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Valley fever hit epidemic proportions last year and experts are wondering if 2002 will be a repeat.

If the disease infects anywhere near the same number of Kern County residents as it did in the early 1990s, the cost could be staggering. During the epidemic years of 1991-93, valley fever costs mounted to more than $56 million. A similar outbreak now could mean even greater costs.

Researchers are making progress toward a vaccine, but the going has been slow. The Californian examines the impact of the disease and the efforts of those ìFighting the Fever.î

Shortcomings in drugs, tests mean frustration for patients

By MICHELLE TERWILLEGER Californian staff writer e-mail: mterwilleger@bakersfield.com

Saturday June 22, 2002, 12:00:00 AM

Dan Ocampo / The Californian Dr. Royce Johnson, chief of medicine at Kern Medical Center, holds a valley fever patient file at his office.

The fungal spores that cause valley fever have lived in dry, southwestern soils for millions of years, infecting both people and animals who tread in those regions.

But it was only about 50 years ago that scientists discovered the first effective treatment for the disease.

Decades later, doctors and patients still aren't satisfied with available drugs.

Some are toxic, causing horrible side effects, and others are only somewhat effective.

Even tests for the disease aren't always reliable.

Making matters more difficult, the pharmaceutical industry isn't interested in producing drugs for valley fever, which only affects people in certain regions.

So, doctors are forced to look for new and better medications that are actually created for other maladies -- such as yeast infections and athlete's foot -- which might also help fight the fungus that causes valley fever.

Some doctors are frustrated by the situation.

"They're not what we want," Dr. Royce Johnson said of the medicines at his disposal for treating valley fever patients. "They're not potent. They fail."

Fever in a haystack

Because valley fever and so many other diseases share the same symptoms -- fatigue, fever and respiratory problems -- many times patients and doctors don't think to test for valley fever.

Even when patients are admitted to the hospital with pneumonia, a classic sign of valley fever, hospital staff may not think of valley fever because pneumonia has plenty of other causes.

When doctors order a valley fever test, the results aren't always accurate. The tests look for an immune response to the disease, not always detectable in infected people.

"We need new tests here," said Dr. Neil Ampel, a professor of medicine at the University of Arizona. Ampel has been researching humans' immune responses to valley fever at the Southern Arizona VA Health Care System in Tucson.

There used to be two skin tests available that checked for valley fever by using a pinprick, similar to a tuberculosis test.

By viewing the skin a few days later, it was evident whether someone had ever had valley fever and developed an immunity to it.

The valley fever skin tests are no longer being produced by drug manufacturers due to business concerns and regulation issues with the U.S. Food and Drug Administration.

Scientists want to use the skin tests as a quick, inexpensive way to screen people and animals for vaccine trials, but must get FDA approval. They are retesting the skin tests in hopes of relicensing them.

Meanwhile, Ampel has been designing new valley fever tests that look to be much more accurate.

One he has developed is a blood test that detects the fungus rather than the body's response to it.

Buying treatment

Valley fever researchers are taking steps to make sure that nikkomycin Z is developed for valley fever.

Last year, Cal State Bakersfield officials created a separate, nonprofit legal entity -- the Cal State Bakersfield Foundation for Research -- to purchase the rights to nikkomycin Z. The drug was bought in an auction from a San Francisco-based pharmaceutical company that was selling off its assets.

In July 2001, the research foundation bought the rights to nikkomycin Z with a sealed bid of $100,001.

"It would augment what we're trying to do for those afflicted with valley fever," said Randal Bye, chief financial officer of the research foundation.

In addition to valley fever, nikkomycin Z could help people with other health problems such as yeast infections and bone marrow transplant infections. That makes the drug a possible big seller in the future, which could attract pharmaceutical companies.

Bye hopes to create an arrangement with valley fever researchers at the University of Arizona, who would develop the drug for the treatment of valley fever.

The final part of the plan would be to get a drug company involved that could manufacture and sell it for the treatment of valley fever and other health conditions.

Valley fever treatment options Existing drugs When valley fever patients are diagnosed, few treatment options are available. The following is a partial list. * Amphotericin B Called the gold standard in valley fever treatment, amphotericin B was the first effective valley fever drug created. It became available in the 1950s and remains the most effective. Doctors only use it, however, for severe cases because of its toxicity and side effects. Valley fever patients with severe pulmonary disease, meningitis or other serious manifestations usually end up on amphotericin B. Nicknamed "ampho-terrible," amphotericin B can cause headache, nausea, vomiting, fever, chills and fatigue. It works by attacking the cell walls of the fungus, which limits its ability to reproduce. * Ketoconazole This oral, anti-fungal drug became available in the early 1980s. It doesn't have amphotericin's rough side effects, but also isn't as effective. Marketed under the name Nizoral, the drug is used for humans, canines and other animals. There are several drugs similar to ketoconazole used for valley fever. * Fluconazole This drug was developed for other fungal maladies, such as yeast infections. Since it became available in the 1990s, it has become the most commonly prescribed medicine for valley fever. Taken orally and marketed under the name Diflucan, it can be expensive for both patients and pet owners, when prescribed for animals. Hope for new drugs The weakness of most of the current drugs, Dr. Royce Johnson said, is that instead of killing the fungus outright, they only inhibit its abilities. There is evidence, however, that amphotericin B can kill the fungus, he said. Physicians hope to have better drugs in the future, but many are being developed for other uses first. "There are no drugs that were developed for cocci (the valley fever-causing fungus)," Johnson said. "We always hang on to other diseases." More common fungal problems, like yeast infections, thrush and athlete's foot, receive the attention from pharmaceutical companies because there is more of a market for those drugs. Still, physicians hold out hope for these experimental anti-fungals. * Pauciconazole It appears to kill the valley fever fungus in study models. * Nikkomycin Z This experimental drug works by attacking chitin, a hard substance found in the cell walls of the fungus. Researchers believe that if it successfully damages the cell walls, it can inhibit the fungus' ability to reproduce and spread in the body. Because chitin is not naturally found in humans, doctors assume its side effects would be minimal.