FRESNO -- Thousands of California and Arizona adults and children annually contract valley fever and find themselves battling the disease for months or years -- missing work and school, spending weeks in the hospital -- with frequent recurrences.
If they had a bacterial infection, such as food poisoning, strep throat or a boil on the skin, their doctors could reach for multiple, cost-effective antibiotics that usually are able to kill the bacteria, even though resistance to antibiotics is on the rise.
If those same patients acquire an internal fungal infection, though, their doctors have far fewer options.
Current treatments can take so long to work that they allow the disease to spread, becoming more damaging and more deadly. Many of the treatments are extremely expensive, costing thousands of dollars a month.
While scientists are working to perfect new treatments, valley fever and other fungal infections have been so low on the national priority list that research doesn't receive much funding.
It's "a clear, unmet clinical need," said Dr. Joseph Heitman, chairman of Duke University's Department of Molecular Genetics and Microbiology.
Even when treatments do fight off valley fever, they can cause significant side effects. Pregnant women can't take the most common and least expensive treatment, the antifungal pill fluconazole, because of extreme fetal side effects. Other treatments can cause fatal heart or kidney damage.
"In some patients, the treatment is as harsh as the disease itself," said Dr. Arash Heidari, an assistant clinical professor at UCLA and an infectious disease specialist for Kern County and Kern Medical Center.
Valley fever is caused by a fungus that grows naturally in the dry, warm dirt of the Central Valley and Southwest. When the wind kicks up, everyone can inhale the spores. Most people don't get sick, but in some, especially those with compromised immune systems, the spores begin a potentially deadly voyage.
"It can go anywhere in the body," said Dr. Steven Larson, a Riverside infectious disease specialist and member of the California Medical Association's executive committee.
Traveling through the bloodstream, the fungus can attack everything from lungs to the brain. It can destroy joints -- causing people to lose strength and mobility -- and it can rupture onto the skin, causing painful and unsightly abscesses.
Research shows that immunization against the disease could work in theory, but funding for vaccine research has been scarce.
"Unfortunately, there's not much the public can do to prevent this," he said. "It's so ubiquitous; there's no way to eradicate it in nature."
That's why doctors have to rely on antifungal treatments. Most often, doctors turn to a class of drugs called azoles that can be taken as pills.
Developed out of research from England in the 1930s, azoles were designed to fight, but generally not kill, a range of fungal infections. Almost all of the drugs, including the most popular one, fluconazole, are available as generic prescriptions, which helps reduce their cost.
Fluconazole, for example, costs about $100 a month and, for many patients, is "a lifesaving medication," said Larson. But it can take several weeks or months for the medication to alter the course of the disease.
This gives the fungus more time to spread from the lungs and harm other parts of the body. It also means patients can be forced to stay home from work or to endure long hospital stays.
For the most severely ill, doctors use intravenous drugs called amphotericins.