Here in California's San Joaquin Valley, the disease known as valley fever can strike anyone at almost anyone at almost anytime. Just ask Dr. James McCarthy.
"It's pretty difficult to prevent something that you can acquire just by breathing in the air," says McCarthy.
Just breathing in the air. Air that contains the spores of a soil fungus found throughout much of the Southwest, but especially in the southern portions of the San Joaquin Valley.
Dr. McCarthy is a pediatric infectious disease specialist at Children's Hospital Central California, in Madera. He is on the front lines of battling the disease that sickens as many as 150,000 in the U.S. every year, and is responsible for as many as 100 deaths annually across the country. That's more deaths than salmonella, hantavirus and whooping cough combined.
Since reported 1995 cases of the disease have risen 12-fold, leading some to call it an epidemic. And according to Dr. McCarthy, many cases of the disease go overlooked or misdiagnosed.
"A delay in diagnosis can sometimes mean the difference between a moderate illness and a severe illness. So it's important that doctors or clinicians in the San Joaquin Valley, and particularly the south valley, when they have patients with pneumonia that they always think about valley fever, and when they have patients that have prolonged and unexplained illnesses that they also think about valley fever," says McCarthy.
If people inhale the spores of the fungus, they can grow inside the lungs, resulting in a fever, persistent cough and night sweats.
"Many of those patients, if not most will get better on their own. And then a small percentage about five percent of people who get valley fever will get pneumonia, and this can range anywhere for mild to moderate to severe," says Dr. McCarthy.
But if left unchecked, the consequences of the disease can be much worse. "About 1 out of 100 people if they get valley fever it will spread outside of the lungs, and go to other parts of the body, and when it does that it usually goes to the brain, the bones or the skin."
African Americans and Filipino Americans are two groups that are most at-risk, as well as those with weakened immune systems, and women in the third trimester of pregnancy. And while medication can help treat the disease, there is no cure, and research into a possible vaccine has stalled due to a lack of funding.
As part of the Reporting on Health Collaborative, reporter Rebecca Plevin talked with several south valley residents who have had their lives touched by the disease.
Monika Blake's son, Tyler Bridgewater, died from the disease after it spread to his brain.
"He was little mister athlete, played football, never sick. He never went to the doctor unless it was for sports physicals. And then he was slammed by this. He was 12. He passed away a little over a month before he would have been 13."
She says that it took doctors too long to point to valley fever as the cause of his illness, even after he was discharged from the hospital in Bakersfield.
"They diagnosed him with meningitis, and then when he was rushed back, with encephalitis, but never once did they test for valley fever. It wasn't until he was airlifted to Children's Hospital did the diagnosis of valley fever become clear."
Rob Purdie of Bakersfield spent five weeks in the hospital trying to beat his case of valley fever.
"[I was] born in Bakersfield, and everybody's familiar with valley fever, but I wasn't familiar with it being something that occurred in the lungs, I certainly wasn't familiar with it being a form of meningitis, and [I was] surprised to learn that I was going to have to deal with it for the rest of my life."
Paula Einstein is the daughter of one of the doctors who helped lead research into valley fever for years in Kern County, and she too contracted the disease.
"People always say once you get it you're immune. You're not really immune, it's in your system kind of like chicken pox can turn to shingles sometimes. That's sort of a rough analogy, but it's with you. And if your immune system gets compromised, some people get something else, and then they find out they had it and they never even knew."
It's a disease that has touched many here in central California, and will continue to do so. But with greater attention and awareness, the hope for better treatment and perhaps even a cure remains.
Gabriela Ornellas, Rebecca Plevin, and Louis Amestoy contributed to this report.