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 report.
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 will.
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 added.
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, experts said.
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.
More information
The U.S. National Library of Medicine has more about injections for back pain.
All content © Copyright 2000 - 2013 WorldNow and WOWK. All Rights Reserved.
