When Nora Bruhn bought admission to the Lightning in a Bottle arts and music festival on the shores of Kern County’s Buena Vista Lake earlier this spring, her ticket never mentioned she might end up with a fungus growing in her lungs.

After weeks of night sweats, “heaviness and a heat” in her left lung, a cough that wouldn’t quit and a painful rash on her legs, her physician brother said she might have valley fever, a potentially deadly disease caused by a dust-loving fungus that lives in the soils of the San Joaquin Valley.

Bruhn said she hadn’t been warned beforehand that Kern County and Buena Vista Lake are endemic for coccidioides — the fungus that causes the disease.

“If there had been a warning that there’s a potentially lethal fungal entity in the soil, there’s no way I would have gone,” said the San Francisco-based artist. “Honestly, I would have just been paranoid to breathe the whole entire time I was there.”

The incidence and range of valley fever has grown dramatically over the last two decades, and some experts warn that the fungus is growing increasingly resistant to drugs — a phenomenon they say is due to the spraying of antifungal agents on area crops.

As annual cases continue to rise, local health officers have sought to increase awareness of the disease and its symptoms, which are often misdiagnosed. This messaging however focuses only on Kern County and other Central Valley locations and rarely reaches those who live outside Kern County, or other high-risk areas.

In the case of the Lightning in a Bottle festival, Bruhn said she wasn’t provided with any information about the risk on her ticket, or in materials provided to her by the event organizers. As far as she can recall, there were no signs or warnings at the site where she ate, slept, danced and inhaled dust for six straight days.

And she wasn’t the only one infected. According to state health officials, 19 others were diagnosed with coccidioidomycosis in the weeks and months following the event. Five were hospitalized.

According to a statement provided by the California Department of Public Health, officials have been in communication with organizers and “encouraged” them to notify “attendees about valley fever and providing attendees with recommendations to follow up with healthcare providers if they develop illness.”

Do LaB, the company that stages the festival, said through a spokesperson that it adheres to the health and safety guidance provided by federal, state and local authorities. “Health and safety is always the primary concern,” they said.

The company’s website warns festivalgoers about the prevalence of dust — but doesn’t mention the fungus or the disease.

“Some campgrounds and stage areas will be on dusty terrain,” the website says. “We strongly recommend that everyone bring a scarf, bandana, or dust mask in case the wind kicks up! We also recommend goggles and sunglasses.”

Bruhn said that’s not enough.

“I think it’s really irresponsible to have a festival in a place where breathing is possibly a life-threatening act,” she said.

Kern County’s health department is also in discussions with the production company.

In California, the number of valley fever cases has risen more than 600% since 2000. In 2001, fewer than 1,500 Californians were diagnosed. Last year, that number was more than 9,000.

Most people who are infected will not experience symptoms, and their bodies will fight off the infection naturally. Those who do suffer symptoms however are often hard-pressed to recognize them, as they resemble the onset of COVID or the flu. This further complicates efforts to address the disease.

Take for example the case of Brynn Carrigan, Kern County’s director of public health.

In April, Carrigan began getting a lot of headaches. Not really a “headache person,” she chalked them up to stress: Managing a high-profile public health job while also parenting two teenagers. But as the days and weeks went by, the headaches became more frequent, longer in duration and increasingly painful. She also developed an agonizing sensitivity to light.

“I’ve never experienced sensitivity to light like that … all the curtains in my house had to be closed. I was wearing sunglasses inside — because even the clock on my microwave and my oven, and the cable box … oh, my God, it caused excruciating pain,” she said. In order to leave the house, she had to put a blanket over her head because the pain caused by sunlight was unbearable.

She also developed nausea and began vomiting, which led to significant weight loss. Soon she became so exhausted she couldn’t shower without needing to lie down and sleep afterward.

Her doctors ordered blood work and a CT scan. They told her to get a massage, suggesting her symptoms were the result of tension. Another surmised her symptoms were the result of dehydration.

Eventually, it got so bad she was hospitalized.

When test results came in, her doctors told Carrigan she had a case of disseminated valley fever, a rare but very serious form of the disease that affects the brain and spine rather than the lungs. In retrospect, she said she probably had the disease for months.

Valley fever, a fungal infection, spreads through dust.

(Jason Armond/Los Angeles Times)

And yet, here she was, arguably the most high-profile public health official in a county recognized as a hot spot for the fungus and the disease, misdiagnosed by herself and other health professionals repeatedly before someone finally decided to test her for the fungus.

Now she’ll have to take expensive antifungal medications for the rest of her life — medication that has resulted in her losing her hair, including her eyelashes, as well as making her skin and mouth constantly dry.

As a result of Carrigan’s experience, her agency is running public service announcements on TV, radio and in movie theaters. She does news conferences, talks to reporters and runs presentations for outdoor workforces — solar farms, agriculture and construction — to educate those “individuals that have no choice but to be outside and really disturbing the soil.” She’s also hoping to get in schools.

But she realizes her influence is geographically constrained. She can really only speak to the people who live there.

For people who come to Kern County for a visit — like Bruhn and the 20,000 other concertgoers who attended Lightning in a Bottle this year — once they leave, they’re on their own.

A truck raises dust on a dirt road in Bakersfield in March 2022.

(Jason Armond/Los Angeles Times)

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Outside of California, valley fever is also prevalent in Arizona and some areas of Nevada, New Mexico, Utah and Texas, as well as parts of Mexico and Central and South America

Experts worry that as the range of valley fever spreads — whether by a changing climate, shifting demographics, or increased construction in areas once left to coyotes, desert rodents and cacti — more and more severe cases will appear.

They’re also concerned that the fungus is building resistance to the medicines used to fight it.

Antje Lauer, a professor of microbiology at Cal State Bakersfield and a “cocci” fungus expert, said she and her students have found growing pharmaceutical resistance in the fungus, the result of the use of agricultural fungicides on crops.

She said the drug fluconazole — the fungicide doctors prescribe off-label to treat the disease — is nearly identical in molecular structure to the antifungal agents “being sprayed against plant pathogens. … So when a pathogen gets exposed via those pesticides, the valley fever fungus is also in those soils. It gets exposed and is building an immunity.”

It’s the kind of thing that really concerns G.R. Thompson, a professor of medicine at UC Davis and an expert in the treatment of valley fever and other fungal diseases.

“If you ask me, what keeps you up at night about valley fever or fungal infections?, it’s what we do to the environment” he said. “We learned that giving chickens and livestock antibiotics was bad, because even though they grew faster, it led to antibiotic resistance. Right now, we’re kind of having our own reckoning with fungal infections in the environment. We’re putting down antifungals on our crops, and now our fungi are become resistant before our patients have ever even been treated.”

He said he and other health and environment professionals are working with various local, state and federal agencies “to make sure that everybody’s talking to each other. You know that what we’re putting down on our crops is not going to cause problems in our hospitals.”

Because at the same time, he said, there’s a growing concern that the fungus has become more severe in terms of clinical outcomes.

“We’re seeing more patients in the hospital this year than ever before, which has us wondering … has the fungus changed?” he said, quickly adding that health experts are actively investigating this question and don’t have an answer.

John Galgiani, who runs the Valley Fever Center for Excellence out of the University of Arizona in Tucson, is hopeful that a vaccine may be forthcoming.

He said a Long Beach-based medical startup called Anivive got a contract to take a vaccine that’s being developed for dogs — outdoor-loving creatures with noses to the ground and a penchant for digging, and therefore susceptible to the disease — and reformulate it to make it suitable for human clinical trials.

He said prison populations, construction workers, farmworkers, firefighters, archaeologists — anyone who digs in the soil, breaths it in or spends time outdoors in these areas — would be suitable populations for such inoculations.

But he, like everyone else The Times spoke with, believes education and outreach are the most important tools in the fight against the disease.

As there is with any other risky activity, he said, if people are aware, such knowledge empowers them with choice — and in this case, the tools they need to help themselves should they fall ill.

A recent UC Davis study found that as Central Valley residents go about their day, they regularly breathe in pesticides, including one that has been banned in California and another whose effects on people is unclear.

The study, which was conducted in 2022 with the help of Central Valley residents, found that seven of 31 adults and one out of 11 children were exposed to detectable amounts of pesticides, including chlorpyrifos, which was banned by the state in 2020 after research showed it had a harmful neurodevelopmental effect on children.

The researchers recruited volunteers to wear backpacks with air-collection tubes for at least eight hours a day. They found that the residents were exposed to five other pesticides including 1,3-dichloropropene, also known as 1,3-D, a pesticide used to eradicate parasitic worms that has been banned in more than 20 countries, and penthiopyrad, a fungicide used to prevent mold and mildew that has not yet been studied for its effect on mammals, so the human impact is unknown.

It concluded that pesticide monitoring should be expanded because residents’ personal exposure included compounds not regularly measured in routine monitoring and that the pesticides should undergo additional toxicity testing.

“It really highlights the need that we research the health impact of all these different pesticides that are being used because people are being exposed to a range of pesticides,” said Deborah Bennett, a scientist, UC Davis professor and lead author of the study, which was published Sept. 10 in the Journal of Exposure Science and Environmental Epidemiology.

Bennett said she was surprised to find detectable amounts of chlorpyrifos because farmers were supposed to have stopped applying the pesticide. It was commonly used on alfalfa, almonds, citrus, cotton, grapes and walnuts. Before it was banned, more than 900,000 pounds of chlorpyrifos were used in 2017 — more than in any other state. The primary manufacturer of the pesticide announced in 2020 that it would stop producing it due to reduced demand.

It could be that a farmer was using the last of their reserves, or the individuals who tested for chlorpyrifos might have been exposed at home with products that use the pesticide, Bennett said, but researchers were ultimately unable to determine the cause.

Leia Bailey, deputy director of communications and outreach for the state Department of Pesticide Regulation, said the agency did not have enough information to investigate the findings independently, but the department continues to enforce the ban on chlorpyrifos and maintains four air monitoring stations in areas where pesticides are used.

She added that a preliminary review of the pesticide levels cited in the study found that they were “significantly below health screening levels.” Still, Bailey said, studies like this one complement the department’s work to inform their regulatory efforts.

“Community-focused studies like this are key inputs to inform our continuous evaluation of pesticides,” Bailey said.

She added that the department requires mammalian toxicology data for all pesticide evaluations, including penthiopyrad.

Jane Sellen, co-director of the Californians for Pesticide Reform and co-author of the study, said she wasn’t surprised by the “toxic soup” of pesticides that they found through the study.

“There’s not nearly enough pesticide monitoring happening in the state,” Sellen said.

They recruited volunteers for the study in farmworking communities, and found that people were eager to participate because they wanted to know what they were being exposed to, she said. The volunteers were told to go about their regular day and wear the backpacks wherever they went, including to the grocery store, work and school. She said exposure to or illness from pesticides does not get reported as frequently as it occurs because people are afraid of being retaliated against or deported, as many farmworkers are in the U.S. without authorization.

When the researchers were recruiting volunteers, the Tulare County Agricultural Commissioner Tom Tucker issued an advisory warning farmers to be “on the lookout for people trespassing onto orchards and farms” during or immediately after pesticide applications. The advisory asked residents to call Tucker’s office or the county sheriff.

“We are concerned these individuals may attempt to enter a field or orchard during a pesticide application or immediately thereafter to utilize their air monitoring equipment in an attempt to detect pesticide spraying,” the advisory stated.

The advisory, issued June 22, 2021, cited fliers that sought volunteers to wear backpacks. But those behind the study never asked participants to trespass or go near where pesticides were being applied, Sellen said.

The state Environmental Protection Agency and Tucker later issued a joint statement clarifying the advisory and described the study as a project supported by the Air Resources Board and consistent with the Legislature’s intent to support community-led air monitoring.

“The last thing we would ever do is send anyone into harm’s way,” she said. “It was really disheartening and disappointing that [the agricultural community] was threatened by the idea of monitoring air quality in these communities.”

The communities, which were not named in the study, were in Kern, Fresno and Tulare counties, which have the highest pesticide applications in the state.

A San Fernando Valley resident is the first person in L.A. County to die this year from West Nile virus, a mosquito-transmitted illness that can cause lethal inflammation in the brain.

The L.A. County Department of Public Health reported on Thursday that the patient died from neurological illness caused by severe West Nile. So far in 2024, there have been 14 confirmed cases of the virus in the county and 63 in the state, according to state and county public health departments.

“To the family and friends grieving the loss of a loved one due to West Nile virus, we extend our heartfelt condolences,” said Muntu Davis, L.A. County health officer. “This tragic loss highlights the serious health risks posed by mosquito-borne diseases, such as West Nile virus, dengue, and others.”

West Nile virus is the most common mosquito-borne disease that harms residents in L.A. County. The disease lives in infected birds and is transmitted to humans via mosquito bites.

Davis recommended Angelenos take simple steps to protect themselves from mosquito bites. This includes using insect repellent, getting rid of items that hold standing water around the home — such as flowerpots and bird baths — and using screens on doors and windows to keep mosquitoes out.

Most people who are infected will not experience any symptoms, but 1 in 5 will suffer a fever with symptoms including:

• headache
• body ache
• joint pain
• vomiting
• diarrhea
• rash

About 1 in 150 people will experience more severe symptoms such as high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness and paralysis, according to the World Health Organization. The Department of Public Health recommends anyone with severe symptoms call their doctor immediately.

In serious cases, the virus can cause inflammation of the brain or spinal cord, leading to permanent neurological damage or death. People older than 50 and those with health problems are at greater risk of complications, according to the Public Health Department.

The disease was first found in Africa before being discovered in the U.S. in 1999 and California in 2003. Since then the state has reported more than 300 deaths and 7,500 cases.

This year, there have also been deaths reported in Santa Clara County, Contra Costa County and Fresno County. Orange County reported its first case of West Nile in August, but so far there have been no deaths.