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Missouri: Aggressive fungus compounds tornado trauma, 10 cases, 5 fatalities

Ronan Kelly

Retired 2020
Aggressive fungus compounds tornado trauma
Doctor says at least 9 survivors may have contracted infections.
12:00 AM, Jun. 9, 2011 |

Some injured people who initially survived the May 22 Joplin tornado have been stricken by a rare, rapidly growing and sometimes fatal fungal infection.

The exact number of patients is unclear, but one doctor who has treated some of them puts the number at at least nine.

Dr. Uwe Schmidt, an infectious disease specialist at Freeman Health System, said three or four people with the infection -- known as zygomycosis -- have died.

"It's difficult to say if it killed them, but it definitely was a contributing factor," he said.

The Springfield-Greene County Health Department sent a memo Monday to area health providers warning them to be on the lookout for the infections.

Kendra Williams, the administrator of community health and epidemiology for the health department, said the common fungus likely came from soil or vegetative materials imbedded in the skin by the force of the tornado.

Schmidt said about five patients at Freeman have had the infection. He said he heard that four cases had been found at another hospital.

...

Schmidt said a week after the tornado, Freeman admitted three patients who had aggressive fungal infections. Doctors tried to control the fungus with intravenous medicine and by removing tissue that had been killed by the rapidly spreading infection.

"We could visibly see mold in the wounds," Schmidt said. "...It rapidly spread. The tissue dies off and becomes black. It doesn't have any circulation. It has to be removed."

Schmidt said one woman who was taken to another hospital had her arm amputated in an effort to control the fungal infection but ultimately died. Another patient who died was on life support and had a fungal infection to the head.

"This fungus invades the underlying tissue and actually invades the underlying blood vessels and cuts off the circulation to the skin," Schmidt said. "It's very invasive."

...

http://www.news-leader.com/article/...ado-trauma?odyssey=tab|topnews|text|FRONTPAGE
 
Re: Missouri: Aggressive fungus compounds tornado trauma, several fatalities

Re: Missouri: Aggressive fungus compounds tornado trauma, several fatalities

Source: http://www.foxnews.com/health/2011/06/10/deadly-fungal-infection-strikes-victims-joplin-tornado/

Deadly Fungal Infection Strikes Victims of Joplin Tornado

Published June 10, 2011

| Reuters

KANSAS CITY, Mo. ? Health officials say flying debris from the tornado that tore through Joplin, Missouri, last month is to blame for an outbreak of a rare but serious ? and in some cases deadly ? fungal infection among some of the more than 900 people injured in the disaster...
 
Re: Missouri: Aggressive fungus compounds tornado trauma, several fatalities

Re: Missouri: Aggressive fungus compounds tornado trauma, several fatalities

Epidemiology and Outcome of Zygomycosis: A Review of 929 Reported Cases [ http://cid.oxfordjournals.org/content/41/5/634.full ]

I have not seen the name of the individual species in the Joplin cases.
 
Re: Missouri: Aggressive fungus compounds tornado trauma, several fatalities

Re: Missouri: Aggressive fungus compounds tornado trauma, several fatalities

The Centers for Disease Control and Prevention said Friday that it was conducting tests to help investigate the infections, which are so uncommon that even the nation's largest hospitals might see only one or two cases a year.

"To my knowledge, a cluster like this has not been reported before," said Dr. Benjamin Park, head of the CDC team that investigates fungal diseases. "This is a very rare fungus. And for people who do get the disease, it can be extremely severe." [ http://www.huffingtonpost.com/2011/06/10/joplin-tornado-health-fungus_n_874806.html ]


Park said the CDC has not received any reports of fungal infections this year involving people injured in other tornadoes. He called the fungal infections extremely rare and clusters of them even rarer. [ http://www.usatoday.com/news/nation/2011-06-10-joplin-tornado-fungus_n.htm ]
 
Re: Missouri: Aggressive fungus compounds tornado trauma, several fatalities

Re: Missouri: Aggressive fungus compounds tornado trauma, several fatalities

Below is the health warning from the Missouri department of health [ http://health.mo.gov/index.php ] - the actual species involved still hasn't been named. I suspect it will be posted on the state site first.

Health Advisory: [ http://health.mo.gov/emergencies/ert/alertsadvisories/pdf/advisory61011.pdf ]

Assistance in diagnostic testing, such as identification of fungi from isolates or
tissue specimens, is strongly encouraged by MDHSS and can be provided from
CDC through the Missouri SPHL. MDHSS urges health care providers to promptly
report cases of suspected deep skin wound fungal infection and other cases of
unusual fungal infection among persons associated with the tornado to MDHSS or
your local public health agency. MDHSS also urges health care providers to ship
any suspected isolates or tissue specimens to the SPHL.


Something also rather striking is a quote from the LA times of an account of one of the physicians :

The first cases were noticed by Dr. Uwe Schmidt, an infectious diseases specialist at Freeman Health System in Joplin. A week after the tornado, he and other doctors observed three patients in the intensive care unit with what looked like white, fluffy mold growing on the surface of some of their wounds. The infections continued to spread even though the doctors removed the diseased skin. But the infections slowed when amphotericin was administered. [ http://www.latimes.com/health/la-he-joplin-fungus-20110611,0,5212890.story ]
 
Re: Missouri: Aggressive fungus compounds tornado trauma, several fatalities

Re: Missouri: Aggressive fungus compounds tornado trauma, several fatalities

CDC Studying Deadly Fungus After Joplin, Mo., Tornado

William Browning ? Sat Jun 11, 2:42 pm ET

The Centers for Disease Control has gotten involved in a mysterious case of a fungal infection known as mucormycosis in victims of the Joplin, Mo., tornado. As many as three people have had severe enough infections to have possibly died from a rare form of fungus after receiving injuries due to the massive twister.

Death rates are as high as 30 percent for people who have the fungus spread through their blood. The rate goes as high as 50 percent in those who inhale the spores.

Some of the injured received multiple injuries with bleeding. The Springfield News-Leader reports eight people have been diagnosed with massive fungal infections, three of whom have died. Samples are being sent to the CDC for further tests.

...

http://news.yahoo.com/s/ac/20110611/us_ac/8621939_cdc_studying_deadly_fungus_after_joplin_mo_tornado
 
Re: Missouri: Aggressive fungus compounds tornado trauma, several fatalities

Re: Missouri: Aggressive fungus compounds tornado trauma, several fatalities

12 cases of rare fungus now confirmed among tornado victims
Five people with mucormycosis infections have died.
12:00 AM, Jun. 18, 2011

Written by
Sarah Okeson Filed Under
News
Ozarks News
The number of confirmed cases of a rare, sometimes deadly fungus that has sickened survivors of the Joplin tornado has risen to 12, according to the federal agency that is investigating the disease.

Five people with the fungal infections have died, but Kristen Nordlund, a spokeswoman for the U.S. Centers for Disease Control, said it was unclear if the five are included in the 12 confirmed cases or in addition to them.

A team of investigators from the CDC is in Joplin trying to pinpoint whether there are common risk factors associated with people who got the infection, called mucormycosis. They expect to be there about two weeks.

...
http://www.news-leader.com/article/...s?odyssey=mod|newswell|text|Special Reports|s
 
Re: Missouri: Aggressive fungus compounds tornado trauma, 12 cases, 5 fatalities

Re: Missouri: Aggressive fungus compounds tornado trauma, 12 cases, 5 fatalities

http://www.physorg.com/news188045426.html
Fungi can change quickly, pass along infectious ability
March 17, 2010
Fungi have significant potential for "horizontal" gene transfer, a new study has shown, similar to the mechanisms that allow bacteria to evolve so quickly, become resistant to antibiotics and cause other serious problems.

[snip]
"They are not nearly as confined to the more gradual processes of conventional evolution as had been believed, scientists say. And this raises issues not only for crop agriculture but also human health, because fungi are much closer on the "evolutionary tree" to humans than bacteria, and consequently fungal diseases are much more difficult to treat."....

http://www.sciencedirect.com/science/article/pii/S1878614611000729
Fungal Biology
Available online 7 May 2011.
Dishwashers ? A man-made ecological niche accommodating human opportunistic fungal pathogens
 
Re: Missouri: Aggressive fungus compounds tornado trauma, 12 cases, 5 fatalities

Re: Missouri: Aggressive fungus compounds tornado trauma, 12 cases, 5 fatalities

CDC lowers number of mucormycosis fungal infections in Joplin to 10
11:19 AM, Jun. 25, 2011 |

The federal agency investigating cases of a fungal disease in people who initially survived the Joplin tornado has lowered the number of confirmed cases to ten, a spokeswoman said.

Kristen Nordlund, a spokeswoman for the U.S. Centers for Disease Control,
said two of the cases that were initially counted as mucormycosis were
caused by a different fungus.

...

http://www.news-leader.com/article/...-Joplin-10?odyssey=tab|topnews|text|FRONTPAGE
 
Re: Missouri: Aggressive fungus compounds tornado trauma, 10 cases, 5 fatalities

Apophysomyces trapeziformis was found in all 13 of the samples from confirmed cases (18 were suspected) and is thought to have been the infectious agent - From The Report ( http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6029a5.htm?s_cid=mm6029a5_w ):

The field team reviewed medical charts to describe the 13 confirmed cases. The median age of the patients was 48 years (range: 13--76 years); seven were female, and all were white. Injuries sustained during the tornado included lacerations (12 patients), fractures (11), and blunt trauma (nine). The 13 patients had an average of four wounds documented in the medical chart when they were examined at the emergency department. Post-trauma wound management included surgical debridement for all 13 patients and removal of a foreign body from six. Wooden splinters were the most common foreign body, found in the wounds of four patients. Two patients had diabetes, and none were immunocompromised. Ten patients required admission to an intensive-care unit, and five died...

CDC received 48 clinical specimens, including 32 fungal isolates and 16 tissue blocks collected from wounds for microscopic evaluation, immunohistochemical staining, and DNA sequencing; specimens from all 13 patients yielded the Mucormycete Apophysomyces trapeziformis. Further laboratory and epidemiologic studies are ongoing, including case-control studies to evaluate risk factors for infection...

...Cutaneous mucormycosis has been reported after previous natural disasters; however, this is the first known cluster occurring after a tornado. None of the infections were found in persons cleaning up debris. Health-care providers should consider environmental fungi as potential causes of necrotizing soft-tissue infections in patients injured during tornados and initiate early treatment for suspected infections. Additional information is available at http://www.cdc.gov/mucormycosis.
 
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