In its most recent tally, the U.S. Centers for Disease Control and Prevention (CDC) confirms 105 cases of rare fungal meningitis and eight deaths in patients who received epidural steroid injections to treat back pain.
The CDC reports that the illness has been seen in nine states — Florida, Indiana, Maryland, Michigan, Minnesota, North Carolina, Ohio, Tennessee and Virginia — stemming from three contaminated lots of methylprednisolone acetate injections produced by New England Compounding Center (NECC).
Federal health investigators and state officials are looking closely at the Framingham, Mass., facility where NECC made more than 17,000 potentially tainted steroid injections — which are believed to have been tainted with two types of fungus, Aspergillus and Exserohilum, during manufacturing — and shipped them to 75 clinics in 23 states. NECC has since recalled all of its products.
The CDC estimates that about 13,000 patients may have been exposed to the contaminated steroid injections, and clinics are continuing to reach out to all patients who may have been affected. In Ohio, health officials are even mobilizing sheriff’s offices to locate people who may have been exposed, Reuters reports. “If that means knocking on doors, then that’s what they will do,” Beth Bickford, executive director at the Association of Ohio Health Commissioners, said in a statement.
The CDC expects to see additional infections, but says that far fewer than the number of people exposed to the contaminated injections will become ill.
“Since we are still unfortunately in the early days of this investigation, it is anticipated that new cases will come to light over the next several weeks,” says Dr. William Schaffner, chairman of the department of preventive medicine at Vanderbilt University Medical Center. “This is an ongoing story and there may be new twists of which we are of the moment unaware. There will probably be new information every day in the foreseeable future.”
Here are the five things you should know about fungal meningitis and how it’s treated:
1. How is fungal meningitis typically contracted?
First, patients should be aware that fungal meningitis is extremely rare and not contagious. A variety of fungi may cause meningitis; spores can be inhaled in the environment, from infected soil, or sometimes in a hospital setting. Meningitis develops when the fungus spreads through the blood to the spinal cord. Although anyone can get fungal meningitis, patients with weakened immune systems like those with AIDS or cancer are at higher risk, according to the CDC. Steroid drugs, such as those used by the patients who were infected in the current outbreak, can also reduce immunity, as can drugs taken after organ transplants and medications that treat rheumatoid arthritis and other autoimmune conditions. In general, epidural injections are considered safe and complications are rare.
2. What are the symptoms?
Meningitis is an inflammation of the brain and spinal cord lining, and fungal meningitis occurs when the membranes protecting the brain and spinal cord become infected with fungus. Symptoms of fungal meningitis include fever, headache, stiff neck, nausea and vomiting, sensitivity to light, weakness and numbness. Patients who may have received the contaminated injections should also look out for increasing pain as well as redness and swelling at the injection site. If the infection continues long enough without treatment, it may impact consciousness causing patients to lapse into a coma state, says Schaffner.
Aspergillus-related meningitis can also impact patient’s blood vessels, causing clots and bleeding as well as trouble speaking and maintaining stability. Schaffner warns these symptoms can often be mistaken as side effects of a small stroke. “This is the sort of information we are getting out to both patients and doctors. This way patients who have had these inoculations and appear as though they had a stroke can get tested for this fungal meningitis,” he says.
3. How is fungal meningitis diagnosed?
If fungal meningitis is suspected, the most secure diagnosis is made with a lumbar puncture or spinal tap. The cerebrospinal fluid surrounding the brain and spinal cord is withdrawn and the examined under the microscope by the physician. The fluid is also sent to a laboratory where the fungus is isolated and grown. “This procedure can be done safely and efficiently with very little discomfort,” says Schaffner.
4. How is the infection treated?
The infection is treated with antifungal medications administered in a hospital through an IV. Although bacterial meningitis can be treated within a week, fungal meningitis can take much longer, sometime longer than a month. “We have fewer antifungal drugs available and because this whole instance of fungal meningitis is so unusual, there is very little clinical experience,” says Schaffner. The two drugs used to treat fungal meningitis, amphotericin B and voriconazole, can also cause serious side effects like liver and kidney damage and must be monitored meticulously by physicians.
5. How is it different from bacterial or viral meningitis?
Bacterial and viral meningitis are more common than fungal meningitis. The bacteria and viruses that cause these other types of meningitis can be contagious, but they will not necessarily cause meningitis in those who are exposed or infected.
Symptoms of fungal meningitis present themselves much more slowly than those of bacterial meningitis. “Symptoms of bacterial meningitis come on quite suddenly and very prominently,” says Schaffner. “[In fungal meningitis] they kind of just ease on for the most part. The onset is not as dramatic and they become gradually more severe.”
Both Schaffner and the CDC recommend that any individual who received the injectable steroids and are experiencing symptoms to alert their doctor as soon as possible. Early diagnosis is crucial for the most effective treatment.