Aide Moreno remembers how Valley fever claimed her mother’s last year of life.
Carlos and Roselia Aguirre raised Moreno and three boys in Westway, a small unincorporated community in the northwestern part of El Paso County. Roselia was a cafeteria worker in the Canutillo Independent School District and had a habit of “adopting” schoolchildren – buying jackets for students who didn’t have any, keeping an extra eye on the ones who didn’t have mothers at home, Moreno said.
Then in the summer of 2015, Roselia started getting sick. She developed a cough that wouldn’t go away and headaches so severe she couldn’t work. Strokes would cause half her face to droop. But doctors couldn’t figure out the source of these symptoms, Moreno recalled.
About a year of hospital visits later – including with one doctor who said “it was all in her head” – Roselia finally got the answer she was looking for in 2016: Coccidioidomycosis, a fungal infection known as Valley fever.
Nobody in her family had heard of the disease.
Roselia started antifungal medication to treat the infection, but died less than a few months later Aug. 24, 2016, from a heart attack. Her death certificate attributed the cause to coccidioidomycosis. She was 52 years old.
Coccidioidomycosis affects humans and susceptible animals that inhale airborne fungal spores found in soil, stirred up by disturbances such as construction, agriculture and wind.
Intense dust storms and high winds engulfed El Paso this month, though scientists have not come to a consensus on the possible link between dust storms and Valley fever transmission.
Physicians and researchers who spoke to El Paso Matters did agree on one thing, however: Knowledge of the disease is the first and perhaps best defense against life-threatening complications of coccidioidomycosis.
El Paso has reported more than 320 cases of Valley fever since 2013, the first year the local public health department began surveilling the disease. That is likely an undercount as an estimated tens of thousands of Valley fever cases in the country go unreported, never diagnosed or misdiagnosed, according to the Centers for Disease Control and Prevention.
Since her mother’s death, Moreno said she tries to ask every doctor and nurse practitioner she meets if they have heard of Valley fever. Maybe two out of three she’s encountered don’t know what it is, she estimated.
“It’s just to spread awareness,” Moreno said. “Maybe somebody else doesn’t have to go through what my mom did, all the experimenting, wondering if it’s this or that. Maybe they can figure it out faster.”
Why Valley fever disease goes undetected
University Medical Center of El Paso treated 66 patients diagnosed with coccidioidomycosis in 2024, the most in a single year since 2016, according to data provided by the hospital. UMC has also seen 15 Valley fever patients in January through February of this year.
Valley fever is not a communicable disease, meaning it does not transmit from person to person, or animal to person. Symptoms typically show up one to three weeks after breathing in fungal spores, but not everyone who’s exposed becomes sick.
Evidence suggests the fungus that causes Valley fever lives in the soil of the U.S. Southwest, including a swath of West and South Texas. The “valley” in the name comes from the San Joaquin Valley in California, where the disease was first identified and studied.
The vast majority of coccidioidomycosis cases are reported in Arizona and California. Texas is one of the states that does not require reporting and the number of Valley fever incidents across Texas is unknown.
Though not required, El Paso is the only county in Texas that reports Valley fever cases, according to a study advocating for coccidioidomycosis to be a reportable disease nationwide. The El Paso Department of Public Health publishes new diagnoses of coccidioidomycosis in its monthly notifiable conditions report.
The fungus that causes Valley fever is endemic to El Paso and causes significant illness in the community, said Dr. Hector Ocaranza, El Paso city-county health authority. The health department added coccidioidomycosis to its notifiable conditions list in 2013 to improve disease surveillance and response efforts, he said.
Coccidioidomycosis-related hospital visits in Texas from 2016 to 2021 were highest among patients who are Hispanic, ages 46-64 and male, according to an analysis of discharges by the Texas Department of State Health Services.
Only a third of those hospital visits listed coccidioidomycosis as the main reason for hospitalization. In the other visits, patients were diagnosed with conditions related to coccidioidomycosis infection, including sepsis, pneumonia and respiratory failure.
Moreno said doctors prescribed her mother, Roselia, pain medication before she was diagnosed, but the headaches didn’t go away. A doctor at one El Paso hospital told Moreno there was nothing wrong with her mother and they should seek a psychiatric evaluation for Roselia.
“My mom doesn’t play around like this,” Moreno said. “I told them, ‘I don’t understand why you’re saying this. If you’re not going to believe her, there’s no reason to stay here.’”
Eventually Roselia was hospitalized at Las Palmas Medical Center in El Paso in 2016 after a stroke led to brain swelling. Roselia needed a shunt to drain excess brain fluid and was put in an induced coma to reduce swelling.
By chance, a weekend physician who saw Roselia for the first time asked Moreno and her father if Roselia had ever been tested for Valley fever, Moreno said. The family didn’t know what that was, but two weeks after testing Roselia’s brain fluid, doctors finally learned she had Coccidioidal meningitis.
More than half of people with Valley fever don’t show symptoms and most people who do have a cough and fever, like any other common respiratory illness, said Dr. Armando Meza, an infectious disease physician at Texas Tech Health El Paso. These milder cases could resolve on their own, he said.
But in 5-10% of cases, the infection can progress and cause more severe complications, from pneumonia to cavities in the lungs, according to the CDC. The infection can also turn into disseminated Valley fever, which means the disease has spread from the respiratory system to other body parts – the bones, skin, brain. Coccidioidal meningitis such as Roselia’s, a fatal form of the disease if left untreated, attacks the central nervous system.
Disseminated Valley fever requires longer antifungal treatment that can take years and for meningitis, treatment is lifelong, Meza said. The meningitis vaccine required for Texas college students treats bacterial infection, so it would not work on Coccidioidal meningitis, he said.
Meza said he tends to see patients who are already diagnosed and have more advanced cases of Valley fever. The infection usually doesn’t strike twice, but immunocompromised patients should also get additional checkups after they recover because they are at risk of recurrence, he added.
“Sometimes it’s not easy to make a diagnosis because doctors just think they have simple pneumonia and give antibiotics, but those patients will not get better, they will get worse,” he said.
Can dust storms spread Valley fever fungus?
Valley fever came to Moreno’s mind during El Paso’s recent dust storms, but scientists disagree on the link between dust events and infections.
There appears to be little relationship between wind events and spikes in Valley fever cases, at least in Arizona, said Dr. John Galgiani, an infectious disease physician at the University of Arizona and director of the Valley Fever Center for Excellence. Storms are only a small slice of soil disturbances. Human activities and breezes throughout the year have more or less potential to spread spores in the air, he said.
“That’s because the spores are only in certain parts of the dirt,” Galgiani said. “Most of the Sonoran Desert doesn’t have spores in it. There are colonies here and there, like wildflowers.”
Galgiani is working with the University of Arizona, Arizona State University and Northern Arizona University on a project to map out where cocci spores are located.
One 2021 study looking at recorded dust storms around Phoenix and the Bakersfield area of California found no consistent patterns of coccidioidomycosis cases following dust storms versus non-dust storm conditions.
But some experts question that study, among them: Thomas Gill, an environmental scientist at the University of Texas at El Paso; Karin Ardon-Dryer, a geoscientist at Texas Tech University; and Dr. Gabriel Ibarra-Mejia, a physician-researcher at UTEP.
While a dust storm has defined parameters, the storm events database used in the 2021 study relies on reports from a variety of sources, including untrained observers and social media posts.
“Going back and checking the data that was published in the paper, we realized the majority of the events that were reported were not dust storms,” Ardon-Dryer said. “Surprisingly, El Paso is not even reported in this data.”
El Paso experienced more than 450 dust events between 2000 and 2020, according to a study Ardon-Dryer co-authored examining regions in West Texas. Most dust events occurred in spring to early summer, with drought conditions correlating with more dust events.
A dust event refers to blowing dust with one to 10 kilometers of visibility, while a dust storm is a more severe event with less than one kilometer of visibility. Haboobs – towering walls of dust and debris – originate from thunderstorm winds.
Gill said that while there are many ways to become exposed to spores, the science community should be careful about dismissing windblown dust as a potential health risk for Valley fever.
“Coccidioides spores probably don’t care what the actual visibility is when they’re floating in the wind,” Gill said. “Some of them get in some events, some spores get in some dust and some don’t get in others. That’s kind of the big mystery I think a lot of us are trying to drill down to – exactly what sort of conditions of windblown dust might be most prone to distribute these Valley fever spores.”
Spores appear to thrive in semi-arid and arid soil, rather than more fertile soil with a lot of organic material, Gill said. Some of El Paso’s recent dust storms had a reddish color rather than the usual white-gray, suggesting the dust came from an area rich in iron, but he doesn’t know yet how the mineral makeup of soils affects Valley fever spread.
Researchers will try to answer at least one question in a study that’s currently in peer review. Ibarra-Mejia presented a poster of the study last year at the annual American Geophysical Union meeting, suggesting there is a higher incidence of Valley fever in El Paso following months of certain high temperatures, high PM 10 pollution or strong wind gusts.
The impact of human-driven climate change on soil conditions and dust trends could also encourage Valley fever to proliferate across Texas.
El Paso County has been in a continuous drought since August 2013, according to the U.S. Drought Monitor. Drought loosens soil, allowing the wind to kick up spores, Ibarra-Mejia said. Fungal spores do depend on rainfall and the right conditions to germinate, so a wet spell followed by hot, dry period and winds could disseminate those spores, he explained.
It’s unclear how long exactly coccidioides spores can survive, but they can remain dormant for a long time before germinating – and they might not germinate until they’re inside someone’s lungs, Ibarra-Mejia said.
Prioritizing Valley fever testing
One thing is certain: The El Paso community won’t know how prevalent Valley fever cases are if doctors don’t test for it.
Gill recalled attending a symposium in Las Cruces about the health impact of dust storms sometime in the last decade. He was shocked to learn many people from the El Paso medical community were not familiar with Valley fever.
“You have to wonder, for every case that’s diagnosed, how many cases go undiagnosed or misdiagnosed?” Gill said.
The problem is doctors who trained where Valley fever is rare might not know to test because it’s not part of their practice, Galgiani said. Even Phoenix and Tucson suffer from massive underreporting, despite people in Arizona having more awareness, he said. This not knowing can lead to anxiety in patients, in addition to unnecessary medical procedures and medications that don’t work.
“If you’re in an endemic region and you have pneumonia, you should test for Valley fever because that’s a possible cause,” Galgiani said. “Even if you get over it on your own, people can make more rational decisions to manage it.”
The Valley Fever Center for Excellence is working with Banner Health to ramp up testing, mostly in Maricopa County so far – an initiative El Paso County health leaders could try to follow. Banner Health’s urgent care clinics went from testing about 2% of pneumonia patients for coccidioidomycosis to testing 40% or more last year, Galgiani said. He found about 3% of those pneumonia patients had Valley fever.
If a patient’s X-ray shows a lung cavity, that should be an automatic trigger for Valley fever testing, Meza said.
Animals can catch Valley fever and test for infection, too, though some are more susceptible to disease than others. Sheep and cattle are fairly resistant to illness, while dogs show more obvious symptoms. Dogs likely inhale fungal spores when they’re outside digging in the dirt, rolling around and sniffing low to the ground, Ardon-Dryer said.
There is no cure for the infection, but a new Valley fever vaccine for dogs could become available to veterinary clinics as early as this year – and mark a potential step closer to a human vaccine.
To this day, Moreno feels upset about the months of uncertainty that plagued her family as her mother’s health declined.
Before she got sick, Roselia liked choreographing dances to Spanish-language Christian music for her grandchildren and organizing summer activities for the children at her church in Anthony, Iglesia Novia del Cordero. There were schoolchildren in Canutillo who even called Roselia mom, Moreno remembered.
Weakened by brain damage and unable to walk on her own after the coma, Roselia began attending physical therapy and taking antifungal medicine – first intravenously, then orally by pills.
“What damaged my mom more was we didn’t know what it was, so we didn’t know how to treat it,” Moreno said. “Mom felt like she was going crazy… Now I want everyone to know it doesn’t just happen to people living in California, Nevada, Arizona. It’s present here, too.”
The post Dust and disease: Valley fever’s quiet toll on El Paso appeared first on El Paso Matters.
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