Meningitis: Death Toll at 28

October 30, 2012

Three more people — two in Michigan and one in Tennessee — have died of fungal meningitis, the CDC reported Tuesday.

The tally in the outbreak, linked to spinal injections of a contaminated steroid, now stands at 356 cases of the disease  –  28 of them fatal  –  in 19 states.

And seven people have developed peripheral joint infections after they the tainted steroid — preservative-free methylprednisolone acetate — was injected into joints to control pain.

No fatalities have been associated with those injections.

The outbreak began after a Massachusetts company, the New England Compounding Center, shipped three separate lots of the steroid  –  some 17,000 vials  –  to pain clinics in 23 states, where it was mainly used in epidural injections to control chronic back pain.

Unopened vials from two of the three lots have now been shown to be contaminated with the black mold Exserohilum rostratum and testing is continuing on the third lot, the CDC reported.

The CDC said its labs have confirmed that 52 patients with fungal meningitis have Exserohilum rostratum in clinical specimens. Two other patients have a lab-confirmed fungal infection, one with Aspergillus fumigatus and one with Cladosporium.

Typically, symptoms have developed between 1 and 4 weeks after an injection with the tainted steroid, but the CDC is cautioning pain patients and clinicians to be watchful because both longer and shorter incubation periods have been reported.

The steroid was recalled Sept. 26 and the manufacturer followed up by recalling all of its products Oct. 6, so health officials are confident no new infections are likely since the meningitis in these cases is not contagious.

But it remains an open question how many more cases will be identified. The CDC estimates that 14,000 people were exposed to the steroid in 22 states (vials sent to Nevada were not used before the recall) and most of those have been contacted and told to watch for symptoms.

The agency is defining a probable case associated with the outbreak as a person who had a spinal injection of the steroid after May 21 and who now has:

• Meningitis of unknown etiology
• Posterior circulation stroke without a cardioembolic source and without documentation of a normal cerebrospinal fluid (CSF) profile
• Osteomyelitis, abscess, or other infection of unknown etiology, in the spinal or paraspinal structures at or near the site of the steroid injection
• Osteomyelitis or worsening inflammatory arthritis of a peripheral joint of unknown etiology diagnosed following injection into the joint

Signs and symptoms of meningitis include headache, fever, stiff neck, or photophobia, in addition to a CSF profile showing pleocytosis, the agency said.

Source: Med Page Today at  http://www.medpagetoday.com/Neurology/GeneralNeurology/35655