WEBVTT - Ep 68 Coccidioidomycosis: It’s never a spider bite 0:00:01.480 --> 0:00:04.960 So my name is Tory and I'm from Utah. I 0:00:05.040 --> 0:00:08.480 had always been a healthy girl, with no serious ailments 0:00:08.560 --> 0:00:13.000 or illnesses. I spent most of my high school cycling, swimming, running. 0:00:13.320 --> 0:00:16.000 Exercise was my whole life, and I was always very healthy. 0:00:16.400 --> 0:00:19.400 At age nineteen, I created a plan to serve a 0:00:19.440 --> 0:00:22.239 religious mission and then come home and spend the rest 0:00:22.280 --> 0:00:24.639 of my life doing iron mans and one day making 0:00:24.680 --> 0:00:28.520 it to the Cone Ironman Championship. However, those plans would 0:00:28.600 --> 0:00:32.159 quickly change. In March of twenty fourteen, I left on 0:00:32.200 --> 0:00:35.879 a religious mission to Arizona for eighteen months, doing service 0:00:36.040 --> 0:00:39.199 outdoors and teaching. I ran nearly every day of this 0:00:39.280 --> 0:00:41.440 mission ended quite a lot of bike riding as well. 0:00:42.240 --> 0:00:45.320 Initially going out to Arizona, we were warned about valley fever. 0:00:46.080 --> 0:00:47.839 We were told always to stay inside if there was 0:00:47.880 --> 0:00:50.720 a dust storm or if it's extra dusty outside, because 0:00:50.800 --> 0:00:53.280 valley fever was in the spores of the spoiler of 0:00:53.280 --> 0:00:56.320 the dust. While we tried to stay inside from the 0:00:56.400 --> 0:00:59.520 dust storms, being outside was inevitable, and being around the 0:00:59.560 --> 0:01:02.920 dust was inevitable. Hello, it's Arizona, and we spent so 0:01:03.000 --> 0:01:06.399 much time outside. Fast forward, it was August twenty ninth, 0:01:06.440 --> 0:01:10.920 twenty fifteen. I was seventeen days away from going home 0:01:11.000 --> 0:01:14.720 and seeing my family again, and finishing this service, and 0:01:14.720 --> 0:01:17.360 that day my life would change forever. I woke up 0:01:17.400 --> 0:01:19.640 with a bit of chest tightness, but shrugged it off. 0:01:20.200 --> 0:01:22.440 I still went on our morning run, but could barely 0:01:22.520 --> 0:01:24.440 make it more than a quarter of a mile. When 0:01:24.440 --> 0:01:27.479 the chest pain became so intense, I ended up going 0:01:27.520 --> 0:01:29.600 to an urgent care and sitting in the waiting room 0:01:29.640 --> 0:01:33.119 for three hours, gasping for breath because their computer was down. 0:01:33.920 --> 0:01:36.559 I was in so much pain I could barely breathe. 0:01:37.080 --> 0:01:39.200 When the computers finally came up. I was able to 0:01:39.200 --> 0:01:42.120 get an X ray by the urgent care doctor. After 0:01:42.160 --> 0:01:45.360 analyzing the x ray, nothing of concerns showed up, so 0:01:45.480 --> 0:01:49.200 the doctor presumed that the only explanation was something similar 0:01:49.280 --> 0:01:52.120 to shingles because I didn't have a fever, I didn't 0:01:52.120 --> 0:01:54.840 have a cough, I didn't have a rash or anything else. 0:01:55.560 --> 0:01:58.120 I was given steroids, shots, and paid medications, and then 0:01:58.160 --> 0:02:00.600 sent on my way. After a few two days, I 0:02:00.680 --> 0:02:04.840 began to have a low grade fever and somebody aches. Progressively, 0:02:04.840 --> 0:02:07.040 the fevers got worse and the aches more extreme. To 0:02:07.080 --> 0:02:10.520 which point I felt unable to move my joints. Exactly 0:02:10.560 --> 0:02:12.919 one week from my initial trip to the urgent care, 0:02:13.280 --> 0:02:16.680 I was back again with fevers, nausea, a developing cough, 0:02:17.000 --> 0:02:21.080 consistent chest pain with absolutely no relief, and convinced this 0:02:21.240 --> 0:02:23.800 was more than shingles. I wanted to die with the 0:02:23.800 --> 0:02:27.400 pain I was experiencing. Luckily, the computers didn't have issues 0:02:27.400 --> 0:02:29.600 and I was able to get right into the doctor 0:02:29.639 --> 0:02:32.480 and he immediately ordered an additional chest X ray, again 0:02:32.720 --> 0:02:35.800 just to see I will never forget that x ray, 0:02:35.880 --> 0:02:39.120 as his assistants helped me stand up because I screamed 0:02:39.120 --> 0:02:41.840 in agony, trying to expand my joints and my chest, 0:02:42.120 --> 0:02:44.280 all of which were screaming back at me tenfold. When 0:02:44.280 --> 0:02:46.600 I was screaming out loud, the X ray came up 0:02:46.680 --> 0:02:48.600 on the scream starting from the bottom up. As I 0:02:48.639 --> 0:02:52.480 watched it, I saw spiderweb clouds covering my entire right lung. 0:02:53.200 --> 0:02:55.760 Even I knew something was wrong. In a week's time, 0:02:55.800 --> 0:02:59.360 my chest x ray had dramatically changed. The doctor spent 0:02:59.400 --> 0:03:01.560 what seemed like years just looking at the X ray 0:03:01.560 --> 0:03:03.360 and deemed it appropriate for me to go to the 0:03:03.639 --> 0:03:05.959 er and get a stat CT scan and be admitted. 0:03:06.760 --> 0:03:08.960 When I got there, my two SATs were in the 0:03:09.000 --> 0:03:12.800 eighties at best, and the CT scan that they quickly 0:03:12.800 --> 0:03:15.560 did showed fluid or on my entire right lung and 0:03:15.600 --> 0:03:18.680 beginning or on my lower left lobe. It was clear 0:03:18.720 --> 0:03:22.600 whatever I was experiencing was spreading quickly. I was quickly 0:03:22.639 --> 0:03:27.359 treated by teams of infectious disease doctors, pulmonologists, and respiratory therapists. 0:03:27.720 --> 0:03:30.400 Blood samples were taken and sent off to labs. In 0:03:30.440 --> 0:03:33.880 the meantime, I was treated for anything and everything. One 0:03:33.880 --> 0:03:36.160 of the first things they tested for was valley fever. 0:03:36.680 --> 0:03:39.240 The blood antigen tests that they did ended up coming 0:03:39.240 --> 0:03:42.040 back negative for valley fever, oddly enough, but they wanted 0:03:42.040 --> 0:03:44.240 to test part of my lung tissue to be sure. 0:03:44.960 --> 0:03:48.360 I was then presumed to maybe have tuberculosis and or 0:03:48.400 --> 0:03:51.840 a staff infection, and was primarily treated for that, along 0:03:51.880 --> 0:03:55.920 with anti fungals for the possible valley fever. In the 0:03:55.960 --> 0:03:59.400 coming days, I got sicker and weaker. My cough persisted 0:03:59.400 --> 0:04:01.760 and became more violent. So much water was in my 0:04:01.880 --> 0:04:04.400 lungs that each time I coughed, I felt like I 0:04:04.440 --> 0:04:07.640 was drowning because so much water came up. Every bone hurt, 0:04:07.800 --> 0:04:11.520 and my fever couldn't get under control. I remember multiple 0:04:11.520 --> 0:04:14.880 mornings being visited by the infected disease doctor and her 0:04:14.880 --> 0:04:17.360 sitting by the side of my bed, holding my hand 0:04:17.360 --> 0:04:19.840 and telling me she didn't sleep, worried I wouldn't make 0:04:19.880 --> 0:04:23.159 it through the night. On September twelfth, three days before 0:04:23.200 --> 0:04:26.280 I was supposed to return home to Utah, the concoction 0:04:26.400 --> 0:04:29.000 of medication that they had me on seemed to be 0:04:29.080 --> 0:04:32.840 stabilizing me, and my resting arrow two stats looked as 0:04:32.880 --> 0:04:35.080 if they could be stable for a short flight to home. 0:04:36.080 --> 0:04:39.800 By this day, the atrophy and emaciation of my once 0:04:39.960 --> 0:04:43.320 very strong, healthy body was shocking. I could no longer 0:04:43.320 --> 0:04:45.800 even sit up in my hospital bed without being winded 0:04:45.880 --> 0:04:49.200 or gasping for air. Standing up was a special task 0:04:49.240 --> 0:04:51.200 of its own that I could no longer fathom doing 0:04:51.200 --> 0:04:54.160 on my own. I was wheeled in a wheelchair through 0:04:54.160 --> 0:04:58.040 the airport to greet my family. The active, vibrant athlete 0:04:58.040 --> 0:05:00.800 they once knew returned home. It was beaten by an 0:05:00.880 --> 0:05:04.080 unknown cause. We later received a call from Arizona that 0:05:04.080 --> 0:05:07.440 the tissue biopsy did end up growing Valley fever, and 0:05:07.480 --> 0:05:10.799 that Valley fever was indeed the culprit. The year following 0:05:10.839 --> 0:05:13.720 this infection would be very trying, to say the least. 0:05:14.400 --> 0:05:16.880 I continued to be sick, returning to the hospital a 0:05:16.920 --> 0:05:20.120 few additional times. I lived on the couch, barely even 0:05:20.240 --> 0:05:23.279 able to get myself up for months, still coughing up water, 0:05:23.440 --> 0:05:27.800 continuously taking quick, shallow, frightening breaths, and two weeks to 0:05:27.839 --> 0:05:31.080 do much of anything on my own. Everything caused me 0:05:31.120 --> 0:05:33.560 to be out of breath, very different from what I 0:05:33.600 --> 0:05:37.440 grew up knowing. As it stands today, I still get 0:05:37.480 --> 0:05:40.880 a CT scan about once a year, sometimes every six months, 0:05:40.920 --> 0:05:44.520 depending on what my infectious disease doctor says. My lower 0:05:44.560 --> 0:05:47.080 two lobes of my right lung are dead, as well 0:05:47.120 --> 0:05:49.920 as the lower lobe of my left lung. I have 0:05:50.279 --> 0:05:53.440 the equivalent of one lung in my body. The remaining 0:05:53.480 --> 0:05:56.400 tissue eventually took up the task of providing my body 0:05:56.440 --> 0:06:00.279 within the oxygen to live a normal life. So when 0:06:00.320 --> 0:06:03.240 I was able to start moving again after many years, 0:06:03.680 --> 0:06:07.080 exercise became a daunting feed. Getting my heart right up 0:06:07.160 --> 0:06:10.200 was very difficult and typically resulted in a coughing attack. 0:06:10.839 --> 0:06:12.880 It took years for me to work up the stamina 0:06:13.080 --> 0:06:16.279 to ride a bike. To this day, I cannot run 0:06:16.320 --> 0:06:19.520 and am a mediocre athlete at best. I can enjoy 0:06:19.600 --> 0:06:21.719 movement for the most part and do what my lungs 0:06:21.720 --> 0:06:24.839 will allow. Walking up hills and stairs tend to be 0:06:24.880 --> 0:06:29.440 most difficult. I'm on forever anti fungals because for whatever reason, 0:06:29.520 --> 0:06:33.520 my body, being an anomaly, doesn't like to fight balley fever. However, 0:06:33.600 --> 0:06:36.080 today I'm grateful for a body that did fight. Though 0:06:36.080 --> 0:06:40.000 my goals and ambitions changed drastically, I survived and walked 0:06:40.000 --> 0:06:41.520 today with the equivalent of one lung. 0:07:25.520 --> 0:07:28.400 Thank you so much, Tori for sharing your story with us. 0:07:28.920 --> 0:07:31.920 Yeah, wow, thank you, thank you. Hi. 0:07:32.160 --> 0:07:35.240 I'm Aaron Welsh and I'm Erin Alman Updike and. 0:07:35.320 --> 0:07:37.400 This is this podcast will Kill You. 0:07:37.640 --> 0:07:41.960 And today we're talking about coccidioido micosis. 0:07:41.960 --> 0:07:43.280 Oh well done. 0:07:43.520 --> 0:07:43.920 Thank you. 0:07:44.680 --> 0:07:46.960 We think that's how we're supposed to say it. 0:07:47.200 --> 0:07:49.120 We've been practicing a lot. 0:07:49.560 --> 0:07:52.840 Yeah, if that's the wrong way to pronounce it, and 0:07:52.880 --> 0:07:55.720 it's really bothering you. It's gonna be a long episode 0:07:55.760 --> 0:07:56.320 for you, guys. 0:07:56.560 --> 0:07:59.120 It's gonna be terrible. It's gonna be worse than g 0:07:59.280 --> 0:08:00.240 a idea. 0:08:00.320 --> 0:08:03.640 But listen, I went to YouTube and I found like 0:08:03.720 --> 0:08:10.400 an actual clinical lecture on coxadioidomycosis. Nailed it hopefully, and 0:08:10.600 --> 0:08:12.960 this is how the person pronounced it, And so we 0:08:13.080 --> 0:08:17.840 got our pronunciations from a clinical lecture from like a 0:08:17.840 --> 0:08:18.960 school of public health. 0:08:19.160 --> 0:08:23.600 So we're trying our best as always. AKA. In case 0:08:23.640 --> 0:08:25.840 you have not heard of this, the other name for 0:08:25.920 --> 0:08:27.120 it is valley fever. 0:08:27.720 --> 0:08:30.520 Yes, this is going to be a cool one because 0:08:30.600 --> 0:08:34.280 it's our first human fungal pathogen. 0:08:34.080 --> 0:08:37.920 Which is just I can't believe it's taken us this long. 0:08:38.640 --> 0:08:43.720 We've done Kittred, we did Kittrid, and actually someone asked 0:08:43.800 --> 0:08:48.160 us recently if we've ever done courtyceps, which we haven't 0:08:48.200 --> 0:08:50.719 done on this podcast, but we did talk a lot 0:08:50.720 --> 0:08:55.840 about courtyceps on an episode of the Biology of Superheroes podcast. Yeah, 0:08:55.840 --> 0:08:58.560 so definitely check that one out if you haven't listened 0:08:58.600 --> 0:08:59.240 to that already. 0:08:59.480 --> 0:09:02.760 Oh yeah, but we're not talking about cordys ups today. 0:09:02.760 --> 0:09:05.160 We're talking about coxidioid of mycosis. 0:09:07.920 --> 0:09:12.760 But before we begin, it's quarantiny time. 0:09:13.040 --> 0:09:18.280 It is quarantiny time, my favorite time. What are we 0:09:18.360 --> 0:09:19.120 drinking this week? 0:09:19.440 --> 0:09:21.360 We're drinking the dust Devil. 0:09:22.120 --> 0:09:26.679 This is a fantastic name, and it's so fantastic that 0:09:26.760 --> 0:09:29.480 we cannot take credit for it. I actually found it. 0:09:29.480 --> 0:09:31.400 It was the title of a paper. Some of the 0:09:31.400 --> 0:09:33.920 papers I read for this episode have the greatest titles. 0:09:34.320 --> 0:09:37.160 This one is dust Devil, The Life and Times of 0:09:37.200 --> 0:09:40.680 the fungus that causes Valley Fever. Oh, I love it great, 0:09:40.679 --> 0:09:43.800 and that's by Lewis Bauers and Barker. Another one of 0:09:43.840 --> 0:09:49.640 my favorite papers paper titles for this episode was coxcidioido mycosis. 0:09:49.640 --> 0:09:52.360 What a long strange trip it's been, or something to 0:09:52.440 --> 0:09:53.280 that effect. 0:09:53.559 --> 0:09:54.679 It's like, hoorable. 0:09:55.080 --> 0:09:58.880 Yeah, that's great. Anyway, what is in the dust Devil? 0:09:59.400 --> 0:10:03.959 It's a tequila based pair cider situation. 0:10:04.679 --> 0:10:08.520 Yeah, it's tasty. It's got tequila, of course, it's got 0:10:08.559 --> 0:10:13.320 like pair juice. It's got a spiced simple syrup and 0:10:13.360 --> 0:10:16.719 we threw in some orange liquor. And anyway. We will 0:10:16.760 --> 0:10:19.480 post the full recipe for this quarantini as well as 0:10:19.520 --> 0:10:22.360 our non alcoholic plus suberrita on our website This podcast 0:10:22.360 --> 0:10:24.240 will Kill You dot com as well as on all 0:10:24.240 --> 0:10:27.400 of our social media channels, so make sure you follow 0:10:27.480 --> 0:10:27.840 us there. 0:10:28.160 --> 0:10:31.800 Definitely, what other business do we have to attend to aarin. 0:10:32.320 --> 0:10:37.520 We got some of the most incredible responses from our 0:10:37.679 --> 0:10:40.520 sweating sickness episode or after our sweating sickness episode. 0:10:40.760 --> 0:10:41.320 Yeah we did. 0:10:41.440 --> 0:10:44.200 Oh my gosh, so many people you know wrote to 0:10:44.280 --> 0:10:48.080 us or commented with their different hypotheses as to like 0:10:48.160 --> 0:10:53.160 what caused this, you know, super bizarre disease. And I 0:10:53.160 --> 0:10:56.440 wanted to shout out one in particular from someone who 0:10:56.440 --> 0:11:00.480 wrote us this like incredibly detailed email about how they 0:11:00.480 --> 0:11:03.800 went down into this deep rabbit hole looking into possible 0:11:03.840 --> 0:11:10.040 causes and came up with a walnut mold penetrum a 0:11:10.040 --> 0:11:11.160 as their hypothesis. 0:11:11.880 --> 0:11:17.040 Like I just love it, Like I love that there 0:11:17.040 --> 0:11:20.600 are people out there as nerdy as us doing these deep, 0:11:20.640 --> 0:11:24.680 deep dives on things like what caused sweating sickness? 0:11:25.080 --> 0:11:28.920 Yeah, and came beautiful a walnut mold And like, honestly, 0:11:29.160 --> 0:11:32.280 I'm I'm kind of I kind of buy it. It 0:11:32.360 --> 0:11:35.480 seems like quite plausible, like the symptoms lineup, a food 0:11:35.520 --> 0:11:38.160 borne toxin could very well move along trade routes like 0:11:38.200 --> 0:11:42.679 we talked about. And I just wanted to say thank 0:11:42.720 --> 0:11:47.760 you for everyone's responses and this email in particular, because 0:11:48.200 --> 0:11:49.360 I got such a kick. 0:11:49.200 --> 0:11:50.400 Out of it. I love it. 0:11:52.320 --> 0:11:53.680 Do we have more business? 0:11:53.840 --> 0:11:56.079 I did want to say I finally checked our po 0:11:56.160 --> 0:11:59.280 box that I'm really bad about checking. And I wanted 0:11:59.320 --> 0:12:02.400 to say thank you you to Sabrina for your thank 0:12:02.480 --> 0:12:07.360 you note. Oh my gosh, so adorable. She sent us 0:12:07.840 --> 0:12:10.160 a thank you card just to say thanks for making 0:12:10.160 --> 0:12:13.600 the podcast, so that she really likes it and I 0:12:13.640 --> 0:12:14.400 really like you. 0:12:14.920 --> 0:12:17.560 It was the sweetest thing. 0:12:18.040 --> 0:12:19.280 Anyways, that's all. 0:12:20.000 --> 0:12:24.840 Okay, okay, let's talk fungus, please please. 0:12:26.160 --> 0:12:28.000 We'll take a quick break and then dive into the 0:12:28.040 --> 0:12:33.280 biology of coxdioido my coases? Do I say it right 0:12:33.360 --> 0:12:33.680 that time? 0:12:34.280 --> 0:12:34.720 I think so? 0:12:34.760 --> 0:13:01.560 I think I did. Okay, coxiitu aido my coas aka 0:13:01.640 --> 0:13:08.439 valley fever akaur, first human fungal pathogen. It's actually two 0:13:08.440 --> 0:13:13.480 different species of fungi, Coxidioides imodus and Coxidioides pos odyssey, 0:13:14.520 --> 0:13:19.360 which are both endemic to desert areas in mostly the 0:13:19.400 --> 0:13:24.520 southwestern US, so Coxidioides immodus tends to be more prevalent 0:13:24.559 --> 0:13:31.920 in California and Coxidioides posodicy mostly in Arizona, but these 0:13:31.960 --> 0:13:36.319 fungi are also found throughout New Mexico, Utah, into Texas. 0:13:36.720 --> 0:13:38.840 We'll talk a little bit later about how maybe it's 0:13:38.840 --> 0:13:42.040 all the way up in Washington as well as down 0:13:42.120 --> 0:13:45.960 into parts of Mexico and Central and South America. So 0:13:46.760 --> 0:13:51.599 let's get into the disease that's actually caused by this fungus. 0:13:52.480 --> 0:13:57.080 This is a pathogen that is not contagious, so it 0:13:57.120 --> 0:13:59.560 has not been shown to be spread from person to 0:13:59.600 --> 0:14:02.760 person or from animal to person. Because this is also 0:14:02.800 --> 0:14:05.840 a fungus that can infect other animals aside from humans, 0:14:06.200 --> 0:14:09.600 especially dogs. But I am not really going to talk 0:14:09.640 --> 0:14:13.439 anymore about infection in animals like at all. But this 0:14:13.520 --> 0:14:16.720 is a fungus that's called dimorphic, so it has two 0:14:17.800 --> 0:14:22.960 entirely different forms that it exists in. And I have 0:14:23.000 --> 0:14:26.840 to confess that I know so little about fungus that 0:14:26.960 --> 0:14:31.440 I still have so many questions about how the heck 0:14:32.600 --> 0:14:36.680 this is possible, Like it's so fascinating. Okay, let's get 0:14:36.680 --> 0:14:41.000 into it. In the environment, this fungus exists as a mold. 0:14:41.120 --> 0:14:44.160 It's called a miceelium. So if you were to grow 0:14:44.280 --> 0:14:47.520 a whole bunch of it, like very concentrated in like 0:14:47.560 --> 0:14:49.680 a jar or something, and pick it up, it would 0:14:49.720 --> 0:14:52.040 look kind of like a little cotton puff like a 0:14:52.080 --> 0:14:59.920 little ball of white little wispies like cotton candy yum. Microscopically, 0:15:00.200 --> 0:15:02.400 if you look at these little wispies in more detail, 0:15:02.520 --> 0:15:06.720 they look they're called branching septate hiphie, what does that mean. 0:15:07.080 --> 0:15:09.160 They're kind of like, this is the way I'm gonna 0:15:09.160 --> 0:15:11.720 describe it. Arin, It's like a tree made out of 0:15:11.720 --> 0:15:17.160 toilet paper. So it's like long stringy bits that have 0:15:17.520 --> 0:15:21.600 branches like a tree wood, but then they're separated at 0:15:21.600 --> 0:15:23.920 certain points like the way that toilet paper is, so 0:15:23.960 --> 0:15:28.160 it has septations, Okay, And so what happens is that 0:15:28.280 --> 0:15:33.240 during times of drought or low precipitation, those like toilet 0:15:33.240 --> 0:15:38.320 paper squares, which in the fungus are called arthrocnidia or arthrospores, 0:15:39.120 --> 0:15:42.080 they dry out and then they break off super easily, 0:15:42.240 --> 0:15:44.480 Like if your house got toilet papered and then the 0:15:44.520 --> 0:15:46.680 wind picked up and broke off a bunch of little 0:15:46.680 --> 0:15:48.840 squares of toilet paper, and then toilet paper flew all 0:15:48.840 --> 0:15:53.200 around your neighborhood. Yeah, and then what happens is that you, 0:15:53.520 --> 0:15:58.800 as a human breathe those spores in. So that is 0:15:58.880 --> 0:16:01.840 kind of the life cycle in the environment. So you 0:16:01.880 --> 0:16:06.960 have these mycelia, these little long, branchy stringy bits that 0:16:07.160 --> 0:16:10.800 break off when they dry out and then can become 0:16:11.600 --> 0:16:13.320 borne on the wind in the soil. 0:16:13.720 --> 0:16:14.240 Excellent. 0:16:14.640 --> 0:16:17.200 Now you breathe them in, and now we have to 0:16:17.240 --> 0:16:20.760 talk about what happens in us because it's totally completely 0:16:20.800 --> 0:16:24.920 different than what happens in the environment. So when you 0:16:24.960 --> 0:16:29.800 breathe in a spore literally potentially just one, it only 0:16:29.880 --> 0:16:33.040 has to be one spore could potentially infect you. What 0:16:33.200 --> 0:16:35.760 happens is you breathe it in and it goes down 0:16:35.880 --> 0:16:39.520 into the bottom of your respiratory tract and lodges in 0:16:39.560 --> 0:16:43.480 your terminal alveoli, your terminal bronchioles, like right where gas 0:16:43.520 --> 0:16:46.560 exchange is supposed to be happening. And once it gets there, 0:16:46.640 --> 0:16:50.640 it begins to enlarge and it forms what's called a 0:16:50.720 --> 0:16:53.560 sphere youle, like a big sphere. 0:16:54.160 --> 0:16:56.960 Okay, I don't know why it's called that, like a 0:16:57.000 --> 0:16:59.040 beach ball in your lung. 0:17:00.200 --> 0:17:04.520 In this spherule, it begins to replicate and forms thousands 0:17:04.560 --> 0:17:11.200 of endospores ooh, within this sphere in the spherule, okay. 0:17:11.400 --> 0:17:14.840 And then eventually that spherule will rupture and release those 0:17:14.880 --> 0:17:17.800 thousands of endospores that can go on to travel form 0:17:18.080 --> 0:17:22.960 new spherules which make more endospores, et cetera, et cetera. 0:17:23.560 --> 0:17:27.760 That's cool. So it brings its own little like reproductive machinery. 0:17:28.320 --> 0:17:30.359 Yeah, it just it does it all on its own. 0:17:30.680 --> 0:17:34.200 It's asexually reproducing. Just boot boom, boom boom. Make it 0:17:34.240 --> 0:17:37.840 a bunch of little endospores. But that's completely different than 0:17:37.880 --> 0:17:41.920 how it lives and replicates in the environment, in the soil. 0:17:43.400 --> 0:17:46.960 And it gets even weirder because if, for example, you 0:17:47.080 --> 0:17:50.800 take a sample of someone's speutum like like gunk that 0:17:50.800 --> 0:17:54.639 they coughed up when they were infected with coxidioids, and 0:17:54.920 --> 0:17:57.800 that's a whole bunch of endospores inside a spheerule. If 0:17:57.840 --> 0:18:02.919 you left that on the counter, it would grow my celium, 0:18:02.960 --> 0:18:05.840 It would grow into the environmental form, which by the way, 0:18:05.880 --> 0:18:08.000 would be highly infectious if it dried out. 0:18:08.400 --> 0:18:12.439 So there's some kind of cues that it's using. 0:18:12.800 --> 0:18:15.560 Yeah, some kind of cues to know that it's in 0:18:16.200 --> 0:18:19.200 a host versus in the external environment. 0:18:19.840 --> 0:18:21.400 I wonder what those cues are. 0:18:21.720 --> 0:18:29.119 Me too, Aaron, me too, huh. But we're going to 0:18:29.160 --> 0:18:31.320 focus on what happens when it's inside of your body. 0:18:31.800 --> 0:18:34.880 If somebody is a fungus researcher, it would be awesome 0:18:34.920 --> 0:18:41.720 to know more details about that fungus because woboy. But 0:18:41.840 --> 0:18:46.360 in general, once this happens inside of our lungs, our 0:18:46.400 --> 0:18:49.800 body reacts to this fungus, it's going to induce an 0:18:49.880 --> 0:18:53.760 immune response. It's going to recruit a lot of inflammatory cells, 0:18:54.240 --> 0:18:57.439 and that's going to kind of result in the symptoms 0:18:57.640 --> 0:19:01.480 that we see. So let's talk about those. Yeah, if 0:19:01.480 --> 0:19:05.119 you have any symptoms at all, which about forty percent 0:19:05.119 --> 0:19:08.840 of people who get infected with coxidioids will sixty percent 0:19:08.880 --> 0:19:11.840 of people won't have any symptoms at all. If you 0:19:11.920 --> 0:19:16.480 have these symptoms, most commonly it presents as an acute pneumonia. 0:19:17.640 --> 0:19:21.960 And I think we've talked very peripherally about pneumonia in 0:19:22.000 --> 0:19:23.919 the past. I'm actually going to talk kind of a 0:19:23.960 --> 0:19:28.040 lot about pneumonia in this episode, which is exciting. Yeah, 0:19:28.080 --> 0:19:31.240 but pneumonia is basically just the way that we say 0:19:31.400 --> 0:19:37.320 there's an infectious cause of inflammation and fluid filling up 0:19:37.359 --> 0:19:42.000 the air sacs of the lungs. Okay, so it's inflammation 0:19:42.200 --> 0:19:46.080 of the lungs. But pneumonia is used specifically to mean 0:19:46.119 --> 0:19:51.840 an infectious cause of that inflammation. So with coxidioido micosis, 0:19:52.640 --> 0:19:53.360 did I get that right? 0:19:53.960 --> 0:19:57.560 I think so. Honestly, it's it's like we've said it 0:19:57.720 --> 0:20:00.880 and I've thought it so many times, and to sound. 0:20:00.760 --> 0:20:06.239 Weird, I know, one to three weeks after inhalation of 0:20:06.280 --> 0:20:11.600 the spores, you have basically pretty typical pneumonia symptoms. Fever, 0:20:12.400 --> 0:20:18.400 a cough that's quite productive of like gunk, very profound fatigue, 0:20:18.440 --> 0:20:23.480 like just feeling very exhausted, and probably chest pain, especially 0:20:23.520 --> 0:20:27.600 when you take really deep breaths. With coxidioid's infection, it's 0:20:27.640 --> 0:20:30.600 also really common to have a headache and the chest 0:20:30.640 --> 0:20:34.080 pain tends to be very severe. And with this type 0:20:34.080 --> 0:20:38.520 of pneumonia, the fatigue can last for months and months, 0:20:39.200 --> 0:20:44.000 so even as the pneumonia resolves, that fatigue can persist. Okay, 0:20:44.240 --> 0:20:46.199 if you were to take a chest X ray or 0:20:46.320 --> 0:20:49.480 a chest CT scan, which would be very likely to 0:20:49.480 --> 0:20:51.800 happen if you went to the er or the doctor's office, 0:20:52.280 --> 0:20:56.000 it would look like pretty much most other causes of pneumonia, 0:20:56.080 --> 0:20:58.440 which means it would look like there's fluid in some 0:20:58.520 --> 0:21:01.920 portion of your lung, either in just one lobe or 0:21:02.000 --> 0:21:04.399 maybe in like the middle region, which is called the 0:21:04.480 --> 0:21:08.480 high lar region around the trachea, like where the trachea divides, 0:21:09.520 --> 0:21:12.879 you might have some swollen lymph nodes along that region. 0:21:12.920 --> 0:21:15.960 That's a little bit more common with a cooxidioides pneumonia 0:21:16.080 --> 0:21:19.760 than other types of pneumonia. One other thing you might 0:21:19.800 --> 0:21:22.440 have that's not as common with other forms of pneumonia 0:21:22.560 --> 0:21:25.680 is you might have some skin changes, like some red, 0:21:26.080 --> 0:21:31.880 painful swollen bumps along your shins that are called erythema nodosum, 0:21:32.080 --> 0:21:35.239 or another red splotchy rash that can occur kind of 0:21:35.320 --> 0:21:37.919 across your body that's called arithema multiform. 0:21:38.840 --> 0:21:44.120 Question, Okay, what else causes those two things? 0:21:44.240 --> 0:21:47.560 So a number of different These are not specific to 0:21:47.720 --> 0:21:51.440 coxidioides infection. These are both caused by an immune response 0:21:51.920 --> 0:21:55.840 to this infection, not from a disseminated fungus. So there's 0:21:55.840 --> 0:21:58.480 actually a number of different infections that can cause similar 0:21:58.600 --> 0:22:01.639 findings viruses and bacteria. 0:22:02.080 --> 0:22:04.399 Okay, but I mean, like, I guess what's the mechanism, 0:22:04.440 --> 0:22:07.480 Like why does that happen in these different infections? 0:22:07.640 --> 0:22:10.119 That's a really good question that I don't know the 0:22:10.160 --> 0:22:13.120 specifics of it. Aside from the fact that whatever specific 0:22:13.119 --> 0:22:16.199 immune response is being generated, that's what then causes this. 0:22:16.520 --> 0:22:19.600 Okay, and this is only like an occasional mm hmm, 0:22:19.720 --> 0:22:21.800 it's not always sign of disease, okay. 0:22:21.880 --> 0:22:24.800 Yeah. Yeah, So it's also kind of person specific, like 0:22:24.880 --> 0:22:27.720 some people might be more likely to have this immune 0:22:27.760 --> 0:22:33.000 response than others. But most of these people with this 0:22:33.160 --> 0:22:38.920 presentation will recover and be pretty much fine with or 0:22:38.960 --> 0:22:43.520 without any treatment. And keep that in mind, ding ding 0:22:43.600 --> 0:22:46.639 ding with or without treatment, because it'll become really important 0:22:46.720 --> 0:22:50.840 later on. Okay, but some people won't. So there's a 0:22:50.840 --> 0:22:53.800 few other forms that this disease can take. Some people 0:22:53.880 --> 0:22:56.639 will go on to have a chronic form of pneumonia 0:22:56.720 --> 0:23:00.600 that's called chronic progressive pneumonia. And I had a hard 0:23:00.600 --> 0:23:03.560 time finding the exact percentage of people that go on 0:23:03.680 --> 0:23:06.679 to have like a chronic pneumonia, which basically would be 0:23:06.720 --> 0:23:08.760 all the same things that you had with this pneumonia, 0:23:08.880 --> 0:23:11.840 so cough potentially coughing up blood because you have so 0:23:11.960 --> 0:23:15.160 much inflammation and infection. You'd go on to have weight 0:23:15.200 --> 0:23:17.760 loss because you've essentially been sick for so long that 0:23:17.800 --> 0:23:20.760 you're just not eating. You feel really really bad, the 0:23:20.840 --> 0:23:24.120 fatigue is extreme, and on X ray you still see 0:23:24.119 --> 0:23:31.000 those same pneumonia changes. But what based on everything that 0:23:31.040 --> 0:23:33.800 I read, it seems like it's likely less than five 0:23:33.840 --> 0:23:35.680 percent of the time. But I didn't get a hard 0:23:35.760 --> 0:23:41.200 number on chronic pneumonia. Okay, But even if the pneumonia 0:23:41.280 --> 0:23:47.240 resolves or is treated and goes away, sometimes all of 0:23:47.280 --> 0:23:49.720 the fluid and gunk that's left behind from the infection 0:23:49.960 --> 0:23:53.440 can kind of persist. And what it does is contract 0:23:53.960 --> 0:23:57.280 into like a cavity that our body kind of walls 0:23:57.320 --> 0:24:00.919 off and it just stays there. And this can happen 0:24:00.960 --> 0:24:03.040 like five to ten percent of the time, So you'd 0:24:03.040 --> 0:24:05.520 still see like a nodule or a cavity if you 0:24:05.520 --> 0:24:07.520 looked at an X ray of a person with this. 0:24:08.280 --> 0:24:10.440 This is in their lung, in their lung. 0:24:11.400 --> 0:24:14.719 And now most of the time that's all and nothing 0:24:15.040 --> 0:24:19.200