Lung Granuloma: Treatment, Causes, Symptoms, and More

TikTok Star Susi Vidal Is Diagnosed With Deadly Fungal Infection Valley Fever After Breathing In DIRT In Arizona

A popular TikTok influencer has revealed that she's been diagnosed with the deadly fungal infection Valley Fever, after visiting her parents in Arizona in September.

Speaking in a clip posted in December, which has attracted more than 500,000 views, Susi Vidal explains how the disease gave her a full body rash, disabling fatigue, a tight chest and a 'stabbing sharp pain that would randomly come into my side'.

The condition, which is increasingly prevalent in the US, is caused by the inhalation of spores from the fungus Coccidioides.

The spores are released into the atmosphere when the soil is disturbed - which is why the infection surge has been linked to rising temperatures across the globe.

While the fungus was previously only found in dry, western patches of the country, it is spreading fast. 

Experts fear that the infection - which can lead to meningitis - could be endemic in 17 states by 2100.

TikTok influencer Susi Vidal has revealed the collection of worrying symptoms that arose from her Valley Fever infection - including nasty rashes and chest pain

Susi Vidal, who has 3.6 million followers on TikTok - where she posts examples of healthy recipes - told followers that she originally mistook the condition for worsening depression.

'I think I got it in September. I've been living in Michigan, and I'm from Arizona,' she said. 'I visited my family in September. 

'My symptoms started off as just severe fatigue, and I just thought it was my depression because I literally could not get out of bed.

'I upped my therapy...And therapy was basically the only thing I could do. I had zero explanation for any of my symptoms.'

Susi goes on to explain that her doctor in Michigan could not figure out what was wrong. 

Valley Fever is thought to affect at least 20,000 Americans every year and, in worse case scenarios, can cause deadly meningitis

'Then I broke out in this rash all over...I broke out in this rash all over my stomach all over... It looks like ringworm.'

The rash began with a little patch before spreading all over the content creator's body. 

Other symptoms she suffered include a dry cough, a tight throat which 'felt like I was wearing a turtle neck 24/7', and a stabbing pain in her side a couple of times a day. 

'And then when we went to Florida I went to urgent care in Florida. I literally couldn't do anything there. I literally slept the entire time,' she says.

'They thought my rash was hives so they gave me a steroid shot in my butt.' 

When this didn't work, Susi returned to doctors in Arizona who conducted a series of blood tests, as well as scans of her chest - before eventually diagnosing Valley Fever.  

'It's basically a fungal infection in my lungs that I inhaled from dirt in Arizona. It's found in the dirt and soil there.'

The infection was dubbed Valley Fever because 97 percent of cases are found in Arizona and California

The prescribed treatment is anti-fungal medication, which Susi says she believes is helping to reduce the severity of her rash. 

According to the Centers for Disease Control and Prevention (CDC), roughly 20,000 cases of Valley Fever were reported in 2019.

When humans or animals breathe in the spores, they travel through the respiratory tract and into the lungs, where they reproduce, causing further disease.

Most infections are mild and clear up on their own within a few days or weeks, and the infection cannot be passed between people or animals.

Symptoms — fatigue, cough, fever, aching muscles and breathlessness — mimic those of a respiratory virus infection, so they are easy to mistake for something else.

Other symptoms include night sweats, joint aches and a red rash, usually on the legs but occasionally on the chest, arms and back.

But up to ten percent of cases become severe and take months to recover from.

In these cases, known as disseminated coccidioidomycosis, the disease can spread through the bloodstream to other parts of the body, including the brain, skin and liver. 

If it infects the membranes and fluid around the brain, it can cause meningitis.

In 2019, a study published in the journal GeoHealth predicted that, due to climate change, the endemic region of the fungus will spread north to include dry western states such as Idaho, Wyoming, Montana, Nebraska, South Dakota, and North Dakota.

The Fungus In 'The Last Of Us' Is Real—and It's Very, Very Expensive

Qinghai, ChinaMa Beng sprawls on his stomach, his nose nearly touching the dry, brown grass. He army-crawls slowly across the mountain, inspecting the ground inch by methodical inch. Nearby, friends and family likewise creep along, carefully studying the tangles of grass and shrub. At 16,400 feet above sea-level, close to the height of Everest's Base Camp, exertion in the oxygen-deprived air seems to phase no one. Chatting as they crawl, the group trades idle gossip, but their eyes never leave the ground.

They're all searching for the same thing. It's a prize often worth more than its weight in gold: ophiocordyceps sinensis, or more simply, caterpillar fungus.

From a distance, another man cries out in excitement. A short fungal stalk just barely pokes out of the grass, marginally thicker than the vegetation that surrounds it, and he carefully begins excavating around it. Onlookers gather, pulling out their smartphones to take photos; one woman begins a livestream on Douyin (China's version of TikTok). A few painstaking moments later and he has freed his bounty—a small caterpillar perhaps an inch long, caked in earth with a reddish tendril of fungus sprouting from its head. He produces a tobacco tin, gingerly wraps his find in plastic, and secures it inside as the crowd disperses again, resuming their hunt with renewed enthusiasm.

Called yartsa gunbu in Tibetan, the literal translation becomes "winter worm, summer grass". It's an apt, if scientifically inaccurate, name for a macabre instance of symbiosis that begins when the underground larvae of the ghost moth are infected by ophiocordyceps spores. Scientists think the fungus takes control of the caterpillar's nervous system, forcing its host to dig upwards, then ­killing it just before breaking the surface. Dormant through winter, the fungus reawakens in spring, consumes the corpse's interior for nutrients, and sprouts out of caterpillar's head into the sunshine.

Cordyceps have long been a local folk remedy, but within the last few decades Chinese demand has mushroomed, driving up prices. Since the early 1970s the cost of a kilogram of high quality cordyceps has increased up to forty thousand-fold—fetching as much as $110,000 per kilogram. The result has been an annual "wormrush" on the margins of the Himalaya, what is historically one of the poorest regions on the Asian continent.

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Left: Part social gathering, part livelihood rivalry, villagers scour the slopes together in Yushu Tibetan Autonomous Prefecture. For many, this will be their only source of income for the year.

Right: At these extreme elevations, hats and masks are a necessity to protect pickers from the harsh light. Specialized tools are carried to carefully extract any finds without damaging them.

For many pickers, the cordyceps harvest represents their only income for the entire year; so, every May and June, the plateau fragments into thousands of hyper-localities where only residents are permitted to enter.

Regardless of how or by whom the worms get dug up, there's one alarming thing everyone on the plateau has noticed: there are fewer to find every year.

Locals and scientists alike offer the one-two punch of overharvesting and climate change as means of explanation. With hundreds of distinct sets of regulations governing their harvest, there remains no cohesive system, or incentives, to ensure a sustainable harvest. Simultaneously, new sprouts require a specific range of temperature, moisture, and snow cover. Those variables are no longer so predictable, and the fungus today cannot be found at the lower elevations where they were once plentiful.

 Part caterpillar, part fungus, cordyceps are prized in traditional medicine for being both "plant" and animal. The industry here is worth billions of dollars.

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The world's most expensive fungus

Roughly sixty miles away in the city of Yushu, it's barely 8 a.M. In the cordyceps market, but already it has the frenetic energy of a stock market trading floor. Hands are grasped beneath towels in the traditional means of bartering, whispers circulate the crowds, and prices fluctuate from shop-to-shop, minute-to-minute as every node in this supply web tries to eek out a couple more yuan per worm.

Middlemen purchase worms from the pickers for approximately $5 and will sell them to established shops in Yushu and other urban centers for a 10-20 percent markup. From there, they enter a well-oiled machine. The cordyceps are cleaned, counted, sorted, and packaged in vacuum-sealed bags before being shipped off that same afternoon. During peak season, a single worm broker can buy over 1,500 pounds of product per day, spending tens of millions of dollars in the process.

By the time they reach the gleaming shops of Beijing and Shanghai, the price of a caterpillar fungus has at least doubled. They're more likely to be found in a luxury shopping mall than a pharmacy. The perceived value of the resource is now so high that it's a fashionable gift or party favor among China's elite. Counterintuitively, demand for cordyceps doesn't remain high in spite of high prices, it remains high because of them.

(Fungi are key to our survival. Are we doing enough to protect them?)

One saleswoman in Beijing's high-end Wang Fu Jing district suggests buyers are primarily interested in the social status the worms provide rather than any purported health effects. She points at the different ornate boxes of dead caterpillars, secured behind glass.

"High-quality" cordyceps are priced based on a fungus's size, color, symmetry, ratio of stalk-to-body, freshness, and any other variables that makes them more uncommon or visually appealing, and therefore more desirable. The very best are priced in excess of six figures per kilogram; their uglier counterparts are more likely to sell for around $40,000 per kilogram. The least aesthetic will be ground to powder for supplements and additives in other products.

A growing interest in alternative medicine from Western markets also suggests demand will continue rising.

The product appeals to a diverse cross-section people: it has been sold by celebrity Gwyneth Paltrow on her controversial Goop website, as well as by right-wing conspiracy theorist Alex Jones' Info Wars. Recently, the hit HBO series The Last of Us put a spotlight on the fungus, introducing it to new audiences.

(Learn more about the real science behind the show.)

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Left: Local shops have taken to social media to help grow their businesses. These women are brushing the dirt from fresh yartsa ganbu while being live streamed to Chinese viewers.

Right:  This buyer samples the aroma of some dried worms for sale before making an offer. 

Photographs By Justin Olsvik

The dried fungi are less desirable than their fresh counterparts and are sold by weight. Fresh ones are sold per piece, but only last a few weeks, so will be packaged and shipped out the same day. 

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A moral tradeoff

Escalating demand means more pressure on an already fragile ecosystem, but a company from Guangdong province, Sunshine Lake Pharma, might have a solution. For decades, many have tried to cultivate cordyceps artificially, and until recently, the complex life cycle, interactions, and environment had proven too difficult to simulate. But in 2014, Sunshine Lake made a breakthrough, producing lab-grown cordyceps with a highly secret procedure, for the first time. Studies indicate that the medicinal components of cultivated cordyceps were equivalent to wild ones, and better yet, lack the heavy metal pollutants often found in the natural variety.

Since the discovery, Sunshine Lake has been growing, and by their own estimate, project their production could make up 20 percent of the entire market. Lab-grown cordyceps should reduce pressure on wild fungus, giving populations a chance to recover. However, that environmental win jeopardizes what's now a lucrative resource for some of China's poorest citizens.

There's little time for rest during cordyceps season. Here, a buyer inspects the haul of a picker's family by headlight, extending his bargaining well into the night.

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Many pickers have responded by using social media to create a distinct "natural" brand identity. Scroll any number of Chinese social media apps in May and June and you're likely to find livestreams of these businesses picking, processing, and packaging their products against dramatic mountain backgrounds, and encouraging you to purchase directly from their online stores.

As the sun approaches the horizon, Ma Beng heads back down the mountain empty-handed. When asked if he's worried about the cultivated fungus, he just shrugs.

"This is a traditional medicine," he says. "You can't replace tradition."

3D Printed Facial Implants To Revolutionize Black Fungus Treatment In India

Around the world, we have already seen the viability of additive manufacturing technologies for the creation of implants. This is especially the case for those living in regions that may be less economically prosperous, with citizens who may have less access to affordable, advanced healthcare. It is in these areas that 3D printing is putting itself forward as a viable way to creation customizable, low-cost implants that can truly revolutionize healthcare. Most recently, this has been seen in India where researchers from the Indian Institute of Technology Madras (IIT Madras) have partnered with ZorioX Innovation labs, a startup founded by dental surgeons in Chennai, to create 3D printed, metal face implants for patients suffering from black fungus disease in the country.

According to the CDC, black fungus disease, known officially as Mucuormycosis, "is a serious but rare fungal infection caused by a group of molds called mucormycetes. These fungi live throughout the environment […] in soil and in decaying organic matter, such as leaves, compost piles, or rotten wood." The disease can be contracted by coming into contact with the fungal spores in the environment, for example after breathing them in. However, the CDC notes that "These forms of mucormycosis usually occur in people who have health problems or take medicines that lower the body's ability to fight germs and sickness." For example, the disease can occur in patients with AIDS or uncontrolled diabetes.

The IIT Madras team with their metal 3D printer

Moreover, it has started becoming a serious concern in India post-COVID, with about 60,000 mucormycosis cases already registered, leading to a growing need for face reconstruction in the country. Starting in 2021, medical personnel started seeing a resurgence of mucormycosis, previously considered a relatively rare fungal infection. The cause seems to have been the immune suppression that occurs during a COVID infection. And the symptoms can be devastating.

Though these can differ depending on where exactly in the body the fungus is growing, common black fungus symptoms include shortness of breath and chest pain, swelling on one side of the face, sinus congestion and, most relevant in this case, black lesions on your nose and inside your mouth. Treatment usually involves taking strong, prescription antifungal medications, but if the disease has been left long enough or is severe, removal of the infected or dead tissues, including entirely taking out parts of a patient's nose or eyes, is the only remedy. But this can lead to disfigurement and the need for full facial reconstruction. This is where this project comes in, including the #Right2face movement from IIT Madras and ZorioX Innovation Labs, which will give this implants free of cost to patients who cannot afford treatment.

Dr. Karthik Balaji, CEO, ZorioX Innovation labs, commented, "Post-Covid there has been an increase in number of black fungus cases. To save the lives of the patient, a lot of facial bones had to be removed. These patients are mostly breadwinners of the family and are now confined within four walls because of their facial deformity. #Right2face movement is aimed to help these needy patients in association with the oral and maxillofacial surgeons to restore the faces and give them back their smile." Indeed, already 50 implants have been done on patients from what a press release refers to as economically-weaker sections of India.

Using 3D Printing to Create Facial Implants for Black Fungus Patients

But how exactly will this process work? Well, in fact, it will be similar to many of the other implant or prosthesis initiatives we have seen around the world. Especially those that have been developed for more rural areas or those will less access to affordable healthcare. Dr. Murugaiyan Amirthalingam, Associate Professor, Department of Metallurgical and Materials Engineering, IIT Madras, explained, "Using unique in-house algorithms, a patient's MRI/CT data is converted to printable CAD format and custom implants are printed from medical-grade titanium using an indigenously-built laser powder bed facility in IIT Madras. This #Right2Face initiative aims to help poor and needy patients with patient-specific custom maxillofacial implants to treat black fungus patients."

Each facial implant is made by the IIT Madras researchers using a metal laser powder bed solution

Dr. Amirthalingam expanded on the decision to turn to 3D printing specifically, stating "Additive manufacturing (3D printing) has already emerged as a viable and cost-effective, net shape manufacturing process for low volume production of complex body implants with specific custom-made designs. Extensive research activities are already being carried out in IIT Madras to commercialize this technology for printing patient-specific implants in stainless steel, Ti-6Al-4V and Co-Cr-Mo alloys."  

Considering that the work is mainly being used to help lower-income areas as a viable alternative to full facial reconstructive surgery, the cost and personalization that 3D printing enables were both key benefits for the IIT Madras researchers. Furthermore, it seems that the IIT Madras team is particularly excited by the possibility to print an implant that exactly matches a patient's face. You can find out more in the press release from the Press Information Bureau for the region of Chennai HERE.

What do you think of these 3D printed face implants to help patients suffering from Black Fungus? Let us know in a comment below or on our LinkedIn, Facebook, and Twitter pages! Don't forget to sign up for our free weekly Newsletter here, the latest 3D printing news straight to your inbox! You can also find all our videos on our YouTube channel.

*All Photo Credits: IIT Madras

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