A single breath and a single spore. That’s all it takes for the fungal infection called valley fever to take hold. For most people, it’s a blip — a treatable illness. But for some, like Rex Dangerfield and Kyleigh Cooyar, it can cause debilitating symptoms. Climate change is creating ideal conditions for the fungus to spread beyond the West. It’s popping up in places where people have never heard of it. In this Unfold episode, we hear how valley fever altered the lives of Rex and Kyleigh, and we hear from UC Davis Health scientists searching for new ways to understand, treat and one day prevent the infection.
In this episode:
- Dr. George Thompson, professor of medicine and co-director, UC Davis Center for Valley Fever at UC Davis Health
- Kyleigh Cooyar, valley fever patient
- Rex Dangerfield, valley fever patient
Read an in-depth In Focus story on valley fever in both humans and dogs.
Transcript
Transcribed using AI. May contain errors.
Amy Quinton
Patterson, California is a small community in the Central Valley where farming thrives.
Marianne Russ Sharp
It's where Rex Dangerfield visited on a warm day in the late spring of 2013.
Amy Quinton
It was also during one of California's worst droughts
Marianne Russ Sharp
That spring, a silent threat stirred in the soil, a microscopic fungus few people know about.
Rex Dangerfield
I was helping my mother-in-law re-garden her backyard. We were turning over the soil in her backyard one day, and then the next thing I know, a week or two later, you know, I started getting sick.
Amy Quinton
Symptoms were mild at first, headaches and nausea. Doctors diagnosed him with migraines, but his symptoms escalated.
Marianne Russ Sharp
It wasn't until 2015 when he collapsed at work and woke up in a hospital in a state of delirium that doctors would finally make a diagnosis: valley fever meningitis.
Amy Quinton
Valley fever is caused by a fungus called coccidioides, or cocci, that live in the soil. When disturbed, the spores become airborne. If inhaled, they can infect the lungs, and in rare cases, like Rex's, spread to the brain.
Marianne Russ Sharp
Left untreated, it's deadly. And with some patients, it changes everything.
Rex Dangerfield
I don't feel normal anymore. I used to be able to play, you know, run around. I used to be able to play basketball. I used to love to bowl. I can't do that anymore.
Marianne Russ Sharp
And then there's Kyleigh Cooyar. In July of 2015 she left her Bay Area home to drive south to vacation in Palm Springs with her children.
Kyleigh Cooyar
And I woke up in the morning and I felt the worst I'd ever felt. I had a headache. I felt feverish. I had abdominal pain. I was nauseous and I had never felt as tired in my life.
Marianne Russ Sharp
Her symptoms were worse the next day. She ended up in an emergency room and spent a month in the hospital.
Kyleigh Cooyar
Every day, different doctors coming in, oncologists, hematologists, gastroenterologists, every specialty you can think of, and no one could figure out what was wrong.
Amy Quinton
It took six weeks and a blood test before doctors discovered she too had valley fever.
Marianne Russ Sharp
Valley fever could cause a variety of symptoms, says Dr. George Thompson, an infectious diseases doctor who co-directs the Center for Valley Fever at UC Davis Health.
George Thompson
Most of our patients have some respiratory illness, so that can be pneumonia, that can be cough or chills, fever, a lot of weight loss and fatigue are part of that condition.
Marianne Russ Sharp
But he says one to three percent of patients will develop a chronic illness.
George Thompson
So that can be a chronic pneumonia that doesn't go away without antifungals, or in the worst case, it can leave the lungs and go to other sites in the body. And the most feared of those is meningitis, but it can also cause skin disease, bone disease, and really go to any organ.
Amy Quinton
Cocci live in the soil, primarily in the western US, including California's Central Valley, where valley fever got its name.
Marianne Russ Sharp
Wind, farming, even walking a dog can launch spores into the air. Thompson says people aren't even aware they've been exposed.
George Thompson
If you've driven through the valley and you've got a cough or an illness that doesn't seem to be going away for weeks or even a month, think about valley fever. That's you only have to breathe in one spore once to acquire the infection.
Amy Quinton
Most who breathe them in don't get sick, but for people like Rex and Kylie, it becomes life altering.
Marianne Russ Sharp
Climate change is fueling the perfect conditions for cocci to grow, heavy rains followed by long dry spells,
Amy Quinton
And with rising temperatures, it's spreading. East. North. Into places where people have never heard of valley fever.
Marianne Russ Sharp
It sounds grim, a disease on the move, hard to detect and for some impossible to cure.
Amy Quinton
But this isn't a story without hope. UC Davis scientists are working urgently to detect it sooner, treat it better, and maybe even help prevent its spread.
Marianne Russ Sharp
Coming up in the first of two special episodes of Unfold, we explore how this hidden threat is spreading and what's being done to fight it.
Amy Quinton
Coming to you from UC Davis
Marianne Russ Sharp
And UC Davis Health,
Amy Quinton
This is Unfold. I'm Amy Quinton
Marianne Russ Sharp
and I'm Marianne Russ Sharp.
Amy Quinton
For Kyleigh Cooyar, her symptoms spiraled during her month long stay in the hospital. A red and purple rash appeared all over her body. Her abdominal pain got worse.
Kyleigh Cooyar
My stomach started to get more and more bloated and distended to where I looked like I was pregnant. And they found that I had a lot of fluid building up in my pelvic cavity so they did something like an amniocentesis where they pulled the fluid out and it filled like a two liter bottle, like a soda bottle.
Marianne Russ Sharp
Doctors told her she had an autoimmune disorder called Stills' disease and would be under the care of a rheumatologist. They discharged her.
Amy Quinton
A few weeks later, her infectious disease doctor called with her blood test results. It wasn't Still's disease, it was valley fever.
Kyleigh Cooyar
I never heard of valley fever before that happened and I thought it was something that was simple to cure.
George Thompson
Valley fever can look like a lot of different things.
Marianne Russ Sharp
Dr Thompson specializes in diagnosing and treating valley fever and other fungal infections. He says Kyleigh's experience of being misdiagnosed is not unusual.
Amy Quinton
That's because most people who get it either don't experience severe symptoms like hers, or it goes away on its own.
George Thompson
So with that, patients are misdiagnosed as viral infection or bacterial infection. They're given multiple courses of antibiotics erroneously, but eventually they feel better and they really never come to clinical attention or never diagnosed definitively or accurately.
Marianne Russ Sharp
Thompson says in California's Central Valley, one in four episodes of pneumonia is actually valley fever, not a virus or bacteria.
Amy Quinton
For the small percentage with severe cases of valley fever, like Kyleigh's, cocci can set up shop and wreak havoc in any organ. In her case, her ovaries. In Rex's case, his brain.
Amy Quinton
Rex pulls several tiny seafood quiches out of his oven in his apartment in Stockton, California.
Rex Dangerfield
It's kind of thing I do when I get bored, you know, look for different recipes and try to make my own spin on it and stuff like that.
Amy Quinton
He's mentioned his boredom more than once, because before he had valley fever, he was active.
Marianne Russ Sharp
Rex also loved his work as a customer service representative in the medical industry.
Amy Quinton
But now at 56 he can't work and lives on disability.
Rex Dangerfield
I don't have any balance. I lost a lot of skill, motor skills. I don't remember a lot of stuff. You know? I don't feel whole anymore.
Marianne Russ Sharp
Rex had also never heard of valley fever before he was diagnosed. He's still shocked that something as simple as kicking up dirt nearly killed him.
Rex Dangerfield
You know, I almost died a few times over this mess.
Amy Quinton
He remembers one time when he fell asleep on the couch. His wife came in to wake him up to tell him to go to bed.
Rex Dangerfield
I wasn't waking up. I wasn't coherent to anything. I think if she'd have left me on that bed that night, my brain would have swollen to the point where I wouldn't have I wouldn't have survived.
Marianne Russ Sharp
Since then, he's come under the care of Thompson at UC Davis Health, where he's had two surgeries to place and replace a shunt in his brain.
Amy Quinton
The shunt helps prevent his brain from swelling with excess cerebral spinal fluid.
Marianne Russ Sharp
Now he's on antifungal drugs and will be for the rest of his life.
Rex Dangerfield
And this is what I take. I take two pills twice... once a day, every day, and this saves my life.
Marianne Russ Sharp
It took a while for Rex to find an antifungal that worked for him. Treatment is limited. Only two classes of antifungals are effective against valley fever, says Thompson,
George Thompson
One of those is Amphotericin B, and that's nicknamed ampho-terrible by medical students. It's very toxic, causes lots of kidney problems. And the other class are the triazoles, and those are generally well tolerated, but when patients are on those for six months or longer, they tend to accumulate toxicity and side effects.
Amy Quinton
Kyleigh experienced serious side effects from her first antifungal. She felt horrible, drained, exhausted. She began to lose her hair.
Kyleigh Cooyar
Like I really couldn't do anything. I just felt so weak all the time, and the headaches were really debilitating. I even remember times that I felt like maybe it would be better if I were dead, because I felt so terrible.
Marianne Russ Sharp
In desperation, her husband scoured the internet for answers.
Amy Quinton
He found the Center for Valley Fever and Dr. Thompson. With Thompson's management and the right medication, Kyleigh's condition improved.
Kyleigh Cooyar
He's the one that got it under control and I think he saved my life.
Andy Fell
Yeah. How have things been going?
Kyleigh Cooyar
Good? Yeah, no complaints.
Marianne Russ Sharp
Kyleigh now sees Thompson every six months. Her blood is drawn to check her titers, which show how many antibodies she's made against the fungus. She too will remain on antifungals the rest of her life.
Amy Quinton
Kyleigh still isn't sure how she got valley fever. The normal incubation period is one to three weeks. But she does wonder if it might have been during that long drive to Palm Springs down I-5 through California's Central Valley,
Kyleigh Cooyar
They were doing road work, and so our car was stopped there on the road for about an hour, and there was, you know, bulldozers and big machine equipment blowing a lot of dust around, and I rolled down the windows, and it was just a couple days later I started to get sick.
Marianne Russ Sharp
Cocci is primarily in the soil in California and Arizona, but it's spreading into Nevada, Utah and as far north as Washington.
Amy Quinton
But research shows under climate change, it could easily spread to the Midwest. Thompson was a bit unconvinced of those scenarios when he first read about them.
George Thompson
When that paper came out I was pretty skeptical, but we've been called on outbreaks of coccidioides infection or valley fever in Nebraska even. So we think it's probably already in some of these states, and probably in low amounts, or just not diagnosed.
Marianne Russ Sharp
Thompson's research also shows that the fungi can hitch a ride on the particulate matter found in wildfire smoke. As the fire stirs up the spores into the air, it has the potential to travel thousands of miles.
Amy Quinton
But the real danger may lie not in how far it travels, but in how hard it can hit.
George Thompson
We have been a little bit surprised over the last few years as it seems coccidioides has become a little bit more aggressive. So what I mean by that we've seen a big increase in cases after covid, but we've also seen more severe cases. We've got a number of patients in the hospital almost all the time with severe coccidioidal infection.
Marianne Russ Sharp
And those are the cases we know about. Thompson co-authored a paper showing that there were between 200,000 and 360,000 symptomatic cases of valley fever in the US in 2019 that's up to 18 times more than the cases that are reported through national surveillance.
Amy Quinton
The more someone is exposed to soil, the higher their risk.
Marianne Russ Sharp
That means agricultural workers, construction workers, even firefighters who dig fire breaks, are at risk, and men are three to four fold more likely to get it than women.
Amy Quinton
So far, we've talked about some of the worst cases, but it's worth emphasizing that just one to three percent of patients get severe cases of valley fever, like Kyleigh and Rex.
Marianne Russ Sharp
and Thompson says there's hope for all patients infected by the fungus.
George Thompson
Our lab and our research efforts are really focused on, how do we get patients who we're currently seeing better? So that's diagnostics. Can we make sure that these are diagnosed earlier? Can we tell which path they're going to take? Are they going to have a pretty easy course to treat and get better, or are they going to have a stormier course and really need aggressive antifungal therapy and a lot of clinical attention?
Amy Quinton
Thompson says two new antifungal drugs are on the horizon that could be game changers for those with valley fever.
George Thompson
They work for fungal pathogens we currently have no treatment for. Both of these new drugs also work really well for valley fever, so even patients failing other options are going to have these new medications available for them.
Marianne Russ Sharp
People like Rex and Kyleigh are also helping scientists understand other aspects of valley fever by taking part in clinical trials.
Nurse
Take a deep breath for me. Open hand, relax.
Amy Quinton
Kyleigh rolls up her sleeve at a blood lab at UC Davis Health. A nurse gently draws vials of blood, nine in total.
Nurse
I'm going to release her tourniquet. Okay,
Marianne Russ Sharp
Kyleigh's blood will travel several places. First, it goes hundreds of miles to San Antonio. Thompson tells her it will help scientists researching a vaccine to prevent valley fever.
George Thompson
So some of your blood goes to Texas to help us make a vaccine. So we'll take your blood and see which parts of cocci does it bind to, and then they want to make sure the vaccine does essentially the same thing. You know, it stimulates the host response that the person's response to do the same thing. So we can give them the vaccine, and they if they breathe in coccy, they're like, Yeah, we know what to do with this. And it's not an issue.
Amy Quinton
Some of Kyliegh's blood is also helping scientists at UCLA and UC San Diego better understand people's immune response to the infection.
George Thompson
I think we're really at a precipice in infectious disease where we're ushering in this new area of immunotherapy. So we'll give people medication specifically to help their immune system fight different infections, they fail to do so by themselves.
Marianne Russ Sharp
Thompson says researchers are also studying whether certain immune genes could play a role in why some people have such severe illness, while others show few, if any, symptoms.
Amy Quinton
All of the research makes Thompson hopeful.
George Thompson
You know, we're really at the pinnacle of science right now. Every year should be better than the year before, and we're hoping to see some big breakthroughs and advances just over the next six months.
Marianne Russ Sharp
Rex Dangerfield still sees Thompson regularly. He takes his medication every day. He learned the hard way not to ever go off it
Amy Quinton
Last year, he sat down to watch TV one day, not realizing he had walked into a stranger's apartment and not his own.
Rex Dangerfield
I haven't got to the point where I've been that bad, but I still worry about it. It's still back in my mind. You know, am I really acting right? You know, am I doing, you know, what I'm supposed to do, and am I my functioning the way I'm supposed to function, or am I just walking around like a zombie waiting to die, you know? So that's why I'm really diligent now, as far as making my doctor's appointments and making sure I take this these two pills a day to help keep me alive.
Amy Quinton
For Rex, survival means vigilance, daily medication, regular appointments and learning to live with uncertainty.
Marianne Russ Sharp
Together, he and Kylie are helping to shape the science that may one day spare others what they've endured.
Amy Quinton
Coming up in our next episode of Unfold, we follow the trail of valley fever through a different lens. We'll explore how dogs, yes, dogs might help scientists map where valley fever is spreading.
Marianne Russ Sharp
You can find more information on valley fever and read more about Rex and Kyleigh's stories at our website. ucdavis.edu/unfold. I'm Marianne Russ Sharp.
Amy Quinton
and I'm Amy Quinton. Thanks for listening.
Andy Fell
Unfold is a production of UC Davis. It's edited by Marianne Russ Sharp. Original music for Unfold comes from Damien Verrett and Curtis Jerome Haynes. Additional music comes from Blue Dot Sessions.