Up Close: UCSF Fresno Infectious Diseases Specialist Helps Promote Awareness of Valley Fever

Fresno County Board of Supervisors top row (L to R) Steve Brandau, Brian Pacheco, Chairman Sal Quintero, Nathan Magsig, Buddy Mendes. Bottom row (L to R) Joe Prado, Fresno County Department of Public Health, Geetha Sivasubramanian, MD, UCSF Fresno; Rob Pu

The Fresno County Board of Supervisors has proclaimed August as Valley Fever Awareness Month thanks to the urging and health information provided by Geetha Sivasubramanian, MD FIDSA, Chief of Infectious Diseases at UCSF Fresno.

Coccidioidomycosis or Valley fever is an infection caused by breathing a fungus in soil and it is endemic in the San Joaquin Valley. In 2022, there were 3,647 reported cases of Valley fever in the nine-county region between Stockton and Bakersfield – or nearly half of the 7,546 cases reported in all of California last year.

“From a physician standpoint there needs to be awareness about Valley fever, even though it is endemic,” Dr. Sivasubramanian said. “I know the Fresno County Department of Public Health is very involved and active in improving awareness, but as physicians at UCSF Fresno who deal with Valley fever, we want to be right there in the front lines educating our patients.”

In bringing the Valley Fever Awareness proclamation before the Fresno County Board of Supervisors, Nathan Magsig, supervisor for District 5, said Valley fever is an infection that “a lot of people across the United States have never even heard of “because it is kind of is an illness that is unique to the Central Valley and parts of California. So, there are many people who get affected by this. Early treatments can be lifesaving.”

Dr. Sivasubramanian also expressed gratitude to Assembly member Vince Fong, R-Bakersfield, and Sen. Shannon Grove, R-Bakersfield, for sponsoring a state resolution to recognize August as Valley Fever Awareness Month in California and to the Fresno County Department of Public Health for their awareness efforts, including requesting the Fresno County proclamation. And Rob Purdie from the Valley Fever Insitute in Bakersfield also offered his support of awareness efforts in Fresno County, she said. 

Valley fever is under-diagnosed due to the similarity in symptoms to other infections, including influenza and COVID-19, Dr. Sivasubramanian said. The California Department of Public Health Officer Tomás Aragón recently warned of an expected increase in Valley fever cases this year due to the record rainfall, she said. And Dr. Aragón advised individuals with lingering cough and fatigue to talk to a health care provider about Valley fever, she said. UCSF Fresno, Community Medical Centers and partners at the Valley Fever Institute in Bakersfield and UC Davis recommend anyone who has experienced respiratory, or flu-like symptoms for more than 10 days to ask their health care provider about testing for Valley Fever. Additionally, it is recommended that if symptoms continue that those with a negative test be retested three weeks after the initial test, she said.

While 60% of patients who have Valley fever will have a mild respiratory infection, in about 40% of people infected, the disease progresses into chronic pneumonia that is severe enough to require hospitalization. And in a small percentage – about 1%-3% of people, the disease spreads to other organs, such as the skin, bones, brain and spinal fluid, Dr. Sivasubramanian said. People more likely to develop severe infection or complicated Valley fever include adults 60 years or older, pregnant women, people with diabetes, cancer, or other conditions that weaken the immune system and people who are Black or Filipino.

Each year, over 1,000 people are hospitalized in California, and over 80 deaths are attributed to Valley fever, according to the California Department of Public Health.

“A lot of patients are not aware of the risk and are not protecting themselves from Valley fever,” Dr. Sivasubramanian said. “Or they are aware of the disease but are not aware of how much illness this can cause. Valley fever has the potential to cause severe lung damage as well as serious illnesses such as brain infection. We are seeing a lot of patients with severe and complicated Valley Fever infections here at UCSF Fresno/Community Medical Centers.”

Primary care physicians, as well as Emergency Medicine and physicians in urgent care centers in the San Joaquin Valley should test for Valley fever if they suspect a patient has bacterial pneumonia, she said. “Valley fever gets misdiagnosed as a community acquired pneumonia or bacterial pneumonia, and patients get prescribed antibiotics rather than anti-fungal medications.”

Starting treatment for Valley fever soon after diagnosis is important to prevent lung damage and the risk of the infection spreading outside of the lungs to other organs, Dr. Sivasubramanian said. It also is important for patients with Valley fever to know they need to continue taking medications (sometimes lifelong) until advised by their physicians that it is safe to stop. “If they stop taking the medications prematurely, the infection can come back,” she said.

Dr. Sivasubramanian said she is happy to partner with other Valley fever experts from California and Arizona and with the Valley Fever Institute in Bakersfield to build on their expertise in treatment, education and awareness.

Research to improve the health and wellbeing in Central California is integral to UCSF Fresno’s mission and Valley fever is among the diseases being studied by Dr. Sivasubramanian and other faculty at UCSF Fresno. In addition to raising awareness about Valley fever, she emphasizes the need for more clinical trials that include patients in the San Joaquin Valley.

“With our patient population, one of the key issues is adherence to medications, adherence to care, so that is where we want to improve research funding for our patients here. And a project that I am going to be doing this year is focusing on barriers to care in patients with Valley fever,” she said. “We will talk to patients and get information from them on what their problems are, how much they understand about Valley fever and what are the barriers to care that they are experiencing.”