Fungal Meningitis from Steroid Injections

CDC Outbreak Image
Antifungal drug susceptibility testing during the 2012 multistate outbreak investigation.

A multi-state outbreak of meningitis among patients who received epidural steroid injections is growing daily. To date, there are over 700 CDC-confirmed cases of fungal infection in 20 states. 377 of these people contracted fungal meningitis, and 345 of them contracted other infections, including epidural abscess and osteomyelitis (fungal infection in the bone). The states involved include the following: Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas and Virginia. 50 people have died. Fred and his Bad Bug Law Team represent people throughout the United States.

Many of the victims of this outbreak also had strokes that are believed to have resulted from their infection.

All infected patients received injection with preservative-free methylprednisolone acetate prepared by New England Compounding Center (NECC), located in Framingham, MA. The lots of medication that were used on infected patients have been recalled. The lots are:

  • Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #[email protected], BUD 11/17/2012
  • Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #[email protected], BUD 12/26/2012
  • Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #[email protected], BUD 2/6/2013

Investigation of the Outbreak

On September 21, 2012, CDC was notified by the Tennessee Department of Health of a patient with the onset of meningitis approximately nineteen days following epidural steroid injection at a Tennessee ambulatory surgical center (ASC). All initial cultures of cerebrospinal fluid (CSF) and blood were negative; subsequently the patient had Aspergillus fumigatus isolated from CSF by fungal culture.

On September 28, 2012, investigators identified a case outside of Tennessee (North Carolina), possibly indicating contamination of a widely-distributed medication. Fungus has been identified in specimens obtained from three of these additional patients, one of whom also had Propionobacterium acnes, of unclear clinical significance, isolated from a post-mortem central nervous system specimen.

Infected patients have presented approximately one to four weeks following their injection with a variety of symptoms including: fever, new or worsening headache, nausea, and/or new neurological deficit (consistent with deep brain stroke). Some of these patients’ symptoms were very mild in nature. Cerebrospinal fluid (CSF) obtained from these patients has typically shown elevated white cell count (with a predominance of neutrophils), low glucose, and elevated protein.

CDC-Confirmed Case Definition

  1. A person with meningitis of sub-acute onset (1-4 weeks) following epidural injection after May 21, 2012.
  2. A person with basilar stroke 1-4 weeks following epidural injection after May 21, 20122, who has not received a diagnostic lumbar puncture.
  3. A person with evidence of spinal osteomyelitis or epidural abscess at the site of an epidural injection diagnosed 1-4 weeks after epidural injection after May 21, 2012.
  4. A person with septic arthritis3 diagnosed 1-4 weeks following steroid joint injection after May 21, 2012.

For the purpose if this case definition, clinically diagnosed meningitis means 1 or more of the following symptoms: headache, fever, stiff neck, or photophobia and a cerebrospinal fluid (CSF) profile consistent with meningitis (pleocytosis +/-  low glucose, elevated protein). Clinically diagnosed septic arthritis means new or worsening pain with presence of effusion or new or worsening effusion.

What Should Patients Be Doing?

If you have received a steroid injection, and you are experiencing symptoms such as new or worsening headache, fever, neck stiffness, or pain at the injection site, contact your physician to determine if you have received one of the recalled products and to receive further evaluation.

Our meningitis lawyers represent sick people and their families nationwide in personal injury and wrongful death lawsuits against manufacturers, distributors, clinics and others. Contact Fred and his Bad Bug Law Team for a free consultation here.