Rare Fungal Illness Follows Tornado

A 116 infectious disease Rare fungal illness follows tornado More than 1,000 people were injured when a severe tornado ripped through Joplin, Missouri, on 22 May 2011, and 158 eventually died. 1 Within a few days of the tornado, several of the injured began to suffer from a fungal infection suspected to be cutaneous necrotizing mucormycosis. Doctors scrambled to do what they could, but testing to identify the specific causal fungus lagged, treatment (including surgery and medications) was sometimes ineffective, and five people died. 2 A team of U.S. researchers who investigated the outbreak now report what they say is the largest known cluster of the disease, with 13 identified patients. The term " flesh-eating disease " is sometimes used to describe one of the obvious effects of diseases like mucormycosis, but this illness can also seriously affect many other body systems—including the pulmonary, sinus, rhinocerebral, gastrointestinal, cutane-ous, and other body systems. 4 In addition, many microbes other than the 10 fungi genera linked to mucormycosis can cause a so-called flesh-eating effect. 5 The Joplin cases were caused by the fungus Apophysomyces trapeziformis, which is commonly found in soils, decaying vegetation, and water containing organic matter such as leaves and soil. A. trapeziformis and related species thrive in iron-rich, acidic environments and are known to particularly affect individuals with underlying diabetes mellitus, hemato-logical malignancy, iron overload, or acidemia (abnormal blood acidity). 6 These fungi have also been associated with a compromised immune system, malnourishment, transplant receipt, and prolonged corticosteroid use. 4 When comparing the 13 Joplin cases with controls who were injured during the tornado but showed no evidence of mucormycosis, the researchers discovered a significant link between fungal infection and the occurrence of penetrating wounds (especially multiple wounds) containing wood, soil, gravel, and other foreign bodies. All 13 patients were injured in the heart of the path of the EF-5 tornado, which had winds over 200 mph. There was no link with potential con-founders such as age, sex, race, preexist-ing medical condition, or location of the wound(s). 2 There also was no link with contaminated medical equipment, which has been implicated in some previous mucormy-cosis cases. 7 The global incidence of mucormycosis cases is low, though other cases may have gone undetected. Three fungal genera, Rhizopus, Mucor, and Lichtheimia, account for most of the roughly 1,500 documented cases worldwide. Seven other genera, including Apo physomyces, account in total for …