Saturday, October 20, 2012

Fungal Meningitis Linked to Injectable Steroid Contamination

"The fact that we are dealing with contaminated medication, the fact that so many people have been exposed and the fact that this is a rare infection -- there are not many doctors out there who have any experience treating an infection like this, and that leads to a number of challenges for us," said Dr. John Jernigan.
The growing outbreak, which spans 16 states, has been linked to contaminated vials of methylprednisolone acetate, an injectable steroid used to treat back and joint pain.

Sealed vials of the steroid, made by the New England Compounding Center in Framingham, Mass., contained Exserohilum rostratum, a fungus found in soil and plants. It's unclear how the fungus landed in the sealed vials.

The U.S. Centers for Disease Control and Prevention has confirmed 26 cases of Exserohilum meningitis, as well as one case each of Aspergillus and Cladosporium meningitis.

The New England Compounding Center has recalled all its products and shut down operations. NECC and its executives face a civil suit in Massachusetts that seeks to freeze the officers' personal assets. Florida, which has had three deaths and 17 cases, has barred NECC from doing business in the state.

As many as 14,000 patients are thought to have received injections of the suspect steroid.

Seventy-six clinics in 23 states that received methylprednisolone acetate from the recalled lots have been instructed to notify all affected patients. The "potentially contaminated injections were given starting May 21, 2012," according to the CDC.

Meningitis affects the membranous lining of the brain and spinal cord. Early symptoms of fungal meningitis -- including headache, fever, dizziness, nausea, sensitivity to light, stiff neck, weakness or numbness, slurred speech and pain, and redness or swelling at the injection site -- can take more than a month to appear.

The longest duration from the time of injection to the onset of symptoms in the current outbreak is 42 days, according to the CDC's Dr. Benjamin Park.

"But we want to emphasize that we don't know what the longest will be," he added, stressing that patients who received injections of the recalled drug should stay attuned to the subtle symptoms "for months."

Fungal meningitis is diagnosed through a spinal tap, which draws cerebrospinal fluid from the spine that can be inspected for signs of the disease. Once detected, it can be treated with high doses of intravenous antifungal medications.

Unlike bacterial meningitis, fungal meningitis is not transmitted from person to person and only people who received the steroid injections are thought to be at risk.

More information:
» CDC Multistate Meningitis Case Map
» Meningitis Outbreak Pushes Researchers

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