Valley Fever Institute at Kern Medical held its Beyond The Dust symposium on August 5, providing educational updates on the diagnosis and management of the disease. The symposium featured seven expert physicians and focused on the diagnosis of Valley Fever, pulmonary and disseminated diseases, coccidioidal meningitis, and treatment strategies for the community.
The community knows the disease called Valley Fever, which is also referred to as Coccidioidomycosis, “Cocci.” According to Kern Medical, Valley Fever is an infectious but not contagious fungal disease contracted by inhaling spores of Coccidioides spp., which grows in the dirt.
Exposure is possible for anyone living and working in areas with Coccidioides spores, and the risk is even higher for individuals working outdoors. According to experts, by raising awareness and understanding, the public can strengthen its knowledge of Valley Fever and take the next step to address it.
These symptoms can be indicators of Valley Fever:
Fever, headache
Cough, chest pain, shortness of breath
Sputum production
Myalgias
Chills, fatigue
Erythema nodosum
Other rashes, night sweats
Scott Thygerson, CEO of Kern Medical, opened the symposium by sharing his personal experience with Valley Fever, having lived in the Central Valley for 28 years. His first encounter with the disease was in Fresno, where he met a surgeon who had joined the medical staff. He mentioned the surgeon contracted Valley Fever by jogging in the orchards. Thygerson noted he later moved to Bakersfield and then had a conversation with his brother, who asked what Valley Fever is, if individuals present with Valley Fever, and how it is diagnosed, treated, and cared for.
Thygerson mentioned that he has had family friends affected by this disease, and it is devastating.
“We’ve had family friends that have passed away from this disease. And the effects of that, when we visited our last friend in the past in the hospital, she looked like a cancer patient, but she passed shortly thereafter. It is a terrible disease,” said Thygerson.
Brynn Carrigan, Director of Kern County Public Health, shared her personal experience as a public health official and as a patient with cocci meningitis.
“I see thousands of Kern County residents diagnosed with Valley Fever every single year; and it’s heart-wrenching. And I’ve lived in Bakersfield my entire life, so I’ve heard about the disease for my entire life, but at the age of 40, in 2024, I was personally diagnosed with cocci meningitis,” said Carrigan. “So I then got to experience cocci from a patient perspective, and will continue to experience cocci from a patient perspective for the rest of my life.”
For the first presentation, Royce H. Johnson, FACP, Medical Director with the Valley Fever Institute, outlined the history and epidemiology of the disease, stating that it originated in Buenos Aires in the 1890s, with treatment being introduced in the 1950s.
Johnson explained that most people who become infected with Valley Fever do not become sick, accounting for about 60% of infections. Of the 40% who do become ill, about 30% are not diagnosed.
Carlos D’Assumpcao, MD, Associate Medical Director of the Valley Fever Institute, spoke on the diagnosis of Valley Fever through seven methods. One method he explained was growing the disease from a culture, which can help diagnose early disease, assemble it, stage it, and prognosticate for the patient and determine their progress through treatment. He continued discussing other ways to diagnose Valley Fever, including pathology, wet mount, serologic testing, antigen testing, PCR, and skin testing. D’Assumpcao clarified that there can be false negatives in the early stages of the disease depending on the patient’s course, and recommended retesting and testing through culture.
Kuran emphasized the importance of paying attention to headaches when it comes to meningitis. She mentioned that males are more often affected by cocci meningitis than females, although males work in outdoor conditions; that is not the prediction for this diagnosis.
Sanchi Malhotra, MD, guest speaker from UCLA, provided insight on pediatric coccidioidomycosis. Malhotra primarily focused on pediatric epidemiology, as she has seen significant severity in pediatric cases from 2000 to 2024. She stated that cases in California have gone from 1,800 to 500,000, with 10,900 in the last 25 years. Arizona is facing high case rates in the teenage population, from 34,600 to 100,000 in the last year.
Malhotra emphasized the significant issue it is in the pediatric population and the importance of thinking about it early. She highlighted that kids are not little adults and can show differences; similar to adults, 60% are diagnosed positive while they had not shown symptoms. Patients who have symptoms that show influenza or pneumonia illness tend to see less cavitation. She clarified that the disease can progress severely, as seen on CT scans, and progress to acute respiratory distress syndrome and cause death from pulmonary complications.
Shikha Mishra, MD, FACP, Associate Director, Valley Fever Institute, discussed practical management and follow-up. Mishra addressed that, depending on the diagnosis, they assess the severity and then decide if they need to treat the patient, observe, choose the type of antifungal, monitor in the clinic, adjust therapy, and end treatment. Mishra explained that the treatment for diagnosed uncomplicated cocci pneumonia can be monitored and supported if patients have minor symptoms. Those who have severe pneumonia can be treated with therapy if they have all the symptoms and are not improving. The duration for diagnosed pneumonia treatment can last from three to six months or longer.
Mishra emphasized in her discussion that it is important to consider the patient’s characteristics and demographics to determine if they are at risk. She continued to discuss other treatment options, such as asymptomatic painful cavities, which don’t require treatment unless the patient is diabetic; then, they will receive antifungal treatment and imaging, especially a chest X-ray.
Mishra addressed that once patients have completed the required treatment and show that they are clinically well, Kern Medical monitors them for at least two years. She shared her takeaways that management should be individualized and consider patients’ symptoms, imaging, serology, and risk factors together.
During the public comment portion, several members of the public asked questions regarding concerns with Valley Fever to the Kern Medical team.
One community member asked if there were any risks of the disease spreading through pregnant women toward the placenta or fetus. Johnson responded that there are rare cases of maternal-fetal cocci.
A pediatric doctor from Kaiser asked if Kern Valley Medical had seen false negatives. Malhotra clarified that she, in particular, has not seen a lot of false negatives and, as Dr. Carlos said, that in the first three weeks, it is possible to have a false negative. She recommended repeating the test if there is still high suspicion and the patient is still symptomatic, as there can be conflicting results showing false negatives. Malhotra noted that they actually see a lot of false positives with IgM since they screen a lot for transplants and biologic things.
Another comment from the community addressed whether Kern Valley Medical has seen a lot of cocci in diabetics with wound care. Mishra stated that people who are living with diabetes get pulmonary cocci and are more likely to get cavitation.
The symposium ended with a recognition that August is Valley Fever Awareness Month, and Kern Medical will be holding an in-person event on August 12.