FRIDAY, Oct. 5 (HealthDay News) -- Health officials in 23 states
are trying to track down patients who received steroid injections
for routine back pain that may have been contaminated with a deadly
type of fungus-related meningitis linked to five deaths and at
least 30 cases of illness in six states.
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.
The drug was manufactured by a specialty pharmacy, New England
Compounding Center of Framingham, Mass., which last week
voluntarily recalled three lots of the steroid. It has since shut
down operations and stopped distributing its products, health
U.S. health experts said Thursday they expect to see more cases
of the rare type of meningitis, which is not contagious, because
symptoms can take a month or more to appear.
All of the infected patients received the medication from the
Massachusetts pharmacy, Dr. Benjamin Park, a medical officer with
the U.S. Centers for Disease Control and Prevention's National
Center for Emerging and Zoonotic Infectious Diseases, said at a
Thursday afternoon news conference.
"The CDC and FDA recommend that all health care personnel cease use and remove from their pharmacy inventory any products produced by the New England Compounding Center," Park said. "CDC also recommends that clinicians contact all patients who received injections from any of the three recalled lots to determine if they are having symptoms."
Patients who are having even mild symptoms, including fever and
headache, should see their doctor immediately, Park added.
"Unfortunately, despite the current recall, we expect to see additional cases," he said.
The suspected steroid was shipped to 23 states, Park said.
Twenty-five cases of meningitis, including three deaths, have
been reported in Tennessee. There have also been four cases in
Virginia and one death, two cases in Maryland and one death, two
cases in Florida, and one case each in North Carolina and Indiana,
A Nashville clinic reportedly received the largest shipment of
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 Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Nashville.
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 infected patients are doing well, others are in
intensive care and may die, according to published reports.
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 the same rigorous safety
standards, such as FDA oversight.
The U.S. National Library of Medicine has more about
injections for back pain.
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