LIFE-THREATENING MOLD INFECTIONS IN PATIENTS INJURED IN 2011 JOPLIN TORNADO

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 Mucormycosis is a form of infection caused by a group of molds (fungi) such as Mucor, Rhizopus, Absidia, and Apophysomyces. Mucormycosis is also known as Zygomycosis. Mucormycosis is an increasingly common and life threatening infection among immuncompromised patients such as HIV patients, patients on immunosuppressive drugs for bone marrow or organ transplants, patients with certain cancers such as leukemia or lymphoma, or severe malnutrition.


Mucormycosis infections can also cause life threatening infections in patients with trauma. On May 22, 2011, a 200 miles per hour tornado struck Joplin, Missouri, killing 160 and injuring more than 1,000 people. By June 3, 2011, several injured patients had already developed severe soft tissue Mucormycosis infections. Further study found 13 tornado injured patients admitted to the intensive care unit (ICU) with severe infections of Apophysomyces trapeziformis. Seven patients developed severe septic (bloodstream) infections of Apophysomyces trapeziformis and 5 died within 2 weeks after mold infection was noticed. Among the 13 ICU patients infected with Apophysomyces trapeziformis, 12 had experienced lacerations, 11 fractures, 6 puncture injuries and 5 had crush injuries. The median number of injury sites per patient were 5 (range of 1 to 7). Ages among these 13 patients ranged from 13 to 76 years.

Bacteria and mold infections represent severe risks to trauma patients. Physicians, nurses and other health care personnel need to be very alert for bacterial and mold infections in trauma patients and provide rapid antibiotic and other treatment when needed. Proper wound care, clean hospital room conditions, proper handwashing and adequate patient hydration and nutrition are all important to prevent and treat mold and bacteria infections in trauma patients.

Robyn Neblett Fanfair et al. Necrotizing cutaneous mucomycosis after a tornado in Joplin, Misouri, in 2011. New England Journal of Medicine December 6, 2012;367(23):2214-25.

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