*304 cases of fungal meningitis, stroke due to presumed fungal meningitis, or other central nervous system-related infection meeting the outbreak case definition, plus 4 peripheral joint infections (e.g., knee, hip, shoulder, elbow). No deaths have been associated with peripheral joint infections.
# 6658
Proof this morning that they are burning the midnight oil over at the CDC - as they issued no fewer than seven updates on the fungal meningitis outbreak at 11pm last night – including an updated HAN Advisory.
Six of the seven are guidance documents are designed for practitioners treating exposed, or infected, patients, while the final one is an updated Q&A for patients.
NEW: Health Alert Network (HAN) - Oct 23, 2012 Tuesday, October 23, 2012 11:00 PM
UPDATE: Interim Treatment Guidance for Central Nervous System (CNS) and Parameningeal Infections Associated with Injection of Contaminated Steroid Products Tuesday, October 23, 2012 11:00 PM
UPDATE: Interim Treatment Guidance for Osteoarticular Infections Associated With Injection of Contaminated Steroid Products Tuesday, October 23, 2012 11:00 PM
UPDATE: Interim Guidance for Management of Asymptomatic Persons Exposed to Potentially Contaminated Steroid Products Tuesday, October 23, 2012 11:00 PM
NEW: Guidance on Management of Asymptomatic Patients Who Received Epidural or Paraspinal Injections with Contaminated Steroid Products Tuesday, October 23, 2012 11:00 PM
UPDATE: Frequently Asked Questions for Clinicians: Multistate Fungal Meningitis Outbreak Investigation Tuesday, October 23, 2012 11:00 PM
UPDATE: Frequently Asked Questions for Patients: Multistate Fungal Meningitis Outbreak Investigation Tuesday, October 23, 2012 11:00 PM
The stickiest issue for the CDC, patients, and physicians has been whether to institute some kind of prophylactic anti-fungal treatment in those who have been exposed, but are thus far asymptomatic.
And if the drugs needed were well tolerated, and plentiful in supply, that might be an option.
But the truth is, taking these anti-fungal drugs is not without risk, as they have been linked to liver, heart, and kidney damage.
Simply put, they are not something you’d want to take for several months, unless you had to.
And there are also concerns that there may not be sufficient supply of these drugs to provide prophylactic treatment to 14,000 patients.
So far, of the 14,000 patients believed exposed, just 2.2 % have developed symptoms.
While that number will likely rise, the CDC believes that patients who have gone more than 42 days since their last injection without showing signs of illness are at a substantially reduced risk of developing meningitis.
Therefore the CDC continues to advise against prophylactic treatment of asymptomatic individuals who may have been exposed.
This excerpt from last night’s HAN advisory.
October 23, 2012, 22:00 ET (10:00 PM ET)
CDCHAN-00330-2012-10-23-UPD-NIssuance of Guidance on Management of Asymptomatic Patients Who Received Epidural or Paraspinal Injections with Contaminated Steroid Products
CDC analysis suggests that the period of greatest risk for development of fungal meningitis among patients who received epidural or paraspinal injections with contaminated products1 is during the first 6 weeks (42 days) after injection; therefore, additional monitoring of these patients should be considered. Accordingly, CDC provides guidance for asymptomatic patients who received epidural or paraspinal injections with contaminated steroid product1 within the last 6 weeks (42 days), and those who received such products longer than 6 weeks (42 days) ago. For specific details about the updated guidance, see Guidance on Management of Asymptomatic Patients Who Received Epidural or Paraspinal Injections with Contaminated Steroid Products.
As stated above, CDC does not recommend initiation of antifungal treatment in the absence of diagnostic test results indicating fungal meningitis in exposed patients who are asymptomatic. Currently available data do not suggest an added benefit to this approach in comparison to the strategies outlined in the updated guidance, and patients may experience serious adverse drug events associated with treatment.
Watchful waiting is always difficult, particularly when you are dealing with a potentially fatal condition. But sometimes it really is the lesser of two evils.
Patients who go more than 42 days without developing symptoms are believed to be at reduced risk of illness - but as we saw last week (see Revisiting An Earlier Fungal Meningitis Outbreak) during a similar outbreak 10 years ago in South Carolina - infections cropped up as much as six months post-exposure.
All of which means that this story, and the ordeal for those exposed, isn’t likely to be over anytime soon.
