Brynn Carrigan\u2019s headaches started in April 2024. Within a couple of weeks, she was debilitated.<\/p>\n\n\n\n
Her vomiting exacerbated the excruciating pain in her skull. She spent nearly every hour in bed with the covers pulled over her head, blocking out any sliver of light. Even the clock on her microwave was too much. <\/p>\n\n\n\n
\u201cI went from training for a marathon, raising two teenagers and having a job to essentially being bedridden,\u201d said Carrigan, 41, of Bakersfield, California, who works for Kern County Public Health.<\/p>\n\n\n\n
Her condition continued to get worse and doctors couldn\u2019t provide answers \u2014 until her third visit to the hospital, when one doctor asked her if she\u2019d had any respiratory symptoms before the headaches started.<\/p>\n\n\n\n
She had. About a month before the headaches started, Carrigan had what she thought was a typical cold \u2014 though she recalled that her cough lingered a bit longer than normal and she went on to develop a rash on her thighs. Both symptoms got better without treatment. <\/p>\n\n\n\n
These turned out to be key pieces of information. A biopsy of her spinal fluid revealed that Carrigan had coccidioidal meningitis, a rare complication of a fungal infection called Valley fever.<\/p>\n\n\n\n
\u201cI knew something was wrong but never in a million years did I think it would be something so serious,\u201d Carrigan said. <\/p>\n\n\n\n
Valley fever, or coccidioidomycosis, is caused by inhaling coccidioides spores, a type of fungi endemic to the hot, dry climate of the southwestern United States. Climate change is creating drier soils that are inching farther east, expanding the range<\/a> of the fungi. Valley fever is increasingly being diagnosed outside its usual territory and cases have been rising across the Western U.S. While Arizona still sees the highest number each year, California is closing the gap<\/a>. <\/p>\n\n\n\n From 2000 through 2016, California had 1,500 to 5,500 cases a year. From 2017 through 2023, those numbers jumped<\/a> to 7,700 to 9,000 annual cases. Preliminary data<\/a> for 2024 puts the count at more than 12,600 \u2014 the highest the state has ever seen and about 3,000 more cases than the previous record, in 2023. <\/p>\n\n\n\n Early data shows California is on track for another record-breaking year. Already, the state has logged<\/a> more than 3,000 confirmed cases of Valley fever statewide, more than there were at the same time last year and nearly double what cases were at this time in 2023.<\/p>\n\n\n\n \u201cThere is no question that the number of cases of coccidioidomycosis is enormously higher than before,\u201d said Dr. Royce Johnson, chief of the division of infectious disease and director of the Valley Fever Institute at Kern Medical in California. \u201cIf you want to see me, right now you\u2019d have to wait until July, and that goes for my colleagues, too.\u201d<\/p>\n\n\n\n Drought cycles driving spread<\/strong><\/strong><\/p>\n\n\n\n Carrigan lives in Kern County, a dry, sprawling region that sits between two mountain ranges at the southern end of California\u2019s Central Valley.<\/p>\n\n\n\n The county has already recorded at least 900 Valley fever cases<\/a> so far this year and has been ground zero for the fungal infection in the state for the last three years. <\/p>\n\n\n\n But the consistently high cases in places like Kern County are not driving the upward trend in California, said Gail Sondermeyer Cooksey, an epidemiologist at the California Department of Public Health.<\/p>\n\n\n\n Instead, new hot spots are emerging along the edges of the Central Valley \u2014 in Monterey and San Luis Obispo counties, along California\u2019s central coast. Cases in Contra Costa County, just east of Berkeley, have tripled<\/a> so far this year compared with the same time in 2023.<\/p>\n\n\n\n \u201cIt appears to be spreading out,\u201d Sondermeyer Cooksey said.<\/p>\n\n\n\n Many factors likely influence how well coccidioides spores multiply and spread, \u201cbut one thing we have identified as a big driver of those peaks and dips is drought,\u201d she said. <\/p>\n\n\n\n A 2022 study<\/a> in The Lancet Planetary Health found that drought years suppress Valley fever cases, but multiple years of drought followed by a wet winter causes cases to rebound sharply. This shift in weather patterns, which is driven by climate change, appears to largely influence where new Valley fever hot spots emerge. Longer, drier summers can also shift transmission season<\/a>, when the spores spread, from late summer and early winter to earlier in the year. <\/p>\n\n\n\n \u201cWe\u2019re seeing wetter wets and drier dries across the Southwest, but California is seeing that to a higher degree,\u201d said Jennifer Head, an assistant professor of epidemiology at the University of Michigan, who studies Valley fever and climate change.<\/p>\n\n\n\n In Arizona, new hot spots are popping up in places in the state that have a climate more similar to California\u2019s than elsewhere in Arizona. <\/p>\n\n\n\n \u201cThe highest increases in Arizona are in the northern plateau regions, which, similar to California, have historically been colder and wetter,\u201d Head said.<\/p>\n\n\n\n Closely tracking Los Angeles<\/strong><\/strong><\/p>\n\n\n\n The climate patterns expanding Valley fever\u2019s range in California are the same ones that drive increasingly intense wildfires<\/a>. Scientists are still trying to understand how fires may worsen Valley fever risk, but some research has shown a link<\/a> between wildfire smoke and higher rates of diagnoses. <\/p>\n\n\n\n Sondermeyer Cooksey said the state health department warned first responders to January\u2019s devastating fires in Los Angeles County of the potentially increased risk of Valley fever in the area because of the fires. There have been past outbreaks<\/a> among wildland firefighters.<\/p>\n\n\n\n There\u2019s some limited evidence that wildfires may spread the coccidioides spores. In a 2023 study<\/a>, researchers looked at 19 fires across California and observed higher rates of Valley fever following three of those fires. These fires tended to be larger, located near population centers and burned areas that had high Valley fever transmission prior to the fire. <\/p>\n\n\n\n \u201cIt\u2019s not entirely clear whether there is a link between wildfires and Valley fever, but what is important to know is that coccidioides live in the dirt and anything that disturbs the dirt can exacerbate Valley fever,\u201d Sondermeyer Cooksey said. \u201cFires do that, then we have all of the reconstruction projects that also disturb soil.\u201d<\/p>\n\n\n\n Peak Valley fever season hasn\u2019t happened yet this year. Because reconstruction efforts are disturbing soil in the burn scar, Sondermeyer Cooksey said state and local public health departments \u201care closely tracking the numbers\u201d in areas hit by January\u2019s fires. <\/p>\n\n\n\n Cases after Lightning in a Bottle festival<\/strong><\/strong><\/p>\n\n\n\n Diagnosing Valley fever is tricky, mostly because its symptoms overlap with other respiratory illnesses including flu, Covid and pneumonia. If someone experiences those symptoms, it\u2019s important for them to let their doctor know if they\u2019ve been around disturbed soil or dust \u2014 in a construction zone, camping, hiking, working outside or at a festival \u2014 or in an area known to have Valley fever, Sondermeyer Cooksey said. <\/p>\n\n\n\n Symptoms typically show up one to three weeks after exposure, but it can take as long as eight weeks, so people may not make an immediate connection, Head, of the University of Michigan, said. <\/p>\n\n\n\n Last year, at least 19 people<\/a> who attended the Lightning in a Bottle music festival \u2014 which is being held in Kern County again this month \u2014 were diagnosed with Valley fever later in the summer. At least eight were hospitalized. <\/p>\n\n\n\n \u201cLightning in a Bottle is right in the middle of the endemic region, that\u2019s one of the hot spots for the disease,\u201d said Dr. George Thompson, director of the Center for Valley Fever<\/a> at the University of California, Davis, adding that the vast majority of people who attend will not get an infection, but people who aren\u2019t from an endemic area may be at higher risk.<\/p>\n\n\n\n Thompson said it\u2019s clear that he and his colleagues across the state are treating more patients for the infection. Only about 1% of cases<\/a> result in life-threatening meningitis or other complications, as Carrigan\u2019s did, but once a person is infected, they never clear the fungus from their body. <\/p>\n\n\n\n \u201cThere is no drug that kills cocci, so what keeps you from being ill is your immune response,\u201d Johnson, of Kern Medical, said. To treat the infection, people are given antifungals \u201clong enough for a person\u2019s immune system to figure out how to control it. If you then do something to disrupt that immunity, it can start growing again, and that can surface years later,\u201d he said. <\/p>\n\n\n\n Carrigan spent the last year on an intense regimen of anti-fungal treatments. During the first few months, she lost most of her hair and eyelashes and barely recognized herself in the mirror.<\/p>\n\n\n\n She\u2019s now made a full recovery and even ran a marathon this spring, but she still takes anti-fungal medication. Carrigan said she wants more people to understand both the warning signs of Valley fever<\/a> and the importance of telling their doctor if they\u2019ve been somewhere with cases, which could help people get a faster diagnosis. <\/p>\n\n\n\n \u201cEven if it\u2019s only 1% of cases, as we see cases increase, the number of people who experience complications is going to rise, too,\u201d she said.<\/p>\n\n\n\n