Lethal fungus adds to tornado woes in Joplin

Some survivors of last month’s massive tornado that destroyed much of Joplin, Mo., are facing another indignity: an outbreak of a rare but frequently lethal fungal infection.

Eight people have been confirmed to have the infection, known as murcomycosis, and at least three have died, according to the Missouri Department of Health and Senior Services. Health authorities fear other tornado victims may also be infected without realizing it.

“People who have wounds that are not improving should seek medical attention immediately,” said Dr. Benjamin Park, a medical officer in the mycotic disease branch of the Centers for Disease Control and Prevention in Atlanta, which monitors outbreaks of fungal infections.

Murcomycosis, traditionally known as zygomycosis, is a family of rare diseases caused by several different fungi that live in soil. The most common form occurs when fungal spores are inhaled. The organisms take root in the sinuses, then spread to the lungs and throughout the body. It typically strikes people with weakened immune systems, such as those with cancer or diabetes, or who are on immune-suppressing medications because they have had organ transplants.

The more unusual variant -- which has been affecting residents of Joplin -- is the cutaneous form, in which fungal spores get under the skin. Experts believe that the tornado’s 200-mph winds blew contaminated dirt and debris directly into victims’ skin, or that it got into open wounds caused by flying debris. Symptoms include redness or inflammation, swelling, tenderness or pain, heat in the wound area and fever.

Treatment typically involves surgical removal of dead tissue and intravenous infusion of the antifungal medication amphotericin. An oral drug called posaconazole is also used.

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 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.

Schmidt said he ultimately observed five cases at Freeman, out of 1,700 patients treated there after the May 22 twister.

“I was surprised,” he said. “The so-called subcutaneous form of the fungus is not very common. I have never seen it myself before, and to suddenly see this cluster was quite striking.”

He noted that all of the patients with the infections also suffered from severe wounds, so doctors cannot say with certainty that the three deaths were due to the fungus. “But it was probably a contributing factor in their demise,” he said.

Authorities emphasized that the infections do not spread from person to person, and that none of the cases was attributed to food, air, water or admission to a hospital.

Including the three patients whose deaths may have been related to fungal infections, a total of 151 deaths have now been linked to the tornado.

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thomas.maugh@latimes.com