Meningitis outbreak toll rises as complications surface

Nov 5, 2012 (CIDRAP News) – Fifteen more infections and one more death have been reported in a multistate fungal meningitis outbreak, according to federal health officials, and reports are starting to surface about serious complications in some patients.

The US Centers for Disease Control and Prevention (CDC) said today that the number of outbreak infections linked to tainted steroid injections has climbed to 419, with the number of deaths rising to 30. The number of affected states remained at 19, the same as last week.

In addition to use for back pain, the contaminated steroid injections implicated in the outbreak were also used to treat joint problems, and the CDC has been tallying the number of peripheral joint infections, which has risen by one case to 10, according to the latest report.

All but one of the confirmed infections so far has involved a type of black mold called Exserohilum rostratum, which had not been known to cause meningitis before. The same type of mold was found in unopened vials of recalled methylprednisolone acetate injections produced by New England Compounding Center (NECC) in Framingham, Mass.

Federal and state investigation of NECC has found bacterial contamination in two of the company's other products. The events have spurred wider concerns about compounding pharmacy practices, which have temporarily shuttered another compounding pharmacy and led to a recall of all its products. The outbreak has also spurred calls for tighter federal oversight of compounding pharmacies.

In the latest twist, doctors who have been treating patients sickened in the outbreak are seeing worrisome complications in some, including epidural abscess where the contaminated drug was injected into the spine and arachnoiditis, a nerve inflammation near the spine, the New York Times reported on Nov 2.

Tom Chiller, MD, deputy chief of the CDC's mycotic diseases branch, said many of the patients with epidural abscesses have been from Michigan, which has the highest number of infections so far, according the Times report. He said the CDC is gathering more information about the number of and clinical course of the patients who have the abscesses as the agency develops treatment advice.

The complication is puzzling for physicians, because the abscesses developed while patients were already on powerful antifungal medications, requiring some patients to return to the hospital for more treatment and sometimes surgery, the Times said.

In addition, experts said that diagnosing the abscesses can be difficult. The primary symptom is severe injection-site pain, but because the lesions are internal with no visible sign on the skin, they require magnetic resonance imaging (MRI) for detection.

Chiller told the Times that the other complication, arachnoiditis, can cause severe pain, bladder problems, and numbness.

In a report by National Public Radio (NPR), Chiller said it can be difficult for doctors to diagnose epidural abscesses and arachnoiditis, because many of the patients who received contaminated injections were already under treatment for back pain, so sorting out the source of the pain can be challenging.

See also:

Nov 5 CDC fungal meningitis outbreak update

Nov 2 Times story

Nov 3 NPR report

Nov 2 CIDRAP News story "Bacteria found in two drugs as meningitis outbreak tops 400"

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