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Outbreak Investigation: Meningitis

Categories: Disease Investigation, Disease Outbreak, General, Response

CDC scientist looks through microscope at fungus displayed on screenOne Case Sparks National Action

Imagine… A patient goes to the doctor for a routine steroid injection.   A couple weeks later, the patient feels sick – headache, fever and suddenly uncomfortable in bright light.  Within days, the patient is admitted to the local hospital’s intensive care unit.  Doctors discover that the patient has a life-threatening disease they’ve never treated before. 

The medical team immediately calls the state health department to alert them of this rare illness.  A short time later, public health is spurred into action, sparking a national investigation of tainted medication given to thousands of Americans. 

No one ever knows when the next outbreak will hit.  The key to catching outbreaks quickly are astute clinical teams, a strong state and federal public health system, and collaboration with a range of national and local organizations. 

Current Fungal Meningitis Investigation

Fungal sample being held up for examinationCDC and the Food and Drug Administration (FDA) are investigating fungal infections among patients who received epidural steroid injections (medication injected into the spine) with contaminated medication. CDC believes that approximately 14,000 patients may have been exposed to this medication. Most patients who have become sick have developed a rare type of meningitis, fungal meningitis, which is not contagious.  As of October 22, 2012, a total of 297 cases, including 23 deaths and 3 peripheral joint infections, have been reported in 16 states. Patients who become sick  can develop symptoms including fever, new or worsening headache, sensitivity to light, stiff neck, new weakness or numbness, slurred speech, and/or increased pain, redness, and swelling at the injection site.

The medication in question came from the New England Compounding Center (NECC) in Framingham, Massachusetts. NECC has stopped all production and initiated a recall of the manufactured lots of steroid medication in question, preservative-free methylprednisolone acetate (80mg/ml), and other products.  More information.  

What’s Making People Sick?

CDC and FDA recently connected the fungus found in patients with fungus found in unopened steroid vials. The fungus Exserohilum rostratum  was present in a steroid medication called methylprednisolone acetate that was manufactured by NECC.  This fungus has also been found in all but two of the patients with laboratory-confirmed fungal meningitis.

Two CDC scientist working in lab discussing fungal samplesCDC’s Role

Working closely with the FDA and state health departments, CDC is trying to better understand the nature of these fungal infections and how best to stop them. At the same time, experts at CDC are helping physicians understand how to approach and treat patients who may have been exposed (resources for physicians).  Our labs are hard at work analyzing samples from states, and we have sent teams of epidemiologists into states affected by the outbreak.

 

Important Facts

  • Those people injected in joints only are not believed to be at risk for fungal meningitis, but could be at risk for joint infection.
  • The epidural steroid medication associated with this outbreak is not the same as the epidural injections given to pregnant women during childbirth.
  • Patients who believe they might have received a contaminated medication should contact the physician who performed their procedure.
  • Patients who received a contaminated medication should seek medical attention if they have any symptoms. Symptoms may include: fever, new or worsening headache, sensitivity to light, stiff neck, new weakness or numbness in any part of the body, slurred speech, or increased pain, redness, and swelling at the injection site.  Patients might have just one or two of these symptoms, and they may take several weeks to appear.

 

More Information

For patients: http://www.cdc.gov/hai/outbreaks/patients/faq-meningitis-outbreak-patients.html

For clinicians: http://www.cdc.gov/hai/outbreaks/clinicians/index.html

For a list of facilities that received the contaminated medicine visit: http://www.cdc.gov/hai/outbreaks/meningitis-facilities-map.html

General information: http://www.cdc.gov/hai/outbreaks/meningitis.html

FDA Updates: http://www.fda.gov/Drugs/DrugSafety/FungalMeningitis/ucm322734.htm

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this blog is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. October 23, 2012 at 6:33 pm ET  -   Dorothy Bradford, MD

    How many people who were known to be infected have recovered ?

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  2. AUTHOR COMMENT October 26, 2012 at 2:25 pm ET  -   Blog Administrator

    @Dorothy: CDC does not currently have the data to determine the recovery rate of patients infected with fungal meningitis associated with this outbreak. The duration of treatment for patients with fungal meningitis may be prolonged, lasting several months. We will have a better understanding of the recovery process after patients have received several months of therapy and follow up. Thank you for your question.

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  3. October 28, 2012 at 12:08 am ET  -   Linda Pinkstaff

    My husband had the lumbar puncture on Oct.10th and it came back negative, however he continues to have a severe headache, light sensitivity and low grade fever. The headache has become severe with sharp pounding headache, he is still very sensitive to light and he now has motion sickness which he has never experienced before.
    The ER doctor had to try to get the csf from him by multiple punctures, hitting nerves in the process and hitting bone several times.
    Should my husband be tested again? Or is the symptons due to a lumbar puncture headache?
    He has been back to the ER twice and the hospital sent him home with a diagnosis as a spinal headache. Is he ever going to get relief. The hospital did an mri and gave him pain meds and fluid through an IV.

    He had his epidural on 9-11.
    We need help, where can he get relief? Does he need to be tested again?
    He has another epidural scheduled for 10-30.
    Thanks for any help and advice you can give us.

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  4. November 7, 2012 at 12:07 am ET  -   Ibogain

    Really nice post, Easy to understand & really helpful for all.

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  5. June 24, 2013 at 6:28 pm ET  -   Sheena Gale Martin

    Today is 06-24-2013. I am one of the people who survived from the spinal infection. I’m a patient of a long time of having to take the steroid shots. I also remember reading in some of the findings that you could also contract the tainted steroids in other ways : like in the hip, in the arm, or any other ways of being injected with the contaminated vials. I would like to hear from anyone who survived from the infection just to know there were more of us out there. I’ll get back to when I was diagnosed. I had been sick for a few months before they (Drs.) knew what was wrong with me. After several different tests/x-rays/cts,and finally the :MRI. Thats how the spinal infection was found. The drs. told me at first they didn’t know what it was. On the 10-16-2012 was the MRI and on 10-18-2012 I was in the hospital. I was in the medical hospital for 2 wks. and then in the retire/rehab for 6 wks. But I am far from better; I now have to have major spine surgery. When I was released shortly after time was up for the 8 wks. treatment for infection, I started having pain again. So the first thing that my PC phys. ordered another MRI, it showed no infection, so they made me an appmt. with my neurosurgen that I was seeing when I was in the hospital for 2 wks. So when I go in for a follow up, his assistant saw me the first visit. She said something that blew my mind. She said “we kind of expected that”. I said back”you did”? She said “yes”. So now its a must, I have to have spine and disc surgery and I will be laid up again now for who knows for how long, if I”m even walking after the surgery. I would love to hear from anyone who has made through this terriffying experience. Thank You and may GOD BLESS !

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