As of October 16, 2012, 214 cases of fungal meningitis have been reported across the United States. The cause of the outbreak has been traced to contaminated steroids injections used to combat back pain. Approximately 14,000 doses of the drug had been shipped to 76 facilities in 23 states. The steroids were produced by the Framingham, Massachusetts, company New England Compounding Center (NECC).
The outbreak of meningitis has resulted in 15 deaths so far. Cases of fungal meningitis have now been reported in Tennessee, Michigan, Pennsylvania, New Hampshire, Illinois, Indiana, Minnesota, New Jersey, Texas, Idaho, Maryland, North Carolina, Virginia, Ohio and Florida.
Previously, all cases of fungal meningitis were believed to be caused by Methylprednisolone acetate. The latest case, however, was caused by Triamcinolone acetonide, another injectable steroid also produced by NECC.
In addition, according to the CDC, “one transplant patient with Aspergillus fumigatus infection who was administered NECC cardioplegic solution during surgery has been reported. An investigation of this patient is ongoing; there may be other explanations for their Aspergillus infection. Cardioplegic solution is used to induce cardiac muscle paralysis during open heart surgery to prevent injury to the heart.”
The CDC has reported that the medicine Voriconazole “may be effective in treating infections (caused by) brown-black molds” as well as infections caused by Aspergillus, another type of fungus. The agency said patients with more severe disease should be started on the IV form of Voriconazole, while patients with milder cases could be started on the oral version.
The CDC has been releasing updates on what is happening around the country from this outbreak. The agency continues to emphasize that this type of meningitis is not contagious. Several of the patients who received spinal injections had strokes believe to be caused by the injections. There is also concern for patients who may have received the injections into other joints such as shoulders or knees. While the injections in peripheral joints will not result in meningitis, they may result in joint infections. If concerned, patients who received the injections are advised to contact their physicians.
The Food and Drug Administration (FDA) has expressed concern about other injectable drugs produced by NECC. Of particular concern to the FDA are injectable ophthalmic drugs used during surgery, as well as cardioplegic solutions.
The FDA has issued guidelines for the use of the suspected drugs, and has requested medical professionals to retain, secure and withhold from use all products from NECC. As a further precaution, the FDA suggests that medical professionals follow up with any patients who have received medications produced by NECC. Patients should be notified of the symptoms of the fungal infection, which include fever, headache, stiff neck, nausea and/or vomiting and sensitivity to light.
At this point, the outbreak shows no signs of diminishing, and it is possible that more cases may be diagnosed and more states may be added to the list.