At least eight victims of the tornado in Joplin have become ill with suspected fungal infections, according to the Missouri Department of Health and Senior Services.
Three of those people died, although the Jasper County coroner said so far, only one victim is believed to have died directly as a result of the fungal infection. The other two victims, who died in a neighboring county, endured other injuries or had other medical conditions that could have contributed to their deaths.
Dr. Uwe Schmidt, a specialist in infectious diseases at Freeman Health System in Joplin, said he has treated five patients with an invasive fungal infection known as zygomycosis, which they likely contracted from soil or debris that came into contact with soil.
This diagnosis has not yet been confirmed, however. Samples were sent to the U.S. Centers for Disease Control and Prevention in Atlanta for testing.
Schmidt said the patients were admitted on May 23, and the staff started noticing mold growing out of their wounds one week later.
"These people had multiple severe lacerations and wound infections," Schmidt said. "Biopsies indicated tissue invasion by a fungus." In some cases, damage to the tissues is severe.
Fungus Everywhere, but Few People Get Sick
The fungi that cause zygomycosis, also known as mucormycosis, are found in soil almost everywhere.
"Under normal circumstances, they very rarely cause human disease," said Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University School of Medicine. "The only people who usually get infected with these fungi are people who are immunocompromised."
"People with normal immune systems are only at risk with overwhelming exposure or with significant trauma," said Dr. Michele Morris, clinical chief of the Division of Infectious Diseases at the University of Miami Miller School of Medicine.
The tornado that ripped through Joplin provided the perfect opportunity for the fungi to enter the body through open wounds, Schaffner said.
In some cases, the fungus can spread into the blood and cut off blood supply and then invade the internal organs, but that hasn't happened to any of Schmidt's patients yet.
Mucormycosis is also often seen in patients with very severe, uncontrolled diabetes. It can cause infection of the sinuses and brain.
The infection doesn't spread from person to person and does not invade normal, intact skin.
Morris said treatment generally includes antifungal medications and surgical removal of dead tissue. Keeping wounds very clean is another key component of treatment.
Doctors say it's very important for people who do have wounds to keep a close eye on them.
"If they have wounds which they suffered during the tornado that aren't healing and are getting worse with increasing redness, swelling or tissue necrosis, they should be evaluated by a physician and should be biopsied," said Schmidt.
They also stress there isn't a need to panic.
"This is not an infection likely to spread through any population," said Morris.