Fungal Meningitis Outbreak Claims 14 lives

As of Oct. 11, the death count from the recent fungal meningitis outbreak totals 14, with 169 infected across 11 states, according to the U.S. Centers for Disease Control. The victims contracted the disease after receiving spinal injections prescribed for acute back pain, although one victim’s injection was for ankle pain. The steroid injection, manufactured by the New England Compounding Center located in Framingham, Mass., was used on as many as 14,000 people between May 21, the first date the contaminated injections were given, and their recent recall.

The contaminated product, methylprednisolone acetate, was shipped to 76 clinics in 23 states. All clinics have been instructed to notify patients. Six of the fatalities and 49 of the cases have come out of Tennessee, although other infected patients have been diagnosed in Michigan, Virginia, Florida, Maryland, Indiana, Minnesota, North Carolina, New Jersey, Ohio and Idaho.

Meningitis is a disease which affects the lining of the brain and spinal cord and includes symptoms of headache, fever, nausea, light sensitivity, stiff neck, numbness, slurred speech, pain and redness or swelling at the injection site. Symptoms, however, can take months to appear, and proper diagnosis can only be made through a lumbar puncture, also known as a spinal tap. Thus far, the longest duration between injection and onset of symptoms in the current outbreak was 42 days, according to the CDC.

Fortunately, unlike bacterial meningitis, fungal meningitis is not contagious. The cases reported can all be linked back to the contaminated injections. Any person who received the injections, therefore, should continue to proceed with extreme caution, watching for slight symptoms in partnership with his or her health professional.

As of Oct. 10, the CDC’s fungal disease laboratory has identified two fungi present in the investigation: Exserohilum and Aspergillus. Unfortunately, there is no vaccine or preventative drug available for those who may have been exposed, but treatments do exist for those who become infected. The meningitis must be confirmed, however, because the two available antifungal medicines—voriconazole and amphotericin B—carry such severe side effects that the medical community has even nicknamed the latter as “ampho-terrible.” Both can cause damage to the patient’s kidneys and liver. Treatment typically consists of a months-long intravenous drip.

At this point it is unclear how the steroids became contaminated with the fungi, although the CDC continues to investigate, with the assistance of the Food and Drug Administration and the Massachusetts Department of Health. Currently, compounding facilities such as the one who manufactured the tainted injections do not fall under the same FDA authority as other drug manufacturers. Legislators, however, are calling for a congressional investigation and discussion into the lack of federal regulation over compounding facilities.

References:

“Multistate Meningitis Outbreak Investigation.” Oct. 12, 2012. Center for Disease Control. http://www.cdc.gov/HAI/outbreaks/currentsituation/

Moisse, Katie. “Fungal Meningitis Outbreak: 170 Cases, 14 Deaths.” Oct. 11, 2012. ABC News. http://abcnews.go.com/Health/Wellness/fungal-meningitis-outbreak-170-cases-14-deaths/story?id=17454314#.UHiYKVHuz3A

Jain, Manoj. “Diagnosing and Treating Meningitis.” Oct. 12, 2012. The Huffington Post. http://www.huffingtonpost.com/manoj-jain-md-mph/meningitis_b_1957571.html

Khan, Amina. “Meningitis Outbreak: Some Questions and Answers.” Oct. 12, 2012. Los Angeles Times. http://www.latimes.com/news/science/la-sci-meningitis-q-and-a-20121012,0,58615.story