The CDC’s daily update on the ongoing multi-state meningitis outbreak was posted shortly after 2pm EDT, and it shows an increase of 15 new cases identified since yesterday.
Added to the list of states reporting cases today is Texas, with one reported infection.
Greatly complicating the diagnosis and treatment of those infected is that the primary fungus identified so far - Exserohilum - while common in the environment – has never been associated with meningitis.
Exserohilum rostratum – Credit CDC
Exserohilum is a common mold found in soil and on plants, especially grasses, and thrives in warm and humid climates. Exserohilum rarely causes infections for people. The most common infections caused by Exserohilum are sinusitis and skin infections, but it can cause keratitis (eye inflammation), subcutaneous phaeohyphomycosis, endocarditis (inflammation of the lining of the heart), and osteomyelitis (bone infection).
Exserohilum rostratum has been recognized as a human pathogen.
People at Risk
Although anyone can get an infection with Exserohilum, infections most often occur in people with weak immune systems.
Injury is another cause of infection.
Yesterday at the CDC’s press conference on this outbreak, J. Todd Weber MD, Incident Manager for the CDC on the Multistate Meningitis Outbreak, had this to say about dealing with Exserohilum induced meningitis:
“Although we are not prepared to say that Exserohilum is the sole cause of these injections we are certainly seeing a predominance of that fungus among the patients with meningitis.
Let me emphasize that historically fungal meningitis is very rare and Exserohilum has not been seen previously as a cause of fungal meningitis. This is new territory for public health and the clinical community.”
Later during the conference, Dr. Weber warned that treatment may be prolonged and difficult:
“At the present time we are recommending that patients with confirmed fungal meningitis receive two anti-fungal drugs, -- voriconazole and lipsomal amphotericin B.
These drugs are very strong and can be very difficult for patients to tolerate over a long period of time. We are working with our clinical experts to determine the best dose and the best length of time to treat patients.”
Given the potential number of people exposed via steroid injections, and the extended time before symptoms may appear, this outbreak may continue to grow for some time.
The balance of today’s update from the CDC follows:
October 12, 2012 2:00 PM EDT
- Clinicians should continue to contact patients who have received medicines associated with three lots of preservative-free methylprednisolone acetate (80mg/ml) from the New England Compounding Center (NECC) that were recalled on September 26, 2012. The potentially contaminated injections were given starting May 21, 2012. See updated Clinician Guidance webpage for more information.
- CDC's guidance to patients has not changed as a result of the expanded voluntary recall of all NECC products, announced October 6. Patients who feel ill and are concerned about whether they received a medication from one of the NECC products recalled on September 26 should contact their physician.
- Patients need to remain vigilant for onset of symptoms because fungal infections can be slow to develop. Typically in this outbreak, symptoms have appeared 1 to 4 weeks following injection, but it’s important to know that longer and shorter periods of time between injection and onset of symptoms have been reported. Therefore, patients and physicians need to closely watch for symptoms for at least several months following the injection. For more information, see updated Patient Guidance.
Additional Federal Agencies Involved:
- U.S. Food and Drug Administration (FDA)
- Questions and Answers on Fungal Meningitis Outbreak (FDA)
- List of Recalled Products Related to Fungal Meningitis Outbreak (FDA)
- Alert – New England Compounding Center Product Recall Information (Commonwealth of Massachusetts)