meningitis from contaminated steroid injection, commonly used for back pain

Fungal meningitis death toll may rise
By Maggie Fox, NBC News

Health officials have traced an outbreak of rare fungal meningitis to a Massachusetts specialty pharmacy that distributes a steroid injection commonly used to treat back pain. So far, 26 people have been diagnosed with fungal meningitis in five states and four of them have died.

The pharmacy, which shipped 2,000 vials of the possibly contaminated steroid to one center in Tennessee alone, says it has recalled all of the product and is cooperating with federal officials, according to The Associated Press.

Doctors leading the investigation say they expect to find more cases, and if the pharmacy shipped product to many states it's possible many more people across the country will become ill with the hard-to-treat infection. It cannot be passed from person to person, but a fungal infection of the spinal cord is very tricky to treat.

The 26 cases include 18 people in Tennessee, one in North Carolina, two in Florida, three in Virginia and two in Maryland, the U.S. Centers for Disease Control and Prevention reported. Two of the deaths were in Tennessee, one in Virginia and one in Maryland, the Centers for Disease Control and Prevention said.

"Some are doing well and improving," Tennessee health official Dr. David Reagan told The Associated Press about the state's patients. "Some are very ill -- very, very seriously ill and may die."

It was not immediately clear how many vials of the suspect steroid were shipped, and to where. Health officials are asking anyone who had a spinal injection for pain and who has symptoms such as a headache, stiff neck, dizziness or trouble walking to see a doctor right away. The infection may take up to three weeks to incubate.

“We have notified medical professionals the prime suspect for this outbreak is methylprednisolone,” Tennessee Department of Health Commissioner Dr. John Dreyzehner told reporters in a telephone briefing. Tennessee officials were the first to notice the unusual cases of meningitis, and discovered that the patients involved had all been treated at three specialty clinics. All had recieved direct injections of the steroid into their spines for pain.

Late Wednesday, the Food and Drug Administration confirmed that New England Compounding Center in Framingham, Mass., voluntarily recalled three lots of 80-milligram injection doses of methylprednisolone acetate (PF) Sept. 26. The lots included #05212012@68 with a beyond use date of Nov. 17, 2012; #06292012@26 with a beyond use date of Dec. 26, 2012; and #08102012@51 with a beyond use date of Feb. 6, 2013. The firm's website was unavailable on Thursday.

Health officials are not entirely certain the steroid is to blame, said the Tennessee health department’s Dr. Marion Kainer. The health officials, the CDC and the FDA are testing the pain medications and other materials used with the steroid injections, as well as samples from the patients. Patients were also treated with injections of lidocaine and a povidone Iodine skin preparation solution, the CDC said.

Meningitis is an inflammation of the spinal cord, usually caused by bacteria or viruses. It can be very serious and is marked by a headache, fever, often a stiff neck and balance problems. Fungi and parasites can also cause this inflammation and in this case the common mold aspergillus is suspected. “The type of meningitis we are dealing with in this situation is not communicable person to person,” Dreyzehner said.

The Massachusetts health department said it was working federal officials and said the New England Compounding Center had surrendered its license to operate. The department said there have been no reports of the fungal meningitis in Massachusetts.

Aspergillus is tricky to treat. It’s an infection that patients with damaged immune systems can get – notably cancer patients and those with HIV infection. It’s often found in the lungs because the mold – found in dead leaves and elsewhere -- can be breathed in. An antifungal drug called voriconazole can treat the infection but the health officials said in this case they want to be sure before they try it. The side effects from the antifungal treatment can be severe and include kidney and liver damage.

Health officials are now trying to track down people in 23 states who got epidural steroid injections. NBC's Robert Bazell reports.

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