joplin fungus deaths

Fungus hits the injured in Joplin

fungus is striking Joplin tornado victims and apparently has contributed to at least two deaths.

Doctors told the Springfield News-Leader that at least nine survivors may have contracted blood-vessel invading zygomycosis infections. Two women died this week in Greene County hospitals from massive fungal infections, the newspaper reported.

Tom Van De Berg, the deputy medical examiner for Greene County, told the newspaper that both women had suffered substantial injuries from the tornado.

The Springfield-Greene County Health Department declined to release information on the infections or the deaths, citing patient privacy concerns. But the health department issued an alert to doctors Monday to tell them to be on the lookout for fungal infections in tornado victims.

Meanwhile, the death toll from the tornado has risen to 151, Jasper County Coroner Rob Chappel said Thursday. Whether that toll includes the deaths linked to the fungus is unclear.

The health department's alert about the infection was written by Dr. Robert Johnson, trauma director at St. John's hospital in Springfield.

"Several patients have been identified recently with aggressive fungal soft tissue infections," the alert reads.

The affected patients suffered lacerations in the tornado that later became infected. Even after surgeries to clear the infections, they have reappeared within 24 hours, according to the alert.

"Despite aggressive surgical debridement, the wounds have continued to advance," the alert reads. "In some cases, gross fungal elements are visible with the naked eye."

Patients are being treated intravenously with the powerful drug amphotericin, which can have side effects affecting the kidneys. The earlier the treatment is started, the better off the patients are, doctors said.

Kendra Williams, of the Springfield-Greene health department, says the common fungus probably came from soil or vegetative materials imbedded in the skin by the tornado.

After the tornado, Freeman Health System in Joplin treated more than 1,700 patients. An infectious disease specialist there, Dr. Uwe Schmidt, says some wounds that were stitched up in that rush of patients had to be reopened because they weren't adequately cleaned and had debris in them. There is a higher risk of any type of infection in a closed wound.

The zygomycosis fungus is ubiquitous in the environment and is usually breathed in without problems.

Zygomycosis (ZEYE'-goh-meye-koh-suhs) infections are almost exclusively seen in people with highly compromised immune systems caused by health issues such as severe diabetes or bone marrow transplants, said Dr. Steven Lawrence, an infectious disease specialist at Barnes-Jewish Hospital.

It's possible that fungal infections can be complicated by bacterial infections, Lawrence said.

While noting that the investigation is in the early stages, the infections deserve to be closely watched because there could be a new pathogen involved, Lawrence said. If the outbreak of infections in Joplin is found to be caused by zygomycosis, it could mark an unprecedented national concern.

Even people who have experienced trauma should not be affected by the fungus if their immune systems are functioning properly.

"It would be really unusual for it to cause severe illness," Lawrence said. "If this does turn out to be the case, it would be a new problem on our radar screen we haven't really had to think about before."

Zygomycosis infections primarily infect the lungs and can travel into the blood, Lawrence said. In fewer instances it causes skin infections. The fungus can't be transmitted from person to person.

The fungus has historically not been a public health threat after natural disasters, Lawrence said.

With the increased death toll of 151, the Joplin tornado ranks as the seventh-deadliest to hit the nation, according to records kept by the National Weather Service.

The number includes the death of Riverside, Mo., police Officer Jeff Taylor, 31, who died June 3 of injuries he suffered in a lightning strike while helping with rescue efforts on May 23.