From Joplin, Missouri

Some survivors of last month's massive tornado that destroyed much of Joplin, Missouri are facing another indignity: an outbreak of a rare and frequently lethal fungal infection.

As a result of the recent devastating tornado in Joplin, ten people have been confirmed to have the fungal infection, mucormycosis. At least one of them has died, according to recent reports from the CDC. Health authorities fear other tornado victims may also be infected without realizing it.

"People who have wounds that are not improving should seek medical attention immediately," said Dr. Benjamin Park, a medical officer in the mycotic disease branch of The Centers for Disease Control and Prevention in Atlanta, which monitors outbreaks of fungal infections.

Murcomycosis, traditionally known as zygomycosis, is a family of rare diseases caused by fungi that live in soil. The pathogenic agents belong to the subphylum Mucormycotina and contain such genera as Mucor , Rhizopus , Absidia , or Cunninghamella .

A sporangium of a Mucoralean fungus

The most common form occurs when fungal spores are inhaled. The organisms take root in the sinuses, then spread to the lungs and throughout the body. It typically strikes people with weakened immune systems, such as those with cancer or diabetes, or who are on immune-suppressing medications because they have had organ transplants.

The more unusual variant, which has been affecting residents of Joplin, is the cutaneous form, in which fungal spores get under the skin. Experts believe that the tornado's 200 mph winds blew contaminated dirt and debris directly into victims' skin, or that it got into open wounds caused by flying debris.

Symptoms include redness or inflammation, swelling, tenderness or pain, heat in the area of the wound, and fever.

Treatment for both types typically involves surgical removal of dead tissue and intravenous infusion of the antifungal medication amphotericin; also, the oral drug, posaconazole can be used.

"These fungal infections are usually quite serious, and often have a case-fatality rate of 50 percent or higher," said Dr. Park of the CDC.

A week after the tornado, physicians observed three patients in the intensive care unit with what looked like white, fluffy mold growing on the surface of some of their wounds. The infections continued to spread even though the doctors removed the diseased skin. However, the infections slowed when amphotericin was administered.

The CDC sent four employees and two epidemiologists to Joplin to study the fungal outbreak.

Ref: LA Times and The Joplin globe

More information from the CDC.

More information on mycology products.

In 1944, Elizabeth Hazen, a PhD microbiologist from Mississippi, joined the research team at the New York State Public Health Department.

She had a growing collection of fungi and was studying the effects of possible antifungal agents.

However, Elizabeth needed someone to identify and isolate the anti-fungal activity occurring within samples. A biochemist, Rachel Brown from Albany, was asked to join in her endeavor to develop an effective anti-fungal drug.

Their research started by collecting soil samples from all over the country. Dr. Hazen cultured actinomycetes (microorganisms most frequently having anti-fungal properties) from each sample and tested them to see if there was any anti-fungal activity. If there was any activity against fungi, extracts were prepared and tested for toxicity. She would expose the organisms against two fungi , Candida albicans and Cryptococcus neoformans .

Themost promising microorganism was isolated from the soil of a friend's dairy farm. Dr. Hazen named it Streptomyces noursei , after William Nourse, the farm's owner. Hazen and Brown found one of the extracts from this organism to be especially active against Candida albicans . In 1950, they presented their discovery, the first safe and effective anti-fungal antibiotic, to the National Academy of Sciences. They originally named it fungicidin, but later re-named it nystatin, in honor of their employer, the New York State Department of Public Health (now known as the Wadsworth Center).

After several animal and human studies proved satisfactory to the FDA, nystatin was introduced to the market through E.R. Squibb & Sons in 1954, to be used for fungal infections of the skin, mouth (thrush), vagina, and intestinal tract.

In addition to treating human fungal disease, nystatin has also been used to treat such problems as Dutch Elm's disease, for fungal inhibition in culture media (such as Thayer Martin), and to restore water-damaged artwork from the effects of mold.

Hazen and Brown donated their royalties, over $13 million, to a trust fund that was established under both Hazen and Brown for science and advancing women in science.

More information on mycology products.

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