disease.”
Valley fever can be difficult to treat; some patients have to take antifungal medications for months or years, which can come with uncomfortable side effects such as hair loss, chapped lips, and dry skin.
In the years after Buckley was diagnosed, the disease spread from his lungs to his spine and legs. He was put on a ventilator three times. The last time, in 2021, was the longest: he was on a ventilator for two weeks.
“At one point the fan was 100% on. It was breathing for me,” he said. “They said to my mother, prepare that I won’t be here.”
Buckley has re-learned how to walk, feed himself and perform basic daily tasks, but he’s still not out of the woods. His life is radically different from how it was before he fell ill, filled with doctor’s appointments, surgeries and hospital stays.
Hope on the horizon
Scientists have been trying to develop a vaccine against Valley Fever since the 1960s, according to the CDC. One candidate was finally tested on humans in the 1980s, but it didn’t work well.
But in recent years, researchers at the University of Arizona College of Medicine in Tucson have developed a vaccine that is highly effective in dogs. Dogs, like humans, are susceptible to valley fever.
The two-dose vaccine uses a version of the coccidioides fungus that has been genetically modified so it cannot cause disease, but can still train the immune system to recognize and respond to future infections.
The vaccine could be approved by the U.S. Department of Agriculture for use in dogs in early 2024. If so, it would be the first time the US has approved a vaccine to protect against a fungal infection in animals or humans.
Dr. John Galgiani, director of the Valley Fever Center for Excellence at the University of Arizona College of Medicine, worked on the vaccine study in dogs. He is now focusing on getting the vaccine into human clinical trials.
“I’m really, really hopeful,” he said. “In my opinion, right now we have a candidate who deserves to be evaluated and I think he will probably be effective, and we will use him.”
Still, an approved valley fever vaccine for humans is still years away. If all goes according to plan — which doesn’t always happen in the scientific process, Galgiani noted — the earliest he sees this vaccine available to humans is eight years old.
But experts say now is the time to build on the research momentum to advance vaccine development before Valley Fever reaches even more people in the country.
“I think fungi really are the superbugs to come. I think they are really the ones who will be problematic in the next ten years. And Valley Fever will be a big part of that,” said UC Davis’s Thompson. “They’re really here to stay. This battle is just getting started.”
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