VALLEY FEVER VICTIMS BEWARE

Dr. Hans Einstein

 

Three decades ago, Bakersfield physician Hans Einstein sent a Wasco patient to the Stanford University hospital to see heart transplant pioneer Dr. Norman Shumway.

The man was examined and found to be a suitable candidate for a heart transplant. But before Shumway would perform the operation, he tested the man to determine if he had, or previously had valley fever (coccidioidomycosis).

Shumway also required that the man sign an affidavit pledging not to go back to his Wasco home for 10 years after the operation. Shocked by Shumway’s demand, the patient returned to Einstein and asked him what he should do.

“I said, ‘Do you want to live? Do you want a heart? Then sign it,’” Einstein recalled recently.

Einstein, an internationally recognized valley fever expert, concedes that Shumway’s 10-year ban on the patient’s return to his Wasco home may have been an overreaction. But he used the story to illustrate how seriously valley fever must be regarded when a patient’s immune system is compromised by advanced medical treatments, such as organ transplants, or by diseases, including cancer.

Kern County is a valley fever “hot spot,” where in some years the number of reported cases is so large that an epidemic is declared. An endemic fungal infection, valley fever is contracted when someone inhales an airborne spore released by the wind from the soil of southwestern United States, Mexico and some parts of South America.

Symptoms of the disease can be as mild as a common cold or as serious as pneumonia. If the infection disseminates, it can target the nervous system, skin, bones and joint. In some cases, it can be fatal.

Because of the geographically isolated nature of the disease, when valley fever occurs in a patient outside an endemic area, it can go undiagnosed, with appropriate treatment delayed, not given until it is too late, or not given at all.

People who live in Kern County, a valley fever “hot spot,” often leave the area to obtain medical treatment, including organ transplants.  While local doctors recognize the risk valley fever poses to patients who have compromised immune systems, physicians outside the area may not be as responsive.

Earlier this year, The Californian’s publisher and owner, Ginger Moorhouse, shared with readers her  lengthy struggle to donate one of her kidneys to her husband, John. The transplant operation was successfully done at the University of California’s hospital in Los Angeles on Feb. 19.

A few days later, the couple returned to their Bakersfield home to recuperate.

His immune system intentionally compromised to prevent the possibility of the transplanted kidney being rejected, John became ill and had to return to the UCLA hospital, where he eventually was diagnosed as having valley fever.

Einstein said Ginger and John Moorhouse’s experience further illustrates the need for patients from valley fever hot spots to be given specialized attention. Patients who leave the area to obtain advanced medical treatment must insist valley fever be considered in the treatment plan. Einstein praised medical facilities in Arizona — another valley fever hot spot — for the treatment protocols developed there to guard transplant patients.

Dr. Janis Blair, with the Mayo Clinic’s organ transplant program in Scottsdale, Ariz., explained  “high risk” patients — those with valley fever, or who have had valley fever in the past — are given anti-fungal drugs sometimes before, but most often at the same time transplants are performed.

Rarely are organ transplant operations complicated by valley fever when physicians follow this protocol.

Blair stressed the need to identify the presence of valley fever in potential organ donors and recipients. Blood tests are performed that can effectively detect current and recent valley fever cases. But past occurrences only can be determined by reviewing patients’ medical records and interviewing patients. 

Since some valley fever cases are so mild that they are not reported, medical records may not be available and patients may not know they had valley fever.

If a patient with a compromised immune system has had valley fever in the past, the cocci spherules left in the body can be released, reactivating the disease, said Einstein.

With testing limited and some doctors outside Kern County unaware of risks, Kern County patients must be their own advocates, said Einstein, adding that patients must insist potential valley fever complications be assessed and addressed whenever advanced medical treatment is obtained, or whenever patients contract a disease that compromises their immune systems.

 This article appeared in The Bakersfield Californian on Aug. 16, 2009.

https://www.bakersfield.com/kern-patients-must-be-aware-of-valley-fever/article_405961b1-8ef7-5580-8d7a-a8c2e23e7f05.html