THURSDAY, Oct. 4 (HealthDay News) -- Health experts said
Thursday they expect to see more cases of a deadly type of
meningitis that has been linked to an apparently contaminated
steroid used for back pain. The outbreak so far has killed four
people and sickened at least 30 others in five states, authorities
All of the patients were injected with methylprednisolone
acetate, a steroid drug that investigators suspect was contaminated
with a fungus usually found in leaf mold.
"A large group, an increasingly large group, are presenting with an unusual fungal meningitis due to an organism called aspergillus," said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Nashville, Tenn.
"This contaminated product has resulted in this very unusual and extraordinary dire infection," he added.
The suspected steroid may have been shipped to 23 states,
Schaffner said. As a result, he added, "I am sure new cases will be
diagnosed over the next days and weeks."
Eighteen cases of meningitis, including two deaths, have been
reported in Tennessee. Other cases have been documented in
Virginia, which had one death; Maryland, where another death
occurred; Florida and North Carolina, said officials at the U.S.
Centers for Disease Control and Prevention. A Nashville clinic
reportedly received the largest shipment of the steroid.
The drug was reportedly manufactured by a specialty pharmacy,
New England Compounding Center of Framingham, Mass., which last
week voluntarily recalled three lots of the steroid.
The steroid procedure -- called lumbar epidural steroid
injection -- is a common treatment for back pain that has not
responded to medicines, physical therapy or other nonsurgical
treatments. Although it is usually safe, experts now urge anyone
who has recently had the procedure and experiences severe headache,
fever, chills or nausea to notify a doctor immediately.
"From the time of the injection until symptoms appear may be a month or more," said Schaffner.
But he added that not everyone who got the steroid injection
will develop meningitis -- an inflammation of tissue surrounding
the brain and spinal cord -- but it's hard to know how many
Also, he and other experts said some of the symptoms associated
with this rare form of meningitis are unusual.
"One of the things we are just learning about these patients is that they can present with minor stroke-like symptoms, which would include slurred speech and unsteady gait," Schaffner said.
Stroke is not usually associated with either bacterial or viral
meningitis, said another expert, Dr. Pascal James Imperato, a dean
at the School of Public Health of SUNY Downstate Medical Center in
New York City.
Infected patients must receive intravenous drugs in a hospital
setting, Imperato said.
Treatment can take weeks if not months, because these infections
are difficult to treat, Schaffner explained. And the drugs can have
severe side effects, including affecting kidney function, he
While some patients are doing well, others are in intensive care
and may die, according to published reports.
The CDC and the U.S. Food and Drug Administration have told pain
clinics that received this medication to withdraw it and also
contact patients who might have been exposed, Schaffner said.
Although the steroid is the primary target of investigation,
health officials haven't ruled out the antiseptic and anesthetic
used during the injections as a possible cause of the outbreak,
Dr. Marc Siegel, associate professor of medicine at NYU Langone
Medical Center in New York City, said the meningitis outbreak
underscores the importance of sterilization procedures in
intravenous and intramuscular shots.
"I believe that this could have been prevented by more vigilance," Siegel said.
However, he added that he doesn't expect the number of infected
patients to balloon in the near future.
"This is not going to be an epidemic, because the fungus is weak and there isn't a reservoir," Siegel said. "But there will continue to be isolated cases over the next several weeks because of the long incubation period."
Specialty manufacturers like New England Compounding Center make
solutions that aren't available from the big pharmaceutical
companies, but they aren't subject to same rigorous safety
standards, according to
The New York Times.
The U.S. National Library of Medicine has more about
injections for back pain.
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