MONDAY, Oct. 8 (HealthDay News) -- U.S. health officials said
late Monday that as many as 13,000 people may have received steroid
shots from the suspected source of a national meningitis
However, it's not known how many of the shots were contaminated
with the fungus that causes this rare type of meningitis. So it's
not clear how many people might be at risk for infection, the
The 13,000 figure includes not only people who got the shots for
back pain -- and are considered most at risk -- but also patients
who got injections in other places, such as knees and
There was no breakdown on the number of back injections, said
Curtis Allen, a spokesman for the Centers for Disease Control and
Prevention. Those injected in their joints are not believed to be
at risk for meningitis, he added.
Meanwhile, the number of meningitis cases linked to the
apparently contaminated steroid injections has risen to 105 in nine
states, and the number of deaths has increased by one to eight,
U.S. health officials reported earlier Monday.
All of the patients were thought to be injected with
methylprednisolone acetate, a steroid drug commonly used for back
pain that investigators suspect was contaminated with a fungus
usually found in leaf mold, according to the CDC.
Health officials in 23 states that received shipments of the
steroid are still trying to track down patients who got the
On Monday, the CDC offered the following state-by-state
breakdown of cases: Florida: 4 cases; Indiana: 11 cases; Maryland:
5 cases, including 1 death; Michigan: 21 cases, including 2 deaths;
Minnesota: 3 cases; North Carolina: 2 cases; Ohio: 1 case;
Tennessee: 35 cases, including 4 deaths; Virginia: 23 cases,
including 1 death.
The drug was manufactured by a specialty pharmacy, New England
Compounding Center of Framingham, Mass., which last month
voluntarily recalled three lots of the steroid. It has since shut
down operations and stopped distributing its products, health
On Saturday, the pharmacy said it was voluntarily recalling all
of its products, calling the decision a precautionary measure. The
company said there were no signs that any of its other products
have been contaminated, the
The CDC last week released a list of the approximately
75 health-care facilities that received contaminated
U.S. health officials said 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 are thought to have received the
medication from the Massachusetts pharmacy, said Dr. Benjamin Park,
a medical officer with the CDC's National Center for Emerging and
Zoonotic Infectious Diseases.
Infected patients have developed a variety of symptoms
approximately one to four weeks following their injection. Symptoms
include fever, new or worsening headache, nausea, and "new
neurological deficit [consistent with deep brain stroke]," the CDC
said in a news release. Some of these patients' symptoms were very
mild in nature. Cerebrospinal fluid from these patients has shown
findings consistent with meningitis, the agency said.
The CDC said the New England Compounding Center last month
voluntarily recalled the following lots of methylprednisolone
Doctors should immediately contact patients who have had an
injection from any of the three lots to see if they're having any
symptoms, the CDC said.
Although all cases of meningitis detected so far occurred after
injections with products from these three lots, the CDC and the
U.S. Food and Drug Administration recommended, "out of an abundance
of caution," that health-care professionals not use any products
produced by the New England Compounding Center until more
information is available.
Patients who have had a steroid injection since July, and have
any of the following symptoms, should talk to their doctor as soon
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
"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
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, an 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
drug 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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