Dr. Benjamin Park, chief of the Epidemiology Team at the CDC's Mycotic Diseases Branch, said the victims were infected when their injuries from the tornado were contaminated with debris from the storm, including gravel, wood and soil, as well as the aerosolized fungus.
Without the multiple and deep wounds caused the by the storm, cases involving fungal infection are rare, said Dr. Park, the senior author of the NEJM study and a contributing author of the PLOS One study. "A typical hospital might normally see one case in a year."
Engelthaler said Apophysomyces infections rapidly ravage the body, quickly sealing off capillaries, shutting off the blood supply and leaving tissue to rot. Physicians try to get ahead of the infection by surgically removing sections of dead, damaged or infected tissue, a process called debridement.
For example, Engelthaler said, one victim who suffered a deep wound to the upper right chest required a new titanium rib cage after the fungus rapidly destroyed skin and bones.
"It's unlike anything you've ever seen before," said Engelthaler, a former State of Arizona Epidemiologist and former Arizona Biodefense Coordinator. "It's unreal. It looks like there is no way this person can be alive."
The studies show the need for rapid and accurate identification of the exact mold causing an infection, since only two FDA-approved drugs amphotericin B and posaconazole are commonly used against mucormycetes, the group of molds that includes Apophysomyces and causes mucormycosis.
"It is not known whether the outcomes for these case patients would have been different if mucormycete-active agents had been used initially," said the NEJM study. "Th
|Contact: Steve Yozwiak|
The Translational Genomics Research Institute