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Awareness of disaster-associated fungal infections can drive early detection
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Disaster-associated fungal infections are not common, but health care providers should be mindful of the possibility of such infections because of their potential for serious illness and death, according to a CDC report published in Emerging Infectious Diseases.
The report identified and evaluated the three main types of natural disasters — geophysical, hydrometeorological and geomorphological — and outlined the ways in which these disasters might displace pathogenic fungi from their natural environments. The disruption of these fungi can result from small-scale disturbances such as construction or excavation, as well as from earthquakes, tsunamis or tornadoes.
One route through which fungi can cause infection after a disaster is inhalation and subsequent respiratory infection, which can range from asymptomatic to life-threatening. The researchers cited two cases in which natural disasters (an earthquake and a dust storm) have led to outbreaks of coccidioidomycosis (valley fever).
Inhalation-associated fungal infections also have been linked to near-drowning in cases of disaster-related flooding. In these scenarios, contaminated or debris-laden water may be aspirated, leading to “tsunami lung.” Etiology of tsunami lung can be related to bacteria, fungi or both.
Pseudallescheria boydii is thought to be the most common species of fungus involved in infections related to near-drowning, although pathogens such as Aspergillus fumigatus also have been implicated in the infections of near-drowning victims.
The report also discussed disaster-related soft tissue fungal infections, which generally are associated with wounds infected by contaminated water, soil or detritus. Although such infections are more often bacterial in origin, fungal infections occur and can be easily mistaken for bacterial infection, especially at the early stages.
One of the more common disaster-related soft tissue fungal infections is mucormycosis, which has case-fatality rates of approximately 30%. This infection has occurred in clusters after a 1985 volcanic eruption in Colombia, a 2011 tornado in Joplin, Mo., and the 2004 Indian Ocean tsunami. Fusarium also has been linked to soft tissue disaster-related fungal infections.
The report also discussed disaster-related fungal infections spread through health care measures, such as spinal anesthesia associated with an outbreak of Aspergillus meningitis during the 2004 Indian Ocean tsunami. Fungal infection also can spread through indoor mold exposure, as well as global climate change.
The researchers urged clinicians to be proactive in situations where a disaster-related fungal infection should be suspected and to promptly begin appropriate antifungal therapy.
“A fungal infection should be considered early if a patient has a persistent or progressive infection that is not responding to initial antibacterial treatment,” the researchers wrote, “particularly because rapid diagnosis and administration of appropriate antifungal therapy can improve patient outcomes.”
Disclosure: The researchers report no relevant financial disclosures.
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