Coccidioidomycosis.
It’s also known as Valley Fever, which is caused by Coccidioides immitis, a soil-dwelling fungus resembling mildew or yeast.
Hans E. Einstein, professor of clinical medicine, emeritus, for the University of Southern California, lectured in Bakersfield College’s Fireside Room Oct. 24 as a continued part of BC’s Eminent Speakers series.
He said that Coccidioidomycosis is often called “Cocci” for short and is also known as Posada-Wernicke’s disease, desert fever, San Joaquin fever, desert rheumatism, California’s disease and coccidioidal granuloma.
The sagacious, yet spry and elfish-looking elderly man, cousin to Albert Einstein, and chairman of medicine at Kern Medical Center, showed a slide-rendered 19th-century photo of a swollen-faced, cauliflower-skinned Argentine soldier who was the first recorded victim of the disease. Einstein also showed a slide of the first American case, which occurred in 1896. The lesion-ridden afflicted man was a Portuguese fisherman working in the San Francisco Bay area.
“No, this is not Mike Stepanovich’s high school graduation picture,” Einstein quipped, referring to the new director for the BC Foundation who introduced him. The audience chuckled.
Wearing a blue jacket, gray pants and strangely incongruous running shoes, Berlin-born Einstein described Coccidioides immitis as a fungus or mold and member of the mushroom family, which grows best in areas such as Arizona, New Mexico, west Texas, parts of central America, Argentina, northwest Mexico, California’s San Joaquin Valley, and other areas with dry weather and sandy soils. The Sahara, Gobi and Negev deserts are fertile areas as well. Most recently, Brazil has experienced the growth of that particular fungus. Einstein mentioned that if an area contains creosote bushes, then that is a Valley Fever-prone area.
According to Einstein, the mold develops hyphae with chains of arthroconidia, and winds disperse the arthrospores, which are inhaled by vulnerable people. From within the lungs, the arthroconidia soon begins the parasitic stage and forms spherules. According to Einstein, each spherule has within it endospores, which soon burst and then release more endospores. A 10-14-day incubation period starts before symptoms appear.
After the incubation period, sufferers experience coughing fits, fevers, chills and chest pains. As the condition worsens, the afflicted individual experiences myalgia, pleural effusion and meningismus.
Einstein showed a slide of a chest X-ray with a cloudy area indicating infection as well as an enlargement of the lymph nodes. Einstein remarked that the progression of the disease resembles tuberculosis.
The chest in the X-ray belonged to a twenty-seven-year-old male who worked in Valley Fever-prone Maricopa at a kitty litter plant who eventually died of the fever. Einstein also showed a slide of a young female in an advanced state of the disease with a large cavity in her lungs. Einstein after that showed a slide of a young black girl’s spine completely destroyed by the disease.
During the course of the lecture, Einstein mentioned that African Americans are currently the group most often afflicted with the most serious cases of the disease. More than 7,000 Cocci cases strike the U.S. a year, and yearly treatment costs typically go over $60 million.
According to Einstein, to ascertain if a patient has the disease, skin and serologic tests can be performed as well as histologic studies of biopsy specimens taken from the skin and lungs in cases in which patients are coughing up blood.
Cultures derived from sputum (saliva) pus and body fluids can also be used as a basis for diagnosis, according to Einstein. Skin, bones, joints, knees and the spine are the areas usually infected.
An infection in the brain was usually 100 percent fatal until the 1950s. Einstein said that he has never seen a case of the fever infecting the intestines. According to Einstein, 60 percent of Valley Fever sufferers may think that they only have a mild form of a flu or a cold, and 40 percent become sick enough to need medical care. Five to ten percent are gravely ill patients who often wind up with scars on their lungs. For the seriously afflicted, the symptoms resemble pneumonia. The cases in which the disease traversed from the lungs to the bloodstream to the brain usually ended in death. A prolonged period of moderate discomfort is common in the initial stages of the progression of the disease, according to Einstein.
Einstein said that treatments include the use of the drugs Amphoterin B (fungizone), Liposonal B (AmBisome) Micronazoles (Monistat) under the category of Imidazales as well as Amphotericin B, although this drug is not particularly “user friendly,” as Einstein puts it, because it creates abscesses.
Einstein admitted that the research for a Valley Fever vaccine has not been very extensive, and it amounts to a “small pimple on the fanny of progress,” he said.
Fortunately, 53 percent of Kern County residents who have endured Valley Fever are now immune to the disease, according to Einstein.
In fact. Einstein said that all those who have gotten Valley Fever have developed immunity. He added that the disease is never transmitted from person to person. Nevertheless, a vaccine must be speedily developed, he said.
Unfortunately, throughout many decades, other diseases such as polio have received more publicity and funds, Einstein admitted. This has often happened because some famous person brought attention to a particular disease through publicity or by actually contracting a particular disease.
“Franklin Roosevelt got polio. That’s why there’s a vaccine for it,” Einstein said. “I used to pray that Richard Nixon, or Ronald Reagan, or somebody like that would get Valley Fever, and then there would be a vaccine for that. If Britney Spears got Valley Fever, there would be a Valley Fever vaccine,” Einstein said. The audience laughed.
Einstein, who escaped in the 1930s from the Nazis along with his mother and sister to the Netherlands, came to the U.S. as an exchange student and remained to go to medical school.
Einstein served in the US Army’s Berlin Airlift mission during the 1940s. After practicing medicine in New York and serving in the New York National Guard, Einstein came to Bakersfield. Einstein helps run a specialty clinic every Tuesday afternoon at Kern Medical Center along with Dr. Royce Johnson, fellow chairman of medicine at KMC.