Meningitis outbreak: Officials warn of new fungal infections

9:58 AM, Nov 21, 2012   |    comments
Patient receives Meningitis vaccination/AP
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By Walter F. Roche, Jr. and Tom Wilemon, The Tennessean

State and federal officials are issuing a new alarm in the ongoing outbreak of disease caused by tainted steroids from a Massachusetts drug compounder - and the warning applies even to those who may have thought they had dodged serious illness.

While the cases of deadly fungal meningitis are on the decline, there has been a recent surge in potentially dangerous injection site infections, both in patients who already have been diagnosed with meningitis and in those who have not, health officials said Tuesday.

"We are seeing both new patients presenting and then patients who have had meningitis," said Dr. Marion Kainer, director of health care-associated infections with the Tennessee Health Department.

On Monday, the department will begin a new round of contact calls to 1,009 patients who received injections in Tennessee from three tainted lots of methylprednisolone acetate from the New England Compounding Center.

Patients who were already contacted once will be contacted again and warned to be on the lookout for signs of an infection, said Dr. William Schaffner of Vanderbilt University, who participated in a briefing on the new alert Tuesday.

"Tennessee is going to be very proactive," he said.

Steroids from the Massachusetts compounding pharmacy have been linked to 490 illnesses and 34 deaths nationwide. In Tennessee, 82 people have been sickened and 13 have died.

Schaffner said data from the U.S. Centers for Disease Control and Prevention indicate that Tennessee is beginning to experience the same upsurge of infections previously noted in Michigan. Michigan and Tennessee have consistently been the hardest hit in the ongoing outbreak.

Patients experiencing any increased pain at the injection site or other symptoms such as a change in bowel or bladder control should immediately contact their physicians, he said.

According to the new CDC advisory, of the 91 cases reported since Nov. 4, two-thirds had a spinal or epidural abscess or a bone infection of the vertebrae, while only 29 percent were classified as meningitis. Two cases were infections of joints other than the spine, and two patients had more than one condition.

MRIs recommended

The CDC also warned that while some patients will experience new or worsening back pain, symptoms of an infection "may be mild or clinically difficult to distinguish from the patient's baseline chronic pain."

It recommends that physicians order MRIs with contrast of the affected area in patients with new and worsening symptoms. But the CDC said that in patients being treated for meningitis, even in the absence of new or worsening symptoms at or near the injection site, "clinicians should strongly consider obtaining an MRI" within two or three weeks after diagnosis of meningitis.

Kainer said these infections do not cause rapid death, as meningitis can.

She stressed patients should not panic about this new wave of infections that are not meningitis. The state Health Department will be providing descriptions of symptoms and guidance about where to go for treatment.

"We don't want people rushing to emergency departments," Kainer said.

"This, if it is untreated or unrecognized for some time, potentially could end up as causing meningitis, but it doesn't happen just like overnight is what we believe," Kainer said.

The Health Department has compiled data on the secondary infections but is still verifying its numbers.

"We still need to get a better understanding of all of this," Kainer said. "This is, as people have said, uncharted medical territory.

Patients need to be alert, because some of the symptoms might not initially appear to be connected to the epidural steroid injections, she said.

"If they have had severe constipation or urinary retention or urinary or fecal incontinence, those symptoms and signs people may not necessarily think may be related to this - and we want to make sure people are aware of those," she said.

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