Wounded military servicemen are carried to a waiting ambulance bus from a U.S. Air Force C-17 medical evacuation aircraft at Ramstein Air Base in Germany.(Photo: By Jack Gruber, USA TODAY)
Military doctors are fighting to defeat a fungal infection that has
killed a handful of direly wounded troops in Afghanistan and infected
scores of others, often requiring that more of their limbs be cut away
to get above diseased areas.
Out of about 100 troops diagnosed
with the organism in the past three years, six have died either from the
fungus or other causes, says Navy Cmdr. Carlos Rodriguez, who has led
investigations into the infection. The victims are mostly soldiers or
Marines who suffer the worst wounds of the war, multiple amputations
from roadside bombs.
The fungi exist in the soil, and appear to be
prevalent in two hard-fought southern Afghanistan provinces of Helmand
and Kandahar. For the typical patient, the organism is blown deep into
blast wounds from buried explosives - known as improvised explosive
devices or IEDs - during foot patrols in those regions, Rodriguez says.
the stuff that lives in the dirt is getting jammed in there," says Army
Lt. Col. John Oh, director of trauma at the Army's Landstuhl Regional
Medical Center in Germany.
New guidelines were published Nov. 1
urging combat doctors to soak wounds with a diluted bleach called Dakins
consisting of sodium hypochlorite - a product once used on World War I
combat casualties - as a precaution to kill the fungus before it takes
The fungus is nearly undetectable at first because infected
tissue initially appears healthy. Surgeons cutting away dead bone and
flesh from blast wounds will stop short of areas that appear healthy to
preserve as much of a limb as possible.
"Even for somebody that's very experienced, it's hard to tell exactly what's dead and what's alive," Oh says.
days or even hours after the operation, infected tissue begins to die
and more of a limb must be cut away, doctors say. Making matters worse,
the two of the most common fungal organisms infecting troops - Mucor and
Aspergillus terreus - can take days or weeks to positively identify.
medical theory is that troops who suffer massive blast damage are
particularly vulnerable because their immune systems are weakened from
receiving large amounts of donated blood to stay alive.
said doctors have gotten better at identifying the fungus, but the
answer lies in killing or cutting out spores before they infect.
a result, the new guidelines urge military doctors in Afghanistan to
begin using the diluted bleach and anti-fungal medications on those
wounded troops who are most at risk for the infection: those suffering
multiple amputations and lower torso damage from blasts, and who have
received massive transfusions of blood.