Valley fever often misdiagnosed

[Guest guest]

Valley fever often misdiagnosed

Porterville Recorder - Porterville,CA

By Anita Stackhouse-Hite, The Porterville Recorder

http://myopr.com/articles/2006/09/08/news/local_state/news3.txt

Oleta Copass was 45 the first time she contracted valley fever, but

the disease was misdiagnosed as tuberculosis.

" She was coughing up blood, so they put her in a TB ward in

Springville, in a treatment center they had there back then, " said

her daughter, Derinda Goodson. " While she was there, after about a

week they did another test and discovered she didn't have TB. They

quickly moved her out of there. Another doctor examined her, I can't

remember his name, and he said `I think it could be this thing

called valley fever.' That's exactly what she had. It made lesions

on her lungs. "

Twenty-one years later, in 1985, Copass became sick again. A skin

test was performed on her and again doctors told her she did not

have valley fever. It could be pneumonia, or cancer, she was told.

The 66-year-old told her attending physicians she was sure she had

the insidious disease, according to Goodson, a special education

instructional assistant at Porterville High School.

X-rays were taken. Pneumonia was fingered as the culprit. Cancer ran

a close second, doctors said. Finally, Copass' culture samples were

transferred to the University of California Los Angeles Medical

Center.

" The results came back saying she had valley fever of the lungs, "

Goodson said, " but by this time she'd been in the hospital for a

month. The doctor said the treatment itself would be too much

because she was so weak. "

A few months later, Copass succumbed to valley fever and died. She

was 67.

Medical Advances Not Enough

Valley fever's official name is Coccidioidomycosis, Cocci

(pronounced i) for short. It is caused by Coccidioides immitis, a

fungus that grows in the ground as mold. Spores from the fungus are

carried by the wind, when they are unearthed by soil disturbance.

Earthquakes send the microscopic spores flying. So does construction

work and farming.

Unsuspecting victims inhale the potentially lethal spores into their

lungs, where they incubate for seven to 21 days before symptoms

begin to manifest. It is not contagious; one human cannot get it

from another.

Medical science persists in its advancements in conjunction with

21st-century technology, yet valley fever remains difficult to

detect.

The reasons are many, according to Dr. Owen Kim, S. Good

Cancer Treatment Center medical director.

" Radiographically, or in X-ray, valley fever can look really like

cancer, " Kim said. " I think misdiagnosis sometimes comes from

parochial chauvinism. For example, if you're an admiral you think

the Navy is important in fighting a war. If you're in the Air Force

you think planes are important to war. As doctors, first and

foremost, you look for something related to your area of expertise.

It's a form of parochial chauvinism. "

Dr. Debrah Ann Hanks, pathologist and president of Premier Pathology

Laboratories, Inc., agrees that the reasons are many and varied.

" As an infectious disease, valley fever is part of the inflammatory

infectious process, " Hanks said. " That means it causes the body to

have the kind of general reaction that can happen with other

infectious diseases, such as tuberculosis, and it can resemble them.

That makes it hard to decipher at first. "

She was asked why testing for valley fever is not part of the normal

physical exam process, since it is so prevalent in the Valley.

" It's somewhat of an expensive process to go through, " Hanks

said. " We don't automatically test for TB, for example. And people

who live here have a variety of reactions to it. Some may get

exposed and not become infected, so their systems actually make

antibodies against it. You can get an immunity to it by living

around it.

" Then there are people who have a mild infection and think it's

something else. And then there are people who find out they have it

and get treated. Worse is when people don't go to the doctor and

they have the symptoms - fatigue, cough, weight loss. "

Those same symptoms can indicate colds, flu or pneumonia.

In severe cases, valley fever can disseminate into the bones and

joints; painful ulcer-like sores form on the legs, arms and other

parts of the body.

The Nickname

Cocci got the moniker " valley fever " not because it's found in or

named after the San Joaquin Valley, as many believe. It is so named

because the organism that causes it is so common in Southwest region

of the country, in Mexico and Central and South America, according

Larson, executive director of Valley Fever Americas

Foundation.

Like the San Joaquin, many of those areas house their own valley-

like terrain.

" Even sea otters get valley fever, " Larson said. " The spores are so

light they float out into the ocean. They autopsy every sea otter

they find, and many die from valley fever. It's not named for the

San Joaquin Valley. Per capita, Arizona has more cases of valley

fever. "

This summer, Rep. Bill , R-Bakersfield, introduced HR 5416, a

piece of legislation that asks for $45 million to fund vaccine

research for valley fever. It made it to committee for review, but

no further thus far.

As pervasive as valley fever is, blacks and Asians are more likely

to contract to the disease than Caucasians. That statistical enigma

continues to have the medical community scratching its collective

head, according to infectious disease consultant and specialist Dr.

Boken.

Two years ago, in a discussion regarding how valley fever affects

diverse ethnic groups, Boken said there is no known answer.

" We know African Americans and Asians are affected more, " he

said. " We just don't know why. Study after study has been done, but

they haven't produced a satisfactory answer to that question. "

Contact Anita Stackhouse-Hite at 784-5000, Ext. 1043, or astackhouse-

hite@....

This story was published in The Porterville Recorder on Sept. 7,

2006