Testing for Fungal Meningitis after a Spinal Injection with NECC Steroid

Testing for spinal meningitis is painful, and Attorney Fred Pritzker is working to help patients get money to compensate them for this pain and for medical expenses, lost income and emotional distress caused by having a spinal injection of steroid medication made by New England Compounding Center (NECC). This company has been associated with an outbreak of fungal meningitis in 15 states that has 233 confirmed cases to date. Some of these patients also had a stroke.

Fred, who recently won over $40,000,000 for clients injured by another medical product, is representing patients nationwide and has filed his first lawsuit against NECC. Fred is filing individual lawsuits for each client and is not pursuing class action status for meningitis outbreak victims.

Contact Fred for a free consultation here regarding a steroid meningitis lawsuit.

Testing Cerebrospinal Fluid for Fungal Meningitis

The fungi involved in this cluster of fungal infections are still under investigation. To date, CDC has found two different fungi in patient cerebrospinal fluid (CSF), Aspergillus fumigatus and Exserohilum rostratum.

Thorough and rapid diagnostic evaluation is essential to identify the fungi causing a fungal infection in a patient who received an epidural injection of a potentially contaminated steroid product from NECC. This is because the genus of fungi making the person sick may determine what antimicrobial therapy is best and how long it is needed.

The CDC suggests the following for testing cerebrospinal fluid using a lumbar puncture (spinal tap):

  • When possible, collect a large volume of cerebrospinal fluid (CSF), ideally using a different site than was used for the epidural injection.
  • Obtain routine gram stain and bacterial cultures, including aerobic and anaerobic. The priority for remaining CSF specimens is fungal culture, conducted at the local hospital or state lab. When possible, submit a large volume of CSF (minimum 10mL) for fungal culture.
  • Remaining CSF may be sent to CDC for PCR. The minimum volume should be 1 mL; 5 mL is preferred. Samples sent to CDC should be unspun samples or freshly collected, unadulterated samples. If only a small volume can be obtained for CDC and the patient meets the case definition, send what you can.
  • CSF should be sent only on patients with CSF results showing >5 white blood cells (use traumatic tap correction for WBC), regardless of glucose or protein levels.
  • Specifically for the work-up of possible fungal pathogens:
    • Attempt to obtain larger volume of CSF to culture for fungi from intraventricular shunts/drains if patient presents with these.
  • All cultures should be incubated for at least 2 weeks prior to discarding.

We have heard from many patients who have had spinal taps, and every one of them says it was extremely painful. Those with jobs had to take time off of work.

Testing of Blood and Other Fluids

  • In addition to routine blood cultures, consider obtaining fungal blood cultures.
  • Other potentially infected fluid collections should be sampled (e.g., aspiration of epidural abscess) and sent for microbiologic testing as described above for CSF specimens (including fungal smear).

Testing Tissue Specimens

  • Any relevant tissue specimens sent for histopathology should be stained and reviewed for infectious agents, including fungi (silver stain).
  • Save specimens to send to state health departments and CDC for further evaluation. If fresh tissue can be saved, freeze at -70⁰C.
  • Send available autopsy specimens to CDC for further evaluation. See attached guidance for specimen collection and processing.

What about prophylaxis or lumbar puncture (spinal tap) for patients with no meningitis symptoms?

Currently, CDC emphasizes the need for rapid clinical evaluation and diagnosis, only if the patient has meningitis symptoms. Therefore prophylaxis and lumbar puncture (spinal tap) is not recommended by the CDC at this time. Patients with no meningitis symptoms should be closely monitored by a physician for development of symptoms

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Category: Medical Products And Procedures
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