Rare Infection Strikes Victims of a Tornado in Missouri

By: Timothy Williams

Several people who were injured when a tornado devastated Joplin, Mo., last month have become sickened by an uncommon, deadly fungal infection and at least three have died, although public health officials said Friday that a link between the infection and the deaths was not certain.

Also on Friday, the death toll from the tornado was raised to 151.

Eight tornado victims have fallen ill from the mysterious infection, and each had “multiple injuries and secondary wound infections,” said Jacqueline Lapine, a spokeswoman for the Missouri Department of Health and Senior Services. Citing confidentiality rules, officials declined to discuss the treatment or condition of the patients.

The fungus that causes the infection, which is believed to be mucormycosis, is most commonly found in soil and wood, according to the Centers for Disease Control and Prevention, which is studying samples from the eight Joplin patients. “It is a very aggressive and severe infection,” said Dr. Benjamin Park, chief of the epidemiology team in the C.D.C.’s Mycotic Diseases Branch. “It is also very rare.”

Mucormycosis enters the body either via a puncture wound or when a victim breathes in its mold spores, officials said. Those who have weakened immune systems have a mortality rate as high as 90 percent. Other people at risk include those with diabetes or cancer and burn victims.

On Friday, the Jasper County coroner’s office said that 151 people died in the May 22 tornado. It is revising the toll as additional death reports come in from hospitals where tornado victims had been taken.

That figure includes the three dead victims who appear to have had the fungal infection — though the cause of those deaths has not yet been established because they had other injuries as well, said Rob Chappel, the Jasper County coroner.

Even before the updated death toll was released Friday, the tornado was the deadliest in the United States since modern record-keeping began. As many as one-third of the town’s buildings were damaged, including the city’s main hospital, St. John’s Regional Medical Center. St. John’s, which lay in the path of the tornado, was evacuated.

Health officials said they were not aware of any other cases of mucormycosis arising from the series of tornadoes that struck the Midwest and the South this spring, killing hundreds of people and injuring thousands.

“Although this is a naturally occurring infection, to have a cluster which potentially involves this many people is highly unusual,” Dr. Park said.

Health officials said even busy hospitals around the country might see no more than a case or two of mucormycosis each year. They have asked that tornado victims from Joplin who have wounds that have failed to heal properly see a doctor immediately. It cannot be spread from person to person.

Mucormycosis and similar fungal infections that enter the skin through puncture wounds can usually be prevented once a wound is disinfected in a hospital, health officials said. But during a natural disaster, when there is confusion and a shortage of medical personnel and supplies, wounds are sometimes treated inadequately. In Joplin, staff members from St. John’s treated some of the thousands injured at makeshift clinics.

Mucormycosis, which can have an incubation period of two weeks or more, must be treated with intravenous antibiotics and in some cases the removal of the affected tissue.

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