November 4, 2012
New Illness Linked To Contaminated Steroid Injections Surfaces
Lawrence LeBlond for redOrbit.com - Your Universe Online
People recovering from dangerous fungal meningitis have a new worry on their hands, after several people treated for the deadly infection have gone home to recover only to return to the ER with a second illness, according to health experts.
The new problem, called an epidural abscess, was found to be caused by the same injectable steroid, methylprednisolone acetate, which is used to treat neck or back pain, the New York Times reported Friday.
Different from meningitis, which affects the membranes of the brain and spinal cord, epidural abscesses are a localized infection. However, if left untreated, the abscess can potentially cause meningitis itself. These abscesses have formed even while patients were taking powerful antibiotics, putting them back in the hospital for further treatment.
For now, it seems the new problem has been mostly isolated to Michigan, which has seen the most fungal meningitis cases (112) linked to the contaminated steroid injectable.
“We´re hearing about it in Michigan and other locations as well,” Dr. Tom M. Chiller, deputy chief of mycotic diseases at the Centers for Disease Control and Prevention (CDC), told the NY Times. “We don´t have a good handle on how many people are coming back.”
“We are just learning about this and trying to assess how best to manage these patients,” he added. “They´re very complicated.”
Dr. Lakshmi K. Halasyamani, chief medical officer at St. Joseph Mercy Hospital in Ann Arbor, Michigan, said on Friday about a third of the 53 patients that were treated for fungal meningitis had returned with abscesses.
Halasyamani said the new problem is of particular concern. “An epidural abscess is very serious. It´s not something we expected.”
She and other experts noted it is puzzling that the abscesses can even occur after patients being seen for the contaminated injectables were administered high doses of antibiotics to fight the fungus.
The main symptom of the epidural abscess is severe pain near the injection site. However, the abscess is internal, with no signs of infection on the skin itself. To diagnose the infection, an MRI is required. After diagnosis, a neurosurgeon can drain and clean out the infection, unless the fungal strands are wrapped around nerves.
Dr. Carol A. Kauffman, an expert on fungal diseases at the University of Michigan, said in these instances, all that can be done is administration of more antifungal drugs and hope for the best. Doctors have very little experience with this type of infection.
A spokesperson for the Tennessee Department of Health, which has had the second highest number of meningitis cases, said his state has also seen a few cases of epidural abscesses.
This fungal meningitis outbreak has become one of the worst public health disasters ever linked to contaminated drugs. And with this new onset of illnesses also linked to the tainted steroid injectables, the health threat for as many as 14,000 patients who received the contaminated drug for pain management is nothing short of serious.
So far, according to the CDC´s meningitis website, 395 cases of fungal meningitis and 9 cases of peripheral joint infections have been reported. There have been 29 deaths associated with the disease, but that number is likely to rise, along with case counts, as many more people who have had the injections have yet to come forward with symptoms.
The deadly infection stems from three contaminated lots of the drug methylprednisolone acetate produced by the New England Compounding Center (NECC) in Framingham, Massachusetts. The company shipped out 17,000 vials of the drug to 76 facilities in 23 states. In all, 14,000 of the vials had been used since last May, offered mainly for neck and back pain; some have also received the drug for arthritic joints and have developed joint infections.