(HealthDay News) – Following the 2011 Joplin, MO, tornado, a cluster of cutaneous mucormycosis fungal infections was observed, which correlated with substantial morbidity and mortality, according to research published in the Dec. 6 issue of the New England Journal of Medicine.

Robyn Neblett Fanfair, MD, MPH, from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues investigated a cluster of cases of cutaneous mucormycosis among persons injured in a tornado. Cases were defined as persons injured during the tornado who had soft-tissue infection with evidence of a mucormycete on culture or immunochemical testing plus DNA sequencing. Patients and hospitalized controls were interviewed and their medical records were assessed.

The researchers found that five of the 13 cases identified died. All case patients had been in the area that had sustained the most acute damage during the tornado. Patients were treated for a median of five wounds: 85% had one or more fractures; 69% had blunt trauma; and five (38%) had penetrating trauma. Infection correlated significantly with penetrating trauma in case patients vs. controls (adjusted odds ratio [OR], 8.8) and with an increased number of wounds (adjusted OR, 2.0 for each additional wound) in multivariate analysis. In all 13 case patients, DNA sequencing yielded Apophysomyces trapeziformis, with four separate strains present in the isolates.

“Increased awareness of fungi as a cause of necrotizing soft-tissue infections after a natural disaster is warranted,” the authors write. “Public health officials might consider surveillance for cutaneous mucormycosis after disasters in which persons have multiple penetrating traumas.”

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