![]() 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. None of the infections were found in persons cleaning up debris. Early diagnosis, aggressive surgical debridement, and administration of systemic antifungals have been associated with improved outcomes ( 1).Ĭutaneous mucormycosis has been reported after previous natural disasters ( 3,4) however, this is the first known cluster occurring after a tornado. The case-fatality rate for cutaneous mucormycosis has ranged from 29% to 83%, depending on severity of disease and underlying medical condition of the patient ( 1). trapeziformis often is associated with immunocompetent hosts after traumatic implantation of fungal spores ( 2). Although cutaneous mucormycosis often is opportunistic, affecting patients with diabetes, hematologic malignancy or solid organ transplant ( 1), A. Further laboratory and epidemiologic studies are ongoing, including case-control studies to evaluate risk factors for infection.Ĭutaneous mucormycosis is a rare infection caused by fungi of the order Mucorales, which typically are found in soil and decaying wood and other organic matter. Ten patients required admission to an intensive-care unit, and five died.ĬDC 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. Two patients had diabetes, and none were immunocompromised. Wooden splinters were the most common foreign body, found in the wounds of four patients. Post-trauma wound management included surgical debridement for all 13 patients and removal of a foreign body from six. The 13 patients had an average of four wounds documented in the medical chart when they were examined at the emergency department. ![]() Injuries sustained during the tornado included lacerations (12 patients), fractures (11), and blunt trauma (nine). The median age of the patients was 48 years (range: 13-76 years) seven were female, and all were white. The field team reviewed medical charts to describe the 13 confirmed cases. No additional cases have been reported since June 17. A confirmed case was defined as 1) necrotizing soft-tissue infection requiring antifungal treatment or surgical debridement in a person injured in the tornado, 2) with illness onset on or after May 22, and 3) positive fungal culture or histopathology and genetic sequencing consistent with a Mucormycete. On June 14, a CDC field team arrived in Missouri to assist with the onsite investigation.Īs of July 19, a total of 18 suspected cases of cutaneous mucormycosis had been identified, of which 13 were confirmed. By June 10, eight patients with necrotizing fungal soft-tissue wound infections caused by Mucormycetes (formerly Zygomycetes) were identified. MODHSS initiated active surveillance for such infections at hospitals and laboratories serving patients injured in the tornado, and CDC began assisting MODHSS with identification of fungal isolates. On June 3, a local physician notified the Springfield-Greene County Health Department and the Missouri Department of Health and Senior Services (MODHSS) of two patients hospitalized with tornado injuries who had suspected necrotizing fungal soft-tissue infections. a tornado with winds >200 mph struck Joplin, Missouri, injuring approximately 1,000 persons and causing 159 deaths. Notes from the Field: Fatal Fungal Soft-Tissue Infections After a Tornado - Joplin, Missouri, 2011 For assistance, please send e-mail to: Type 508 Accommodation and the title of the report in the subject line of e-mail. Persons using assistive technology might not be able to fully access information in this file.
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