October 5, 2012
Health officials warn that a rare form of meningitis is likely to continue to spread. This was reported after four people died and 26 have fallen ill in five states.
All of those currently infected received steroid injections, primarily for back pain. The steroid was made by a specialty pharmacy located in Massachusetts. The pharmacy issued a recall on the drug last week and has since shut down operations.
The type of meningitis is not a contagious one as the more common forms are. This type is found in leaf mold, which is what health officials suspect may have been in the steroid.
18 of the reported cases are in Tennessee, where a Nashville clinic received the largest shipment of the steroid injections. Investigators are still trying to confirm the source of the infection.
Three cases were reported in Virginia, two cases in Maryland, two cases in Florida and one in North Carolina. Two of the four reported deaths were in Tennessee. One death was reported in Virginia and one in Maryland. The case information has come from the Centers for Disease Control and Prevention.
In the coming days, it is feared that new cases will be reported. The Tennessee Department of Health Commissioner John Dreyzeher has confirmed 5 new cases on Wednesday and is calling the situation, “a rapidly evolving outbreak.”
Although Tennessee is reporting this, the federal health officials are not confirming that this is the case. They have found that the illness has been occurring for the last two to three months.
Tennessee health officials have reported that some of the affected patients have experienced slurred speech and difficulty walking and urinating. Meningitis is inflammation of the lining of the brain and spinal cord. Other symptoms of meningitis include: severe and worsening headache, dizziness, nausea, and fever. The incubation period is estimated to be anywhere from 2 to 28 days, which means that people may not yet have fallen ill that were exposed. Tennessee officials are contacting over 900 patients that received the injections.
"Some are doing well and improving. Some are very ill — very, very seriously ill and may die," Tennessee health official Dr. David Reagan said of the state's patients.
Officials are also investigating the antiseptic and anesthetic that is used along with the injections and has not yet ruled these out. However, the main suspicion is the steroid injection, which is commonly given for back pain and administered along with anesthetic.
The Food and Drug Administration has identified the maker of the steroid as the New England Compounding Center, a specialty pharmacy located in Framingham, Massachusetts. The company issued a recall of three lots of the steroid methylprednisolone acetate. The company issued a statement saying that it had voluntarily suspended operations and was working with regulators to locate the source of the infection. Specialty, compounding pharmacies, such as the New England Compounding Center, mix ingredients for customized medications that are not commercially available and are regulated by states individually.
The outbreak was uncovered about two weeks ago when Vanderbilt University Dr. April Pettit was treating a patient who was not doing well and doctors could not figure out why a patient was not doing well. The lab discovered the fungus when they tested the patient’s spinal fluid and this caused Dr. Pettit to ask questions and uncovered the patient’s steroid injection treatments.
"When it became clear that the infection-control practices at the clinic were up to par, the steroid medication became implicated," according to Dr. William Schaffner, chair of Vanderbilt’s Department of Preventative Medicine.
Federal officials have not released details or the condition of any of the patients. Fungal meningitis is usually treated with intravenous anti-fungal medication. Of the 26 currently known cases, 17 were treated at Saint Thomas Outpatient Neurosurgery Center in Nashville, TN. The clinic had 2,000 vials of the steroid and voluntarily closed to handle the investigation.
For more information, you can look to the Centers for Disease Control and Prevention: http://www.cdc.gov/meningitis/fungal.html
Adapted from: ABCNews.com, “Rare US Meningitis Outbreak Grows; 4 Dead, 22 Sick.” Mike Stobbe and Travis Loller. Nashville, Tenn. October 4, 2012.