Mucormycosis after a Tornado in Joplln, Missouri

摘要

to the editor: Neblett Fanfair et al. (Dec. 6 issue) report that Apophysomyces trapeziformis was a cause of necrotizing cutaneous mucormycosis after an EF-5 tornado. We agree with their rigorous case-control study design and echo their emphasis on timely diagnosis along with aggressive debridement. We cared for two of the case patients described and wish to bring attention to the source and role of coinfection with other pathogens and the need for staged debridement in patients injured in environmental disasters. Among the other pathogens, we identified multi-drug-resistant gram-negative organisms that typically exist in water or soil. Because the tornado hit an agricultural area, we suspect that agricultural antibiotic use, other environmental factors, or both may have had a role in the type and scope of pathogens that we encountered.