SMOKINCHOICES (and other musings)

October 21, 2012

Fungus in Steroid shots

Fungus found in steroid shots

Officials confirm cause of outbreak; meningitis toll: 20

By Bill Berkrot and Deena Beasley REUTERS
By Misti Crane THE COLUMBUS DISPATCH

NEW YORK — U.S. health officials made their first confirmation of the presence of a deadly fungus in one of three lots of steroids tied to a national meningitis outbreak, as the death toll rose to 20 yesterday.

The U.S. Food and Drug Administration said it was still testing two additional lots of methylprednisolone acetate, the steroid used to treat back pain, for the presence of the rare Exserohilum fungus. It is also testing other injectable drugs that were supplied by the New England Compounding Center (NECC) in Massachusetts.

“Now we can definitively say that the injections are linked to the infection,” said Dr. Tom Chiller, an epidemiologist with the federal Centers for Disease Control and Prevention. “To date, CDC has no firm evidence of infection in any patients beyond those exposed to the contaminated lots.”

The CDC said the death toll increased by one, to 20.

Also, nine new cases brought the national total of infections to 254, including the first in New York — the 16th state with a confirmed infection.

Michigan reported its fourth fungal-meningitis death, and additional infections also were reported in Ohio, Indiana, New Hampshire, New Jersey and Tennessee. There are also three cases of peripheral infections in joints, the CDC said.

“There were a lot more spinal injections performed versus joint injections, but the infection rate may also reflect the fact that joint infections might be slower, or the incubation period could be longer … we just don’t know,” Chiller said.

About 14,000 patients are believed to have been exposed to the potentially tainted NECC steroid, and 97 percent of them have been contacted, the FDA and CDC said.

  • Doctors in Baltimore said early diagnosis and treatment of patients at risk of fungal meningitis is vital, based on the case of an otherwise-healthy woman who declined rapidly after receiving steroid injections for neck pain.

Writing in the Annals of Internal Medicine, researchers at the Johns Hopkins School of Medicine described the deterioration of an unnamed 51-year-old who sought care in an emergency room for a severe headache a week after receiving an injection with tainted medication on Aug. 31.

The CDC has said it learned about the fungal-meningitis outbreak on Sept. 21. NECC is under investigation by federal authorities over how it supplied hospitals, clinics and other health-care providers with large orders of compounded drugs, including whether it violated state laws regulating pharmacies.

Fungal infections typically attack only people with severely compromised immune systems, such as patients who have had bone-marrow or organ transplants.

  • In the case described by the team at Johns Hopkins, the injection was the woman’s first, and she had no medical history of having a compromised immune system, nor was she taking a long-term medication.

Doctors found nothing and sent her home, but she returned the next day with more-severe symptoms and was admitted to the hospital, where she was treated with a series of antibiotics and other drugs.

Tests for a host of infections were negative.

  • The woman died 10 days after being admitted to the hospital, the same day that the team found evidence of Exserohilum in her spinal fluid. An autopsy showed massive tissue death in the brain stem, inflammation in the blood vessels and evidence of a stroke.

10th Ohioan sickened

A 44-year-old Franklin County woman is the 10th Ohioan to develop fungal meningitis in an outbreak linked to contaminated steroid shots from a Massachusetts pharmacy.

The woman was hospitalized as of Wednesday, Franklin County Public Health spokeswoman Mitzi Kline said yesterday.

Kline would not say where the woman lives in the county, or which hospital she went to.

The woman was one of several patients with whom the department was in touch earlier this month as part of an effort to warn those who were treated with potentially contaminated shots, Kline said. At that time, the woman had experienced no symptoms.

The only medical practice in Franklin County to have received the steroids from the New England Compounding Center is the Ortho-Spine Rehabilitation Center at 7211 Sawmill Rd. in Dublin.

A man who answered the phone there yesterday said he hadn’t heard of the woman’s illness and had no comment. An office manager was not available, he said. mcrane@dispatch.com

@MistiCrane

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