FRESNO -- Kevin Walker arrived at Taft Correctional Institution, a federal prison in western Kern County, in December 1999 to serve a 14-year sentence for attempted possession of cocaine.
But another kind of sentence awaited him, one far more painful than confinement alone.
In July 2001, fluid-leaking boils broke out across Walker's face and body. Once he was diagnosed with valley fever, doctors put him on an antifungal drug -- amphotericin B -- but the drug was so powerful that it caused his kidneys and liver to begin failing.
He was switched to another antifungal drug -- fluconazole -- and transferred to a prison in Fort Worth, Texas. But the disease continued to spread throughout his body, even into his bone marrow. Boils, then holes, developed on his spinal column and clavicle.
"That 14-year sentence turned into a life sentence," said Walker, who was released from prison in 2010. "Because I have this disease for life, and no one has accepted responsibility for putting me in that situation."
Taxpayers are also paying a price. Californians spend about $23.4 million a year to treat state inmates with valley fever.
The California prison system estimates about 200 inmates are hospitalized every year due to valley fever. Most of them are diagnosed with the disease while serving sentences in eight institutions in the San Joaquin Valley, where the airborne fungus that causes valley fever is rampant.
That doesn't include federal inmates at prisons like Taft, which was described in one lawsuit as a "petri dish for valley fever."
A study by the state prison health system found that the rate of valley fever in Pleasant Valley State Prison in Coalinga was 600 times the rate found outside the prison walls in Fresno County.
When you add up all the time state inmates spend in the hospital for valley fever, it amounts to an average of 5,000 days, or about 25 days for every inmate. The gruesome details of inmates' experiences with the fungal disease, and the disease's long-term impact on their lives, remain largely hidden from the public's view.
Because most inmates are brought in from outside the valley, they have no built-in immunity to the disease, which is the best defense for most valley residents.
On top of that, research studies have shown that blacks are far more likely to develop the most serious form of the disease. The prison population has a higher proportion of blacks than whites, and prisoner advocates criticize state and federal agencies for putting black inmates in harm's way.
The rates of valley fever in the communities surrounding the prisons in Central California already are high. But the rates inside the prisons are worse.
An April 2012 study found that at Pleasant Valley State Prison, the rate of valley fever was 7,011 cases for every 100,000 people. In states that report cases, fewer than 20 people out of every 100,000 are diagnosed with the disease.
There are several reasons inmates in the prison system experience high rates of valley fever.
In addition to most of them being brought into the valley from elsewhere, they also spend lots of time outdoors in the dusty prison yard, where they could inhale the spores. Also, many inmates already have weakened immune systems because of AIDS or hepatitis.
"I don't think I'll ever be back 100 percent," said Gregory Edison, who is serving time at Taft for manufacturing drugs. Valley fever, he said, left him with chills, migraine headaches, dry, scaly skin, exhaustion, weight loss and an uncomfortable tightness in his lungs.