A flesh-eating scourge creeps north
The deadly fungus that causes Valley fever is spreading beyond the American Southwest, said Joshua Partlow in The Washington Post. Scientists suspect climate change is to blame.
BAKERSFIELD, CALIF.—At some point, Erik McIntyre inhaled the fungal spores. He couldn’t see them, or feel them, and it was weeks before he began to lose energy, to drop weight, to cough up blood at a karaoke bar in Arizona.
Now that he’s paralyzed from Valley fever, in a nursing home at age 53, the former U.S. Navy electrician’s day begins at 5 a.m. with a rectal tube procedure to release gas trapped in his stomach. The antifungal injections that left him retching and shaking are less frequent now, and the lesions where the fungus grew on his face and arms have faded to scars. But he knows he will never be cured, or probably walk again. “I try not to dwell on what could have been,” he said.
McIntyre can imagine the moment he encountered those microscopic spores. He remembers driving across dusty Phoenix suburbs with his windows down. But he can’t be sure.
These days, the fungus could be anywhere. Valley fever has long haunted the American Southwest: Soldiers on dusty military bases, prisoners in wind-swept jails, construction workers pushing new suburbs farther into deserts have all encountered Coccidioides, the flesh-eating fungus that causes Valley fever. But the threat is growing. Cases have roughly quadrupled over the past two decades, according to the Centers for Disease Control and Prevention.
A key reason for Valley fever’s spread, researchers say, may be human-driven climate change—and they warn that a much larger area of the United States will become vulnerable to the disease in the decades to come. The fungus thrives in dry soils, rides on plumes of dust, and booms after periods of extreme drought—the exact cycles that scientists say have grown more intense and widespread across the American West due to the warming climate.
While science is not yet able to show a definitive link between the rising case counts and higher temperatures, the connection seems clear to many of the frontline health workers grappling with the disease.
“I cannot think of any other infection that is so closely entwined with climate change,” said Rasha Kuran, an infectious-disease specialist at the University of California, Los Angeles who is one of McIntyre’s doctors.
Today, Valley fever affects tens of thousands —probably hundreds of thousands, federal officials say—of people each year, and in rare cases, such as McIntyre’s, it can be extremely debilitating, even fatal. “Cocci,” as researchers call the fungus, is primarily found in the Southwest but also in parts of Central and South America.
In the United States, it kills a few hundred people each year, according to federal officials—about as many as West Nile virus, the leading cause of mosquito-borne disease in the continental United States. But public-health officials warn that the illness could become more prevalent as drought pushes more agricultural fields into fallow ground, subdivisions sprout in the desert, and the West dries out. Cases in California appear to be marching north from their traditional home in the San Joaquin Valley, where the illness got its name.
Researchers are bracing for an explosion of cases as the ground dries, said Jennifer Head, a University of Michigan epidemiologist who studies the fungus. This fall, she predicted, “is when we’ll start to see a huge spike in Valley fever.”
IN A BARREN expanse of Southern California scrubland, Head crouched down and fed a long-handled spoon into a rat hole. Wearing an N95 mask and blue plastic gloves, she filled several test tubes with dry, crumbling soil from the
Carrizo Plain National Monument. Then she turned to her colleague and asked for a bit more protection. “I feel like I could use an ethanol spritz,” Head said, holding out her hands.
Head and her colleagues were scouring this sun-blasted patch of the southern San Joaquin Valley in September in an effort to pinpoint where cocci lives and unravel how it might be spreading. Out here among the saltbush and vinegar weed is an endless web of rodent burrows—home to squirrels, mice, and the giant kangaroo rat, an endangered species the size of a baked potato. When University of California, Berkeley scientists began coming here to study these rodents in 2007, it didn’t take long before they started getting sick.
“A really serious fatigue and a lack of appetite. For a month,” said Tim Bean, then a UC Berkeley ecologist who came down with Valley fever a couple of years into his research on the Carrizo Plain. “It sucked.”
But it turned out to be a perfect place to hunt for fungus. There has been a known link between rodents and cocci since the early 1940s. More recently, UC Berkeley mycologist John Taylor and colleagues discovered that cocci had lost genes that other fungi use to eat plants and gained those for devouring meat. “These fungi evolved to eat animals,” he said. And a favorite meal: dead rats.
Taylor believes cocci lives not so much in the soil as in the rodents. And when Head and others began scraping out rodent burrows with spoons in the Carrizo Plain, they found that about 30 percent of them had cocci, while random tests of the neighboring soil could find the fungus only about 4 percent of the time.
The fungus is elusive because the microscopic filaments in the soil are invisible to the naked eye. When ground gets disturbed, those filaments can break off, sending tiny spores long distances. A 1977 California Central Valley dust storm—known as the Tempest from Tehachapi—sickened people hundreds of miles north in Sacramento.
James Markwiese, a microbiologist with the Environmental Protection Agency in Oregon, suspects that the growing wildfire footprint in the West might also be spreading spores. He knows smoke transports bacteria and fungi, and research in California found that hospital visits for Valley fever rose 20 percent following wildfires.
Within California, the number of reported Valley fever cases rose 800 percent from 2000 to 2022, according to the state’s department of public health. Cases have been increasing fastest in the northern part of the San Joaquin Valley as well as along the state’s southern coast. The biggest spikes happen after droughts end.
The hardy spores can survive during extreme dry stretches, Head said, then flourish into a kind of fungal superbloom during wet winters. When the ground eventually dries, spores start flying around and cases take off. The past winter in California was one of the wettest on record. The state has been reporting about 7,000 to 9,000 cases of Valley fever over each of the past few drought-stricken years. Head predicted a spike once the rains ended California’s drought. “I would expect that we would see over 10,000 cases in California this year,” she said.
BEFORE THE ONSLAUGHT of snow and rain this winter, California and the West had endured one of the driest two-decade periods in more than a thousand years. Wells in the Central Valley ran dry by the hundreds. The price of water for irrigation skyrocketed, and Jace White, 33, could no longer afford to grow blueberries on a 55-acre parcel outside Fresno.
White was preparing to fallow that ground by hauling away an old storage container. The work kicked up dust from a patch of earth long undisturbed. For some reason, he lingered on the sight. “The dirt caught my eye,” he recalled.
Three weeks later, in early April, he woke up in the middle of the night struggling to breathe, with a sharp pain in his left side. White’s battle with Valley fever was the most severe illness of his life. At night, he sweated torrents into his bedsheets. During the day, he lacked the strength to swipe his cellphone. Doctors punctured his back and drained nearly a gallon of fluid from his lungs. His lips cracked and his hair fell out from the antifungal treatments. He lost at least 30 pounds. “I wouldn’t wish it on anyone,” White said.
More than half of people who get Valley fever feel no symptoms. Those who do are often misdiagnosed because symptoms— cough, fatigue, fever, night sweats—mirror other common illnesses such as pneumonia or flu. CDC officials estimate that about 500,000 people might get Valley fever annually even though reported cases hover around 20,000.
Within about two months, White had recovered enough to return to work. After a year, he was told he could stop taking medication. In this, he was fortunate. For 2 to 4 percent of patients, the fungus spreads out from the lungs, disseminating into the brain, spinal column, or elsewhere, transforming Valley fever into a lifelong, chronic illness that cannot be cured, only managed.
When McIntyre got sick in early 2018, he tried to tough it out, treating his worsening symptoms with turmeric home remedies and over-the-counter cold medicines. It wasn’t until lesions suddenly appeared that he went to an emergency room in Phoenix. “One morning, I’m looking at my arm, and I’ve got these bumps all over,” he said. “And I look in the mirror, and they’re, like, all on my face.”
By that time, the fungus had expanded beyond his lungs, spreading into his bones and throughout his central nervous system. In Arizona, he had worked from home, tracking doctor visits for a health-care company, but his physical deterioration forced him to move in with his sister, then to an apartment for military veterans. It was hard for those around him to know what was wrong. He grew confused, and he staggered when he walked. Doctors at one hospital assumed he was drunk and sent him to a homeless shelter in Bakersfield. “Imagine, this man wasn’t even drinking, and he gets labeled as an alcoholic,” said Kuran, who oversaw his emergency treatments at Kern Medical in Bakersfield.
By the time she saw him in May 2019, McIntyre could hardly speak and felt numb from the chest down. Kuran administered regular injections of amphotericin B, a powerful antifungal drug, into a plastic pouch inserted under his scalp. Despite the treatment, the inflammation around his spinal cord caused enough damage to leave him paralyzed from the waist down.
“It’s like having a fire and you’re trying to put it out,” said Kuran, who is also associate medical director at the hospital’s Valley Fever Institute. “There was nothing we could do. We gave him the maximal treatments, but the process had already started.”
Over months of treatment, McIntyre regained his cognition, but it became clear he would never walk again. The paralysis has led to other complications, including urinary tract infections and kidney stones.
In the nursing home, he posts videos to TikTok from his bed, talks to relatives, and attends physical therapy sessions. He knows he deserves to be angry or miserable, but he tries to keep his sense of humor. “I’m a fun guy,” he said. “I’m filled with it.”
He tries not to get too discouraged about his health. He sees the fungus as part of God’s plan for him. “That’s kind of why I think it may have happened to me. I could take it. God knew that,” he said. “It was one last test.”
But it was one he never saw coming.
Even though he’d spent most of his life in California and Arizona, Valley fever was not something he spent time worrying about. “I’d never heard of it,” he said.