A nasty fungal infection that can spread to the lungs or brain and cause lifetime symptoms is on the rise in the Southwestern U.S., federal health officials reported on Thursday.

Cases of Valley Fever, known medically as coccidioidomycosis, have increased nearly 10-fold between 1998 and 2011, the Centers for Disease Control and Prevention reports.

“Cases in Arizona, California, Nevada, New Mexico and Utah rose from 2,265 in 1998 to more than 22,000 in 2011,” CDC said in a statement.

"Health-care providers should be aware of this increasingly common infection when treating persons with influenza-like illness or pneumonia who live in or have traveled to endemic areas," the agency says in its weekly report on death and disease.

Valley Fever causes at the most mild-flu-like symptoms in most health people, but the fungus can spread and take hold in unlucky victims, requiring a lifetime of antifungal drugs and sometimes even surgery to removed growths of fungus.

“More than 40 percent of patients who get ill from Valley Fever may require hospitalization at some point, with an average cost of nearly $50,000 per hospital visit,” CDC says.

The infection is caused by a fungus called Coccidioides. It lives naturally in the soil, and becomes airborne when dirt or sand is disturbed. Winds can carry the spores far aloft, and people breathe them in unknowingly.

“Because fungus particles spread through the air, it’s nearly impossible to completely avoid exposure to this fungus in these hardest-hit states,” CDC Director Dr. Tom Frieden said in a statement.

“It’s important that people be aware of Valley Fever if they live in or have travelled to the southwest United States.” Antibiotics or antiviral drugs will do nothing to help treat a fungal infection.

CDC and state health officials checked disease surveillance data to see if cases were on the rise. They found that cases of Valley Fever went up 16 percent a year between 1998 and 2011 in Arizona and rose 13 percent a year in California.  More than 90 percent of cases are reported these two states.

“It’s difficult to say what’s causing the increase,” said Dr. Benjamin Park, chief epidemiologist  at CDC’s Mycotic Diseases Branch. “This is a serious and costly disease and more research is needed on how to reduce its effects.” It might be that people are just noticing and reporting it more, or perhaps weather changes are helping to stir up the spores, CDC said.

CDC says 30 percent to 60 percent of people who live in a region where the fungus is entrenched will breathe it in at some point. An estimated 150,000 people are infected every year but many don’t know they have anything other than a cold, and they get better on their own. The elderly and other people with weakened immune systems, such as HIV patients, are especially vulnerable.

According to the University of Arizona, 60 percent of those infected don’t suffer any symptoms, and another 30 percent have just mild to moderate infections. But 5 percent to 10 percent suffer complications, and 1 percent of victims die.

If it does spread, it’s usually to the skin, where it can cause purplish bumps that turn brown.

In people who develop pneumonia, the fungus can form nodules that cause no symptoms but which can look like lung cancer on an x-ray. A very few patients can also develop what are called cavities in the lung, which can cause chest pain and difficulty breathing. They require surgery to fix.

If it spreads to the brain or spinal cord it can cause meningitis, a potentially deadly condition that requires immediate treatment.

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As the death toll and the case counts continued to climb Monday in an outbreak of fungal meningitis tied to tainted pain shots, health officials admit they’ve been stymied in their best efforts to treat patients.

“I don’t think we have a very good handle on exactly what is happening or how this is playing out,” said Dr. Tom Chiller, deputy chief of the mycotic diseases branch at the Centers for Disease Control and Prevention.

Thirty people have died and 419 have developed fungal meningitis or joint infections in 19 states after receiving injections of contaminated steroid drugs earlier this year, the CDC reported Monday.

Those numbers include dozens of patients who have developed abscesses at the infection site or another condition called arachnoiditis, an inflammation of the delicate membranes that surround and protect the nerves of the spinal cord.

In Michigan, for instance, which has logged the most cases -- 119, plus seven deaths -- 61 patients have developed fungal meningitis; 51 who developed epidural abscesses, six joint infections and one stroke.

“In some cases, those abscesses have developed into meningitis,” said Angela Minicuci, a spokeswoman for the Michigan Department of Community Health.

What’s particularly alarming is that some patients have become sicker even though they’ve been taking powerful antifungal drugs aimed at wiping out the black mold Exserohilium, which has been responsible for most of the illnesses.

“What we do know from hearing from a few centers is that around a third of patients with meningitis are having some sort of disease progression,” Chiller said.

It’s not clear why some patients aren’t responding to the therapy. The fungi are difficult to treat, Chiller said, but tests showed that  the organisms should have been killed by the drugs. Doctors don’t know whether the problem is the natural progression of the disease itself, or perhaps the body’s immune system kicking into action, Chiller said.

“Are we actually killing the fungi and this is a reaction?” he asked. “It’s not responding to therapy that well, or it’s responding very slowly.”

For patients who already have been affected, that means they can expect a protracted recovery from the fungal infections. “It will be a long-term therapeutic management issue,” Chiller said.

About 17,000 vials of contaminated steroids were sent out by the New England Compounding Center, the Framingham, Mass., pharmacy at the center of the outbreak. That company has lost its license. A sister firm, Ameridose LLC, is also being investigated for problems with sterility. Both companies have recalled all their products.

For the 14,000 patients who received the shots, the greatest risk of developing infections is in the first 42 days -- six weeks -- after the injections, CDC has said. Unfortunately, Chiller said, some risk of serious illness does remain.

“By 42 days, your risk is really, really low,” he said. “But that doesn’t mean that anyone with a symptom, a sign, shouldn’t express that to their physician. Any pain that’s not getting better, that’s getting worse, they should report that.”

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Handout / Reuters

The fungus Exserohilum has caused most of the infections tied to a deadly outbreak of fungal meningitis.

Contamination has been found in two additional drugs made by the pharmacy tied to a deadly outbreak of fungal meningitis, federal health officials said Thursday.

Ten different kinds of bacteria were detected in the drugs, including eight in separate lots of betamethasone, a steroid injection used to relieve severe itching, and two more types of bacteria found in a batch of cardioplegia solution used to stop the heart during surgery, the Food and Drug Administration reported.

That’s in addition to five kinds of fungi that now have been detected in people or products linked to the New England Compounding Center, the Framingham, Mass., firm at the center of the outbreak.

As of Thursday, the outbreak has caused 377 cases of fungal meningitis, stroke caused by fungal meningitis or other central nervous system infections, plus nine joint infections, for a total of 386 cases in 19 states, according to the Centers for Disease Control and Prevention. At least 28 people have died. 

FDA officials also said they're testing the two additional drugs from NECC for fungal contamination and expect those results soon. 

"The presence of additional microbial organisms and/or fungus in these products cannot be ruled out at this time," FDA officials said in a statement. 

One lot of preservative-free betamethasone was contaminated with paenibacillus pabuli/amolyticus, Bacillus idriensis, Bacillus flexus, Bacillus simplex and Lysinibacillus sp. Another lot was tainted with Bacillus niabensis and Bacillus circulans, while a third lot held Bacillus lentus and Bacillus circulans. Lab tests found Bacillus halmapalus and Brevibacillus choshinens in the cardioplegia solution.

No infections tied to the bacterial contamination of the betamethasone or the cardioplegia solution have been detected, officials said. 

The FDA released the results of new laboratory tests the day after the CDC released lab results that found two new types of fungi in the contaminated injection steroids linked to infections in the ongoing outbreak. 

CDC found that the same fungus that caused most of the meningitis and joint infections in outbreak was also found in unopened vials of the drug, methylprednisolone. 

All but two of 54 infections confirmed by CDC labs as of Oct. 22 were caused by Exserohilum rostrum, a fungus typically found in the environment. That same fungus was found in two lots of unopened vials of methylprednisolone acetate recalled by the now-shuttered New England Compounding Center on Sept. 26.

The remaining two CDC lab-confirmed infections were caused by the fungi Aspergillus and Cladosproium, CDC has previously reported.

In addition, CDC says it has detected two more fungi, Rhodotorula larynges and Rhizopus stolonifer, in unopened vials of the drugs. Those fungi are not known to cause human infections because they can’t grow at body temperature, the agency said.

The CDC lab tests don’t reflect the total case count because laboratory methods used to detect fungal meningitis are not highly sensitive, the agency said. Many patients with fungal infections can actually have negative laboratory results.

State and federal inspections have revealed significant problems with sterility at NECC’s site. The company itself documented mold and bacteria throughout its clean rooms dating from January through September, an FDA inspection report showed.

All products from NECC have been recalled and the company’s pharmacy license has been permanently revoked. In addition, unexpired drugs produced by a sister company, Ameridose LLC, were recalled this week after FDA inspectors raised questions about problems with sterility.

Nearly 14,000 people in 23 states may have received injections of the tainted drugs. The greatest risk of stroke, death or other problems is in the first six weeks after the injections, the CDC has said. For most patients who got the shots, that means that the danger will be largely over by next week, health officials have said.

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"I don't think there is a precedent for this kind of thing," said Dr. Arjun Srinivasan of the Centers for Disease Control and Prevention. Health officials and doctors have tracked down most of the 14,000 people potentially at risk for fungal meningitis, blamed for the deaths of 24 people and sickening more than 300.

"This is definitely new territory for us," he said.

The fungus' brown-black color signals an armor that — along with being injected near the spine —helped this mold sneak past the immune defenses of otherwise healthy people, said Dr. Arturo Casadevall, a fungal disease specialist at New York's Albert Einstein College of Medicine.

"What we're dealing with here is fundamentally different" from a typical fungal infection, he said. "This is a bug that most of us don't know much about."

But they're learning fast, piecing together clues that promise some hope.

Doctors are beginning to detail in medical journals the first deaths in this outbreak, and the grim autopsy findings make clear that treating early is crucial, before the fungus becomes entrenched. In one case, a woman died in Maryland after the fungus pierced blood vessels in her brain, leading to severe damage.

People getting treated earlier "seem to be doing OK," with fewer of the strokes that characterized the outbreak's beginning, said Dr. Carol Kauffman of the University of Michigan. She has advised the CDC and co-authored advice in the New England Journal of Medicine on how to handle the complex medication used in treatment.

People who got contaminated steroid shots made by a Massachusetts pharmacy have been told to be on guard for months for meningitis symptoms. But the CDC said Wednesday that the biggest risk for getting sick seems to be within 42 days of receiving one of the implicated back injections.

With the tainted shots recalled in late September, that means the period of greatest risk is nearing an end. And it should help doctors bombarded with calls from the worried determine who most needs a spinal tap to look for the very earliest signs of infection.

"We know the farther out you are from receiving an injection, the lower your risk becomes for developing meningitis or other infections. We want to emphasize that," CDC's Dr. Tom Chiller told a conference call for physicians on Thursday.

Still, public health officials recall a 2002 meningitis cluster linked to steroid injections contaminated with a different fungus; one of those victims got sick 152 days after the shot.

Fungal infections don't get a lot of attention, but they afflict millions around the world, said David Perlin of the University of Medicine and Dentistry of New Jersey, who is studying better ways to diagnose them. Most are skin infections like athlete's foot, but fungi also can cause pneumonia, sinusitis and other problems.

Serious infections tend to strike people with immune systems weakened because of cancer, AIDS or other problems. Fungus-caused meningitis in particular is extremely rare— especially in otherwise healthy people like in this outbreak — and it's "very bad news," said Michigan's Kauffman.

While the more common bacterial and viral forms of meningitis tend to strike quickly with obvious symptoms, fungal meningitis grows very slowly and is hard to diagnose. Few antifungal drugs are absorbed into the central nervous system, limiting treatment options. Plus, human cells and fungal cells have a lot of similarities, making it hard to attack the fungus without side effects, Kauffman explained.

The main culprit in this outbreak is a black mold called Exserohilum rostratum, common in dirt and grasses. Only 33 human infections previously had been reported, mostly eye or skin infections in people with weak immune systems, Casadevall said.

Here's how scientists think it's sneaking into the well-guarded spinal cord and brain of a healthy person:

• The steroid injected near the spine reduces inflammation, one of the immune system's defenses against contamination. 
• The mold grows quietly until enough accumulates for it to burrow a tiny hole, or abscess, into the lining of the spinal canal, said Dr. William Schaffner of Vanderbilt University. Reaching the spinal fluid inside offers a direct pathway to the brain. 
• The fungus' color signals how intractable it is. Brown-black molds produce melanin, the same chemical that helps human skin tan. It guards against the sun's mold-killing ultraviolet rays — and inside people, it fends off both antifungal drugs and other immune-system attacks, Casadevall said. 

The good news: Black mold is treatable with a drug named voriconazole, with far fewer side effects than the older treatment initially recommended when the outbreak began.

Still, Kauffman cautioned doctors to carefully monitor patients because differences in metabolism can make levels surge in the bloodstream, causing hallucinations, confusion, nausea and occasionally liver damage. On the flip side, their bodies may process the drug too quickly to battle the fungus. Plus, voriconazole can interact badly with a list of other common medications.

"It's not clear" how long to treat but at least three months is advised, Kauffman said. It begins with intravenous infusions that are hard to administer outside of a hospital. Then once the patient is stable enough, pills can be used.

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Infections tied to the outbreak of fungal meningitis from contaminated steroid injections continued to climb Thursday, with 328 cases in 18 states. The death toll still stands at 24. 

So far, 323 cases of fungal meningitis, stroke or other infections related to the central nervous system have been reported. In addition, five infections have been detected in patients who got shots in joints such as the knee, hip, shoulder or elbow. All of the deaths have been associated with the fungal meningitis cases, according the Centers for Disease Control and Prevention. 

The new tally included two cases reported in Indiana, seven in Michigan and one in Minnesota. South Carolina reported its first case.

About 14,000 people may have received injections of tainted steroids produced by the New England Compounding Center of Framingham, Mass. The firm has been shut down, its products recalled and it license permanently revoked. 

On Wednesday, the CDC reported that the most serious infections and illnesses, including stroke and death, appear to occur within the first 42 days -- six weeks -- after receiving the injections. The agency said that the risk of developing serious complications is much lower after that. 

Because the NECC drugs were recalled on Sept. 26, the CDC estimates that the highest risk of infections will end on about Nov. 6. 

Patients who received the injections should be monitored for fever, dizziness, sensitivity to light and other signs of meningitis. They should be in close contact with their doctors if they have any signs of illness. 

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Infections related to an ongoing outbreak of fungal meningitis reached 308 on Tuesday, with 23 deaths.

That includes 304 cases of meningitis, stroke or other nervous system problems tied to epidural injections of contaminated steroids, plus four infections in patients who received pain shots in joints such as the hip, knee shoulder or elbow. 

The death toll has held steady for a few days, but officials with the Centers for Disease Control and Prevention said that doesn't necessarily mean that the outbreak is waning. 

"Too early to say," said Curtis Allen, a CDC spokesman, in an email to NBC News. 

The outbreak has now affected patients in 17 states. Nearly 14,000 patients may have received contaminated steroid injections since May 21 produced by the New England Compounding Center of Framingham, Mass. The potentially tainted drugs were sent to pain clinics and health care facilities in 23 states. 

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CDC

Health officials have found the black mold Exserohilium in unopened vials of injection drugs made by a Massachusetts pharmacy and implicated in an outbreak of fungal meningitis that has killed more than 20 people.

The toll of a growing outbreak of fungal meningitis continued to rise Friday, with 21 deaths and 271 confirmed infections in 16 states linked to contaminated steroid shots from a Massachusetts pharmacy.

There have been 268 cases of fungal meningitis, stroke believed to be caused by fungal meningitis or central nervous system infections tied to the tainted drugs. Three other patients who received shots in their joints, such as hips, knees, shoulders or elbows, have developed infections as well, according to latest figures from the Centers for Disease Control and Prevention.

Nearly 14,000 patients may have received the fungus-contaminated shots distributed by the New England Compounding Pharmacy in Framingham, Mass., since May. All products from the pharmacy have been recalled. 

On Thursday, federal health officials confirmed that they found the fungus Exserohilum rostratum in unopened medication vials of one of three lots of methylprednisolone, a steroid, implicated in the infections and deaths. That discovery confirmed the link between the type of fungus in the drugs and that found in most of the patients who became sick after the shots.

Officials have also confirmed the mold Aspergillus in one infected patient. Another was found to be infected with the fungus Cladosporium. All of the fungi are present in the environment, but rarely cause meningitis.

A second pharmacy connected to the NECC is also being investigated. Ameridose LLC said on Friday that it has agreed to extend a temporary shutdown while state and federal regulators continue an investigation into the company. Ameridose, based in Westborough, Mass., shares some common ownership with NECC. Investigators launched an investigation on Oct. 10.

Most patients got the shots to help relieve back pain. The time it takes for an infection to show up in people who got the tainted shots may be up to four weeks, officials said. 

Patients should be watching for symptoms including fever, headache, stiff neck, nausea and vomiting, sensitivity to light and altered mental status, the Food and Drug Administration said. Symptoms for other infections might include fever, swelling at the injection site, increasing pain, redness, visual changes, discharge from the eye, chest pain or drainage from a surgical site. Anyone who develops these symptoms should seek medical attention. 

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