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Necrotizing cutaneous mucormycosis after a tornado in Joplin, Missouri, in 2011

Robyn Neblett Fanfair1, Kaitlin Benedict, John Bos

  • 1Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, USA.

The New England Journal of Medicine
|December 11, 2012
PubMed
Abstract

Insights

A fungal infection called mucormycosis caused severe skin infections in Joplin tornado survivors, leading to significant illness and death. Awareness of these mold infections after natural disasters is crucial.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Public Health

Background:

  • Mucormycosis is a serious fungal infection caused by molds found in the environment.
  • This study investigated a cluster of cutaneous mucormycosis cases following the May 22, 2011, Joplin, Missouri tornado.

Purpose of the Study:

  • To identify and characterize cases of mucormycosis in individuals injured during the Joplin tornado.
  • To determine risk factors and outcomes associated with this fungal infection in disaster survivors.

Main Methods:

  • Defined cases as soft-tissue infections with mucormycete evidence (culture, immunohistochemistry, DNA sequencing).
  • Conducted a case-control study using medical records and patient/control interviews.
  • Utilized DNA and whole-genome sequencing for species identification and strain analysis.

Main Results:

  • Identified 13 case patients; 38% died. Patients had multiple wounds, fractures, and trauma (blunt and penetrating).
  • Penetrating trauma and a higher number of wounds were significantly associated with infection.
  • Apophysomyces trapeziformis was identified in all cases; whole-genome sequencing revealed four distinct strains.

Conclusions:

  • A cluster of cutaneous mucormycosis cases occurred among Joplin tornado survivors, resulting in high morbidity and mortality.
  • Highlights the need for increased awareness of fungal infections, particularly mucormycosis, as a cause of necrotizing soft-tissue infections after natural disasters.

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