Fungus Risk for Tsunami Survivors

The Lancet reports the case of an injured Australian man who has since been treated for mucormycosis. It is thought wounds he suffered when the waves struck became contaminated and doctors say similar cases will add to the death toll in affected areas. More cases of this disease have also been reported in the region.

A fungus found in soil and rotting vegetation causes the infection, which can prove fatal in up to 80% of cases. The severity of cases depends on the infection site and the patient’s immune system. The 56-year-old man was transferred from Sri Lanka to the infectious diseases unit at St George Hospital in Sydney for treatment after being injured when the tsunami hit on 26 December. His beach hut had collapsed and he was pushed through the debris, ending up in a paddy field a kilometre away.  The man repeatedly ingested, but did not inhale, seawater.

His wounds were irrigated with bottled water, before being bandaged, and he received additional first aid at a regional hospital before being transferred to another unit in the Sri Lankan capital, Colombo. He was transferred to Sydney on 31 December, where he was found to be stable apart from a high temperature. He had deep soft-tissue injuries on his right thigh and left hip, as well as many superficial cuts and bruises across his body.

‘Difficult to Diagnose’

However, on his fifth day in hospital, wounds on the patient’s left chest and right shoulder were found to be infected with the mucormycosis fungus. Doctors removed the infected tissue and gave the man hyperbaric oxygen therapy, to stimulate the growth of new blood vessels. Three weeks later, he is still recovering in hospital. The specialists treating him said the man had probably acquired the fungal infection from contamination of his wounds at the time of the 2004 tsunami, or during first aid treatment.

They warn other people injured in the tsunami might also have invasive fungal wound infections which could go unnoticed unless tissue samples are analyzed. Dr Pamela Konecny, one of the team who has been treating the patient, said: “Wound infections, both bacterial and fungal, will undoubtedly add to the illness and mortality already recorded in tsunami-affected areas. “Other cases of mucormycosis might develop in survivors, but this disease remains difficult to diagnose and even harder to treat, particularly in those who remain in the affected region.” She added: “This case shows that travellers repatriated from affected areas could be good predictors of infections in survivors because they may have greater access to advanced diagnostic services than do those who remain.”

Ron Behrens, of the London School of Hygiene and Tropical Medicine, said it was to be expected after a tsunami. “It is very typical to have contamination with a range of environmental organisms which then lead to unusual injuries. “The problem is they are difficult to treat and difficult to diagnose. They often need multiple antibiotics, which can be very costly. “Tourists who head home will be fine, but the local population will probably not have access to the necessary treatment.”