Valley Fever Redux: How Dangerous Is This Fungus?

We’ve heard a lot about Valley Fever this year. Last week, Bob Uecker’s son passed away due to complications associated with the disease. And back in March, when doctors suspected that Ike Davis was suffering from symptoms of Valley Fever and some worried that Mike Trout might have fallen ill as well, Wendy Thurm asked a timely question: “Should MLB Be Worried About Valley Fever?” She concluded that the answer was, basically, no:

Although Valley Fever doesn’t appear to present a significant health risk to players who live or play in Arizona, with two reported cases among major leaguers in the last three years, MLB should take steps to educate teams and players about the disease and how to lower the risk of infection.

Of course, the number of reported cases of a disease is generally lower than the number of actual cases, particularly in the case of a disease like Valley Fever, whose symptoms often resemble those of the flu. Valley Fever is caused by a fungus called coccidioidomycosis, or cocci for short. Cocci grows in the soil, and so its endemic region is almost entirely confined to a very specific, arid area: the San Joaquin Valley of California that gave it its name, and the desert region of southern Arizona. (Most of the state’s population lies within the endemic area, though much of the state is cocci-free, including the Grand Canyon.) The Phoenix-Tucson corridor of Arizona contains the majority of the population exposed to Valley Fever, so much so that local public health advocates have started to refer to it as “Arizona’s Disease.”

The contours of the endemic region basically haven’t changed in over a century since the disease was first discovered. But the population has, as the population of greater Phoenix has exploded. So the number of cases is on the rise. (Another reason for the rise, of course, is that doctors have grown more familiar with the disease, and so it is being diagnosed more often.) But, as Wendy wrote, there are still only about 100,000 cases a year, and two-thirds or so have symptoms so mild that the sufferer never seeks medical attention. Around 400 cases a year have extremely serious consequences, including pneumonia and fungal meningitis. The disease causes fewer than 100 deaths a year, including Steve Uecker. So, while it’s a big deal in Arizona, it’s a small problem in the scheme of things in the country as a whole.

I spoke to Dr. John Galgiani, director of the Valley Fever Center for Excellence at the University of Arizona and one of the leading experts on Valley Fever, and he explained that it’s considered an “orphan disease” by the government, defined as a disease that affects fewer than 200,000 people a year. That means, among other things, that there has not been as much research into Valley Fever as there has been into other more prevalent diseases, and to date there is no cure: the available medication treats the symptoms and relies on the body’s immune system to destroy the fungus itself. (Galgiani explained that he is currently involved in the development of a drug to cure the disease.)

So just how dangerous is a Valley Fever infection? By now, the lost career of Conor Jackson is well-known. But Jackson wasn’t the first high-profile baseball player to be laid low by the disease. That would be Johnny Bench. He got infected in the 1972 offseason, and in 1973, the 25-year old Bench actually had a mediocre season by his lofty standards, following up his MVP campaign in 1972 (.270/.379/.541, .400 wOBA, 10.2 WAR) with a much less impressive .253/.345/.429, .344 wOBA, 5.5 WAR. Bench caught it while playing in a charity golf tournament in Arizona.

I spoke to Jim Meenaghan about the disease. Meenaghan is a friend of Galgiani’s, and when Galgiani opened the Valley Fever Center at St. Joseph’s Hospital in Phoenix, Meenaghan donated $250,000. Meenaghan, a 70-year-old businessman, became interested in the disease after he was struck by it a few years ago. He’s still in good shape, a former athlete who played for a Class-D affiliate of the Yankees back when he was in college, who remains a frequent hiker and runner. But he was laid flat. “I can tell you firsthand,” Meenaghan said, “Your temperature goes up, you lose weight, depending on how big a dose you have in your lungs, night sweats, you lose appetite. You’re fatigued and tired most of the time.”

After he was diagnosed with the disease, his doctor forbade him from any strenuous activity for nine months. “My doctor said to me, with this medicine, your body is trying to heal the lung, kill off the cocci. The enemy here is fatigue,” he told me. “At one stage, four or five months into it, I was feeling better, and I was thinking of going hiking. My doctor exploded. ‘What’s wrong with you? I’m not going to let you go 6,000 or 7,000 feet up! I told you fatigue is the enemy.'” After nine months, Meenaghan was fully recovered; he didn’t develop any further complications, and he told me that doctors called it “a mild case.”

While the odds of a given person getting an even more serious form of the disease are very low, Arizona has millions of residents and tens of millions of visitors every year. Galgiani wrote a brief piece in the Pima County Medical Society’s newsletter in July 2011 (no link available) in which he calculated rough odds of infection. Galgiani assumed that the annual risk of infection was 3% and that one-third of cases would result in the person seeking medical attention. Extrapolating those assumptions to a six-week Cactus League spring training, that means that around one in 900 people will get an infection serious enough to require medical attention.

Wendy contacted teams to see whether they would be taking any extra precautions against Valley Fever during spring training. None responded, but it’s possible that the answer would have been no in any case. And that isn’t necessarily inappropriate. “I’m thinking that the risk is length of time in the endemic region,” Galgiani told me. “I don’t know how to mitigate that risk.”

The science on this front is inconclusive. The fungus grows in the soil and becomes brittle when the soil is dry, which makes it easy for spores to break off and get into the air, where they can be inhaled and get into the lungs, where they can do damage. But though Arizona is a state where there are periodic dust storms, it’s not clear that the weather has much of a correlation with infection. Galgiani believes that the spores are so fragile that they get into the air whether it’s a breeze or a gale, and so there isn’t much that can be done to reduce the risk. (For its part, the Mayo Clinic recommends wearing a mask and staying inside during dust storms.) Only to educate the public and the medical establishment so that they can make the correct diagnosis. And that, of course, is his life’s work.

As long as baseball is played in Arizona, players will be exposed to Valley Fever, and once in a blue moon, someone will get very sick. Wendy’s absolutely right: the best that can be done is to educate, and increase the chances of rapid diagnosis. “The risk to an individual person is like the risk of getting hit by a car,” Galgiani said. “We live in a dangerous world.” That’s something Conor Jackson knows all too well.