[1]
Date: Thu 9 Jun 2011

Source: Yahoo News [edited]
news.yahoo.com/s/ac/8612835_deadly_fungus_strikes_joplin_tornado_survivors_volunteers


The Greene County (Missouri) Health Department has issued a memo to health care workers who are treating injured victims of May's [22 May 2011] deadly Joplin
[Missouri] tornado, warning them that a powerful fungus has infected patients'
wounds.

The Springfield News-Leader reports as many as 9 cases have been reported in
tornado victims across the area in various hospitals. Once the aggressive fungus
-- [of the class] _Zygomycetes_ -- enter the body, they cause the death of
infected cells. 3 or 4 patients, who otherwise would have survived their wounds,
have died from [the fungal infection].

If the fungus stays in a limb, like an arm or leg, some treatments have
necessitated amputation to save the patient. Others with wounds near the head
weren't so lucky -- as soon as brain tissue started dying, it was too late to
save the patient.

The National Institutes of Health says this rapid form of infection most often
occurs in patients with suppressed immune systems. One study in 2009 noted a
diabetes patient who died of the fungal infection at age 48. Despite being
treated early, the man's health rapidly declined as the fungus spread through
his lungs.

Infections spread through the blood and affects blood circulation. It is unknown
how many people may be suffering from infections, but the problem doesn't stop
with those injured by the tornado.

KYTV in Springfield reports those helping with cleanup efforts may become
scratched by nails or splinters and any fungus residue on those objects may
infect someone.

Anyone with diabetes should be extremely careful. The National Institutes of
Health lists severe symptoms of the infection: fever, headache, sinus pain, and
swelling. Complications that can arise from these fungal infections include
nerve damage, blindness, blood clots to the brain and lungs, or even death in
extreme cases.

Cases of the deadly fungal infection have shown up in massive disasters before
such as the 2004 tsunami off the coast of Indonesia.
Health officials in Greene County stated in their memo that this particular
infection is "invasive" and that aggressive treatment may be needed "within 24
hours" of recurring symptoms.

Any patients suspected of having this infection have been told to seek the
guidance of a trauma surgeon or the infectious disease doctor on call.

[Byline: William Browning]

--
Communicated by:
Lewis B Sckolnick
<info@runanywhere.com>

******
[2]
Date: Fri 10 Jun 2011

Source: 10News.com/San Diego News, CNN report [edited] www.10news.com/news/28202507/detail.html


Officials said Friday [10 Jun 2011] that 8 people injured by the devastating
Joplin, Missouri tornado have contracted a rare fungal infection, and 3 have
died, The US Centers for Disease Control and Prevention is assisting state and
local health officials, who are investigating the cases.

All 3 individuals who died had serious injuries, as well as fungus, Jasper
County Coroner Rob Chappel said. One of the deaths was caused by the infection,
called mucormycosis, but the cause of death for the other 2 victims has not been
determined, he said. All 8 patients sustained multiple injuries and secondary
wound infections, according to the Missouri Department of Health and Senior
Services. The infection can occur when dirt, vegetation, or other material
becomes lodged under the skin.

The death toll from the May tornado stood at 151 on Friday [10 Jun 2011].

CDC researcher Dr Benjamin Park told CNN that in most cases, people with
weakened immune systems inhale [fungal] spores and develop sinus or nasal
infections that spread. The Joplin cases apparently are a form of the severe
infection that appears with soft-tissue injuries.

A [fungal] spore on the tip of a tree, for example, can pierce the skin, Park
said. The infection can progress a few weeks later and cause significant damage
to tissue, which can require hospitalization, antibiotics, and even removal of
the tissue.

Although this is a rare infection, it can have extremely serious consequences,
requiring prompt medical attention, Park said. Anyone in the tornado area that
is suffering wounds that are not healing should seek prompt medical attention,
he added.

Deep skin fungal infection does not spread from human to human, Missouri
officials said. No cases were attributed to air, food, or water.

[Byline: Miriam Falco, Divina Mims]

--
Communicated by:
Denis Green
<legion@q-net.net.au>

******
[3]
Date: Fri 10 Jun 2011

Source: Los Angeles Times [edited]
www.latimes.com/health/la-he-joplin-fungus-20110611,0,5212890.story


Some survivors of last month's [May 2011] massive tornado that destroyed much of Joplin, Missouri, are facing another indignity: an outbreak of a rare but
frequently lethal fungal infection. 8 people have been confirmed to have the
infection, known as mucormycosis, and at least 3 of them 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.

Mucormycosis, also 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 [322 km/h] 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 area of the wound, and fever.

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

The 1st 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 3 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.

Schmidt said he ultimately observed 5 cases at Freeman, out of 1700 patients
treated there after the 22 May 2011 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 3 deaths were due to the
fungus. "But it was probably a contributing factor in their demise," he said.

Pathologists at Freeman have confirmed the identity of the fungus in one case,
and samples from all of the patients have been sent to CDC for further study.

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

[Byline: Thomas H Maugh II]