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Rare, Aggressive Fungus Strikes Joplin Tornado Victims

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Two weeks after a devastating tornado destroyed thousands of homes and businesses and killed 145 people, neighborhoods remain in ruins in Joplin, Missouri on June 8, 2011.  UPI/Bill Greenblatt

Two weeks after a devastating tornado destroyed thousands of homes and businesses and killed 145 people, neighborhoods remain in ruins in Joplin, Missouri on June 8, 2011. UPI/Bill Greenblatt

CBS St. Louis (con't)

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JOPLIN, Mo. (KMOX/AP) - A Joplin doctor said Thursday his hospital treated five Joplin tornado victims for a rare, aggressive fungal infection sometimes found in survivors of other natural disasters.

Dr. Uwe Schmidt, an infectious disease specialist at Freeman Health System in Joplin, said three of those patients who contracted zygomycosis have since died, but he stopped short of blaming their deaths specifically on the infections.

“These people had multiple traumas, pneumonia, all kinds of problems,” Schmidt said. “It’s difficult to say how much the fungal infections contributed to their demise.”

Zygomycosis, now known as mucormycosis, is a fungal infection that spreads rapidly and can be caused by soil or vegetative material becoming embedded under the skin. It’s more prevalent in people with weakened immune systems or untreated diabetes but can affect healthy people who suffer trauma and are injected with contaminated soil.

Dr. Benjamin Park with the Centers for Disease Control and Prevention said people who have had a traumatic skin injury that is not improving should seek medical attention immediately so the infection can be identified and treated promptly.

Here is a portion of the memo from health care authorities:

“Dear Greene County Medical Providers,

The Springfield-Greene County Health Department was made aware of medical concerns associated with tornado victims. Please see the statement below:

All Medical Providers Caring for Joplin Tornado Victims

Several patients have been identified recently with aggressive fungal soft tissue infections. These patients were transferred in from the field and had lacerations that were closed at the scene. These patients have developed cellulitis followed by aggressive necrotizing soft tissue infection. Despite aggressive surgical debridement, the wounds have continued to advance. Microscopy demonstrates invasive fungal elements with capillary thrombosis. Grossly, the wounds have a cellulitic appearance with necrosis of the deeper aspect of the wound. The fat has a saponified appearance. In some cases gross fungal elements are visible with the naked eye. Despite aggressive surgical debridement, the necrosis reoccurs within 24 hours. Treatment currently consists of aggressive serial surgical debridement with IV amphotericin therapy.”

“These fungal infections are usually quite serious, and often have a case-fatality rate of 50 percent or higher,” Park said in an email to The Associated Press. “Although persons with weakened immune systems and those with diabetes are the most common risk groups, otherwise healthy people can develop infection, particularly after a traumatic wound. Skin infection usually occurs following traumatic inoculation of the fungal spores into the skin.”

Schmidt said he had seen only two cases of zygomycosis in his 30 years of practice, and both of those cases involved people with untreated diabetes.

“I never have seen personally this kind of fungal infection of the skin,” he said.

Stacy Fender, a spokeswoman for CoxHealth, said Cox South hospital in Springfield has one patient who may have a fungal infection. Overall numbers weren’t available. The health department in Springfield-Greene County, where some patients were treated, declined to release information about patients sickened by the fungus, citing patient privacy concerns.

The Springfield News-Leader reported the 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 fungus likely came from soil or vegetative materials imbedded in the skin by the tornado.

In the aftermath of the tornado, Freeman Health System treated more than 1,700 patients. Doctors from St. John’s Hospital, which was hit by the twister, treated patients at makeshift facilities. Schmidt said some wounds that were stitched up had to be reopened because they weren’t adequately cleaned.

“These were very extensive wounds,” Schmidt said. “They were treated in the emergency room as quickly as possible.”

A week after the tornado patients began arriving with fungal infections.

“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 the infection is sometimes seen in survivors of mass trauma such as the 2004 tsunami in Indonesia.

“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.”

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Copyright 2011 by KMOX/The Associated Press

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