Skin lesions, 55th Annual Cocci Study Group

I'm glad that Denise continues her restoration to health (and that she's still my wonderful trophy wife). However, we have now started to deal with issues related to her being on voriconazole for her cocci. In 2006 when it was determined that Denise's Valley Fever infection progressed in the liver & brain while she was on fluconazole, she was switched over to voriconazole, and things improved. But the drawback of voriconazole is an increased risk of skin cancer. In spite of her wearing sunscreen and staying out of the sun as much as is practical, she had some precancerous lesions removed, mostly from the backs of her hands (sunscreen washes off easier than we wish). So she's started wearing yoga gloves when she's out & about. I think I'd better get digging and plant some more trees for shade around the house.

April 1 weekend I went to U.C. Davis to attend the 55th annual Cocci Study Group with my aunt, a nurse that can explain the jargon to me. Some major highlights:

• Nikkomycin Z is an antifungal that's been shown to cure (not suppress, but cure) cocci in lab mice. A presenter shared a study done in dogs that likewise seems to show that 60 days of NikZ treatments cured the dogs. When asked about the time when the drug may be available and the cost, the presenter guessed maybe 5 more years, and no idea on cost, but it will be expensive (ever more expensive than voriconazole, I assume). But she also pointed out that much of the financial toll of Valley Fever is the long-term treatment (lifelong treatment if there's been meningitis involved, as is the case for Denise). So 60 days of NikZ treatment and being cured could well be less expensive than lifelong treatment with azole drugs just for suppression. I'm encouraged, and eager to attend the meetings in coming years. 
• Southern Utah will likely become an endemic region for cocci due to anticipated changes in climate and the accompanying migration patterns of burrowing animals that are suspected to be carriers of cocci.
• Pleasant Valley State Prison in Coalinga (where Denise is from... city, not the prison) has the highest number of cocci-related deaths in the prison system. A federal prison is set to open in Mendota (near Fresno). So the thinking is that as the federal prison starts reporting anticipated cases of cocci, then the disease will finally get onto the national radar and stand a better chance of getting more funding for research and treatment.
• Related to finding a vaccine or cure: the cell wall of cocci is very different from cell walls of other fungi. One presenter proposed that the key to vaccine/cure will be found in carbohydrates on the surface of the organism, not in the proteins, as I believe had previously been thought.
• Cocci's not limited to humans, and the veterinary portion of the seminar was fascinating. Of 833 California sea lion deaths examined since 1982, 10 of them died of cocci. The presenter showed a satellite photo of Santa Ana winds blowing cocci-laden dust from California's Central Valley  over the mountains and out over the ocean. 
• A hunter shot a bear around Shaver Lake above Fresno. The hunter gave the hide to a taxidermist and the meat to a meat processor. The meat processor found huge lesions inside the chest cavity and notified a biologist with Fish & Game. Testing showed the lesions to have cocci granulomas, the carcass was discarded, and the hide frozen for further testing. So an interesting discussion arose regarding whether the meat would have been safe to eat and hide safe to display. The answer to both was probably yes, because the heat level from cooking the meat and the pH level of the  pickling process for preserving the hide would have been too high for the cocci organism to tolerate (and ingesting cocci doesn't seem to pose a problem anyway). The hunter would like to get the bear hide back. At any rate, it was strange that the bear contracted cocci that high up in the mountains.
• During a lunch break we were treated to a tour of U.C. Davis' Veterinary Teaching Hospital, and the guide was 94-year-old Dr. Robert L. Leighton, Emeritus Professor of Surgery. He's seen lots of changes to veterinary medicine over the years and pioneered many of the changes. And he was loaded with funny stories, too. Very enjoyable time.
• At dinner after the seminar, a doctor said that there was a case of cocci in Italy during WWII when a ship carrying hay from Arvin CA was unloaded in an Italian port. Another doctor piped in that when PanAm first started flying across the ocean, a case of cocci was reported in Japan. Apparently someone was cleaning the plane after a flight and contracted the disease.

Several of the attendees from Phoenix were on Southwest flight 812 from Phoenix to Sacramento. During flight, about a 3-foot part of the roof peeled back. The aircraft landed safely, no injuries. Sunroof's good in a car, bad on a jet. Next year's conference will be in Tucson AZ. I think I'll drive.