Posted Aug 11, 2011
Health care providers who treat tornado victims in the future will now know to be on the lookout for the rare fungus that sickened 13 people and was a contributing factor in the deaths of five of them after the May 22 tornado.
That is a conclusion of a study released this week by the federal Centers for Disease Control and Prevention, which sent a field team to Joplin on June 14 to probe the cluster of rare infections caused by cutaneous mucormycosis.
The disease has been reported after previous natural disasters, including the March tsunami in Japan, but Joplin is the first known cluster occurring after a tornado, according to the report.
The team identified 18 suspected cases of the fungal infection, of which 13 were confirmed. The last case was reported June 17. None of the cases involved a rescue worker, the report said.
The field team reviewed medical charts to describe the 13 confirmed cases. The median age of the patients was 48 years. The range was 13 to 76. Seven were female. Injuries sustained during the tornado included 12 patients with lacerations, 11 with fractures and nine with blunt trauma.
The 13 patients had an average of four wounds documented in the medical chart when they were examined at the emergency department. Wooden splinters were the most common foreign body found in the wounds of four patients. Ten patients required ICU admission. Five died. At least three of the patients are still being treated for their fungal infections.
Dr. Ben Park, an epidemiologist with the CDC’s mycotic disease branch, in an email communication on Friday, said there were no specific geographic connections among the victims.
“Most of the cases were located in the zone that had the most severe tornado damage,” he said.
All 13 patients had apophysomyces trapeziformis, a specific type of mucormycete. Park was asked whether that suggests a common source.
“At this point it is not yet known if there was a common source,” he said. “Further lab work may help to shed some light on if these organisms were all the same strain.”
Further laboratory and epidemiological studies are ongoing. Park was asked what else might be learned.
“We’re trying to find out what factors were associated with developing these infections in the hopes that we can try to prevent or recognize these infections early in the future,” he said.
The CDC report said early diagnosis, surgical removal of the affected tissue and antifungal medication were used effectively to treat the fungus.
The study involved 48 clinical specimens, including 32 fungal isolates and 16 tissue blocks collected from wounds. Microscopic evaluation, immunohistochemical staining and DNA sequencing yielded apophysomyces trapeziformis.
Cutaneous mucormycosis is a rare infection caused by a fungi that is typically found in soil, decaying wood and other organic matter.
The case-fatality rate has ranged from 29 percent to 83 percent, depending on severity of disease and the underlying medical condition of the patient.
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Copyright © 2011, The Joplin Globe, Mo.