According to the Centers for Disease Control and Prevention (CDC), the number of individuals stricken with fungal meningitis from tainted epidural steroid injections has now risen to 91 in nine states, including seven deaths. Several of these patients have had strokes related to the meningitis. Investigators from the Food and Drug Administration (FDA) and state officials are probing the Framingham, Massachusetts facility where the New England Compounding Center (NECC) produced the 17,676 potentially tainted steroid injections, which were then shipped to 75 clinics in 23 states. Epidural injections of methylprednisolone acetate made by NECC were given to patients suffering from back and neck pain.
The CDC is coordinating a multistate investigation of the outbreak; it is not possible to determine exactly how many more cases will occur. State officials and the CDC were actively searching for new cases last week and over the weekend to track down patients who received the shots to see if they had been sick and to warn them to watch for possible symptoms. The CDC notes that the rise in cases is now not necessarily because people are continuing to get sick; rather, it is due to investigators are locating more illnesses among those who already received the injections. The injections were administered between July and September. To date, individuals who have been infected developed symptoms between one and four weeks after receiving their injections.
Federal and state investigators must determine how many patients received potentially contaminated injections; then track down each one. They must then confirm that those who have subsequently become ill actually had fungal meningitis and not another disease. On October 6, the New England Compounding Center issued a recall of all products made at its facility. “This action is being taken out of an abundance of caution due to the potential risk of contamination,” the center said in a statement. It added that it is cooperating with investigators. Last week, the FDA advised medical professionals last week not to use NECC-made products.
Meningitis is a potentially deadly inflammation of the brain or central nervous system. It is usually caused by viruses or bacteria; however, it can also be brought due to fungi. To date, the two fungi found in some patients are aspergillus and exserohilum; these organisms are commonly found in the air and soil. The CDC notes that fungal meningitis is particularly difficult to diagnose because the symptoms can be vague and mild initially; they include fever, headache, nausea, and stiffness of the neck. Infected individuals can also experience dizziness and confusion.
Although anyone can get fungal meningitis, individuals at higher risk include those who have AIDS, leukemia, or other forms of immunodeficiency. Patients receiving immunosuppressive therapy are also at increased risk. However, most of the individuals who have been stricken during the current outbreak had normal immune systems, noted Dr. John Jernigan, medical epidemiologist at the CDC who is involved in the investigation .The investigation into how patients became infected is ongoing; however, there is some evidence to suggest that the fungi in the medication penetrated the lining protecting the central nervous system after being injected epidurally, said Dr. Jernigan. He explained that the fungi are not harmful in the environment; however, they can become deadly when they flourish in a medication and are then injected directly into a part of the body that should not have germs.