NEWS SCAN: Fungal meningitis update, anthrax response guidance, pneumonia outbreak, more E coli cases

Oct 18, 2012

Fungal meningitis cases increase; clinicians describe fatal case
The number of patients sickened in a fungal meningitis outbreak linked to contaminated steroid injections has risen to 257, an increase of 10 from yesterday, according to the latest update today from the US Centers for Disease Control and Prevention (CDC). One more death was reported, raising the toll to 20, and New York reported its first cases, becoming the 16th state affected. One more peripheral joint infection related to the contaminated steroids was reported, with that total now at three. The infections have been linked to three lots of methylprednisolone acetate injections from New England Compounding Center (NECC) that were used to treat back pain and joint problems. Investigators from the CDC and the Food and Drug Administration (FDA) also said today that tests have confirmed the fungus Exserohilum rostratum in an unopened vial from 1 of the 3 implicated lots. Previous tests had identified fungal contamination in multiple sealed vials, but additional tests were under way to identify the species. Among 47 patients who have lab-confirmed cases, Exserohilum was found in all but two specimens, with those involving Aspergillus fumigatum and Cladosporium.
Oct 18 CDC update
Oct 18 FDA statement
In another development, a medical team from Johns Hopkins University today published a clinical report on one of the index patients, a 51-year-old woman who died, in Annals of Internal Medicine. The woman got sick a week after receiving a cervical epidural injection on Aug 31. After hospitalization, her neurologic symptoms continued to worsen despite treatment and she died 10 days later, the same day Exserohilum was found in tests of her cerebrospinal fluid. An autopsy revealed brainstem necrosis with fungal invasion and hemorrhagic infarction of the brain and spinal cord. The authors said the case shows how aggressive and invasive Exserohilum species can be, with an incubation time that seems shorter than that of an organism that caused a smaller fungal meningitis outbreak in 2002.
Oct 18 Ann Intern Med abstract

Anthrax guidance outlines steps for protecting first responders
The US Department of Homeland Security (DHS) recently issued guidance for protecting responders such as hazardous materials workers, law enforcement personnel, and medical workers in a major aerosol anthrax attack in a large city, focusing on the first week following the event. The 21-page document reflects the work of a federal interagency working group that included biodefense, infectious diseases, and occupational health experts, who cautioned that the advice could change depending on new evidence about exposure risk and the effectiveness of protective measures. The guidance covers a host of issues related to vaccination, antibiotic prophylaxis, personal protective equipment, decontamination, and administration and engineering controls for protecting responders. While acknowledging that exposure risks will be uncertain in the immediate aftermath of an event, the authors suggest the use of two tiers for planning purposes: category 1 activities, such as working in areas at the point of initial release, and category 2 activities, such as working in secondary areas and conducting work that isn't likely to generate aerosols. The report notes that guidance is being developed for pre-event vaccination for first responders.
DHS guidance for protecting anthrax attack responders

CDC profiles 2011 pneumonia outbreak in West Virginia kids
Mycoplasma pneumoniae
was the culprit in a 2011 pneumonia outbreak in West Virginia involving 125 cases, says a report in this week's Morbidity Mortality Weekly Report (MMWR). The CDC was notified Oct 28, 2011, by the West Virginia Department of Health and Human Resources of an increase in pneumonia cases in school-aged children in two rural counties, Gilmer and Calhoun. On Nov 16 the two agencies began active surveillance in all schools as well as all primary care and emergency facilities in the counties, and local healthcare providers' records were examined to find any cases that occurred before the start of surveillance. Of the 125 cases, 23 were confirmed, 39 were listed as probable, and 63 as possible. The mean age was 10.2 years. Eighty-three (70%) patients were students and school employees, but cases were not concentrated in one school. Macrolide antibiotics were given to 92 (79%) of the patients; antibiotic prophylaxis was not used, but such actions as education, distribution of hand sanitizer, and prompt treatment of suspected cases were instituted. Macrolide-resistant isolates were identified in two cases, but there were no severe extrapulmonary manifestations. The CDC stresses the importance of considering macrolide resistance in designing treatment protocols during M pneumoniae outbreaks and says the outbreak demonstrates that "prompt implementation of public health measures can mitigate transmission regardless of strain resistance."
Oct 19 MMWR report

E coli cases tied to North Carolina fair continue rise
The number of people infected by Escherichia coli O157:H7 after attending the Cleveland County Fair in North Carolina has risen to 81, including 52 children and 29 adults, according to a press release today from the North Carolina Department of Health and Human Services. This is 20 more cases than reported in an update yesterday. Eleven people have been or are currently hospitalized, and one, a child, has died. Today's release says that preliminary findings suggest animal exposure as the source of the outbreak.
Oct 18 North Carolina press release

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