Face off: Missouri tornado spawned scary fungus

Faces define people the most (well, unless you’re Representative Anthony Weiner). Makeup can completely transform a person. Tabloids always flash pictures of celebrities without make-up to shock the public. If you’re like me, the number of skin care products in your bathroom equals your age, because our faces are probably the most crucial aspect of our being.

So can you imagine losing your face?

Mucormycosis is a destructive fungal infection that can cause a person to lose his or her face or other body parts. The June 10, 2011, LA Times had a story about some deaths from mucormycosis. This rare fungal disease is thought to have been spawned by the tornado that devastated Joplin, Missouri, in May.

Mucormycosis is very rare– so rare, in fact, that the LA Times article misspelled it twice as “murcomycosis.” (Sorry, it happens to the best of us.) In 2008, I saw a news report about “the man without a face”– he had mucormycosis. Other than that, most major medical centers only ever see one to two cases of this horrible infection.

So it’s very odd that as of June 12, 2011, there have been eight reported cases of mucormycosis in Joplin, with growing concern there will be more. Mucormycosis is part of a group of fungi that live in the dirt or on decaying vegetation. They grow rapidly, and their spores are released into the air.

The mucormycosis in Joplin are cutaneous (i.e. skin) infections; the fungi were probably driven into the skin by the 200mph winds of the twister. Another portal of entry might be wounds. Symptoms start five to ten days after exposure: red, hot, swollen skin. The docs in Joplin noticed a fluffy white mold growing on the surface of the infected skin, which is how they made the diagnosis.

The fungi cause the skin and underlying tissue to die quickly. In a sense it’s like the “flesh-eating bacteria,” and so immediate surgery is necessary to remove the dead tissue and the fungi. Thus an arm, a leg, a huge chunk of the chest, or any body section might be lost. See why it’s so scary?

Also known as zygomycosis, the fungi more often infect the face via the nose. Because the spores are inhaled, they can proliferate in all the sinuses to cause fever, nasal congestion, runny nose, and facial pain. These nasty critters then wipe out the internal structure of the nose, cause Marcia Brady-esque nose swelling, and result in bruises and redness. When they spread to the mouth, they destroy the palate and form hard black scars. If the spores spread to the eye sockets, they can cause eye swelling and blindness. They rarely go to the brain, but if they do, it’s usually fatal.

Because mucormycosis is so devastating, I don’t normally prescribe nasal steroids to folks at risk of the disease. Immunocompromised people (due to steroids, cancer, chemotherapy, HIV, stem cell transplants, or solid organ transplants like a kidney, lung, or liver) are at higher risk of mucormycosis. Diabetics, especially those in diabetic ketoacidosis (a.k.a DKA), are particularly at risk.

In addition to surgery, antifungal medications can treat the problem. Often, though, the damage has already been done.

Interestingly, on June 12, 2011, the woman mauled by a chimpanzee got a new face— the third-ever face transplant in the US. I hope none of the tornado survivors will need that. Losing face in Asia is one thing, but contracting mucormycosis is something no one should have to face.
Dr. Hook cracks a joke or two, but he's a respected physician with an interesting website, drjohnhong.com.