Wednesday, November 14, 2012

CDC Update Of Fungal Meningitis Cases

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# 6717

 

The CDC - which now issues updates on Mondays, Wednesday, and Friday - indicates that 23 new cases of fungal infection from contaminated steroids have been identified since last Friday’s report (Monday was a Federal Holiday).

 

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*451 cases of fungal meningitis, stroke due to presumed fungal meningitis, or other central nervous system-related infection meeting the outbreak case definition, plus 10 peripheral joint infections (e.g., knee, hip, shoulder, elbow). No deaths have been associated with peripheral joint infections.

 

The bulk of these newly identified cases (20) are listed as coming from Michigan, although no details are given.  A quick check of the Michigan Department of Health’s website still shows case counts current as of November 9th.

 

As of November 9, 2012, Michigan's case count associated with the Centers for Disease Control and Prevention multi-state meningitis investigation is 128 total cases and eight deaths [64 cases of meningitis, eight deaths*, 57 epidural abscess, one stroke and six joint infections].

 

Since these reports don’t tell us the date of onset of symptoms, we really can’t tell how many of these cases are `new’ in the past couple of weeks, and how many are older, but just now being identified. 

 

The assumption is that no contaminated steroids were administered to patients after the recall notice was announced in late September.

 

The danger of developing meningitis is believed greatest during the first six weeks after injection, so there is some hope that the number of new cases will begin to decline soon.

 

We’ve also seen reports of epidural abscesses and arachnoiditis among some of these patients. These are localized pockets of fungal infection that are slow to grow, difficult to identify, and even more difficult to treat.

 

The CDC updated their Frequently Asked Questions for Clinicians late last week, with the following information.

Epidural Abscess and Arachnoiditis

There have been media reports of spinal epidural abscesses and arachnoiditis among patients who received treatment for meningitis. What are these conditions and their symptoms?

CDC has received preliminary reports of spinal epidural abscesses and arachnoiditis occurring among a portion of patients undergoing treatment for fungal meningitis due to this outbreak. CDC does not know at this time how many patients developed these disorders or why they occurred.  Both conditions are rare but serious disorders in the general population that require prompt medical attention. 

  • A spinal epidural abscess is characterized by inflammation and a collection of pus around the spine. Spinal epidural abscesses sometimes result in swelling in the affected area (e.g., near the site where contaminated steroid mediation was injected).
    • Common symptoms can include fever, headache, back pain, and neurological problems (e.g., weakness, unusual changes in sensation)
  • Arachnoiditis is a disorder caused by the inflammation of the arachnoid, one of the membranes that surrounds and protects the nerves of the spinal cord. The condition can be caused by irritation from chemicals, infection, or direct injury to the spine.
    • Symptoms can include numbness, tingling, and a characteristic stinging and burning pain in the lower back or legs.  Some people with arachnoiditis may have debilitating muscle cramps, twitches, or spasms.  The condition may also affect the bladder, bowel, and sexual function.  In severe cases, arachnoiditis may cause paralysis of the lower limbs. 
    • For more information about arachnoiditis, see the National Institute of Neurological Disorders and Stroke’s website.

 

The emergence of these new syndromes linked to fungal tainted steroid injections adds yet another level of uncertainty for those who are waiting to see if they will develop symptoms.

 

And finally, the head of the embattled pharmacy that created and distributed these steroid products appeared before a congressional committee today, but declined to testify.   This from the Boston Globe.

 

 

Pharmacy head pleads Fifth at meningitis outbreak hearing

WASHINGTON Barry Cadden, the owner and director of the specialty pharmacy tied to deadly fungal meningitis outbreak declined to testify Wednesday morning before a congressional committee investigating the matter.

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