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Two epidemiologists from the Centers for Disease Control and two other CDC staff members are investigating the fungal infections that have cropped up in a very small number of people in Joplin who sustained injuries in the May 22 tornado. So far, 18 cases of fungal infections in patients are being scrutinized. Of those 18 patients, 10 have confirmed cases of a rare fungal infection of the skin. Dr. Robyn Fanfair is one of the CDC physicians who is in Southwest Missouri. She describes how the CDC is handling this investigation.
“Our investigation includes looking at the charts of patients. We’re also interviewing patients, when possible. The CDC laboratory based in Atlanta is testing all samples from patients to confirm the diagnosis. We’ve also been meeting with local health department officials and physicians who cared for these patients. Finally, what we plan to do is to perform a study that compares patients with the fungal infection to other people also injured in the tornado but who did not develop the fungal infection.”
This fungal infection is very rare and is not contagious. Dr. Fanfair says there’s no evidence that it has ever shown up in victims of natural disasters in the United States.
“There is literature about these type of infections. There were several cases reported after the tsunami in Southeast Asia in 2004 and there’s also been some cases reported after a volcanic eruption in Colombia in the 1980’s.”
Despite the fact that the fungal infection is rare in humans, Dr. Fanfair says the organism that causes the infection is found almost everywhere.
“Mucomycosis is definitely a rare infection. However, the group of fungi that causes this infection are ubiquitous. They exist in the environment. They can be found in soil, in association with decaying organic matter such as leaves, compost piles, and decomposing wood. So, what we think happened with these individuals is that their infection most likely occurred with the introduction of fungus-containing soil or wood into traumatic wounds or injuries of the skin. Speaking with physicians who have taken care of these cases, so many of these patients had foreign objects, foreign bodies in their wound, most commonly wood.”
The importance of studying these infections is evident to Dr. Eden Esguerra, an infectious disease specialist with Mercy St John’s in Joplin. She notes that it’s hard to observe the presence of the fungi in wounds.
“These wounds were taken care of in the usual way and some of these were sutured. After some time, this did not heal as expected. Unfortunately, as we have seen, there are those that washing it out with antiseptics, soap and water, was not enough. At the time of the initial treatment, what the gross eye saw, it may have looked well enough to have been sewn.”
Dr. Esguerra says in the future, medical personnel working in the field after a disaster should be aware of what happened to a handful of patients in Joplin.
“This is sentinel event. It can be very useful in the future, if it happens in some area from a medical standpoint. They will watch with people who sustain these injuries, they will be more careful. I think the whole world will be watching for what happened here in Joplin. This is of epic proportion.”
At this point, the CDC has not given a timeline for when it will complete its study. When the investigation is over and the CDC has recommendations, those will be sent to the local and state health departments.