Wednesday, October 10, 2012

Meningitis warning for those who've had spinal injections of steroids since May 21, 2012

Doctors have been having problems recognizing fungal meningitis.

Doctors Are Off Balance as Patients Show Atypical Meningitis Reactions
Wall Street Journal
October 10, 2012

The rare fungal meningitis behind a deadly national outbreak is difficult to diagnose because it can cause strokes and other reactions unlike those typically seen with the more common type of the illness.

Meningitis, a swelling of the protective membranes of the brain and spinal cord, is typically caused by bacteria that can be treated with antibiotics, or by a virus, for which there is no treatment.

Fungal meningitis, on the other hand, needs to be treated with antifungal drugs. The length of treatment isn't known but the federal Centers for Disease Control and Prevention is telling doctors that patients may need treatment for months.

Bacterial meningitis tends to attack quickly with a fever, a headache that grows worse, a stiff neck and eventually a loss of consciousness.

However, some patients who contracted fungal meningitis in the current outbreak have had just a mild headache and no fever, and "for the most part symptoms occur in a more gradual fashion," said William Schaffner, an infectious disease expert and chairman of the department of preventive medicine at Vanderbilt University School of Medicine in Nashville, which has treated four patients with fungal meningitis.

Dr. Schaffner said fungal meningitis is invading blood vessels and causing strokes in some patients affected by the current outbreak. But doctors don't typically test for meningitis when patients go to the emergency room with signs of stroke, such as weakness or loss of movement on one side of their bodies, slurred speech or sudden vision changes.

"Nobody is totally sure what these patients look like," said Trish Perl, senior hospital epidemiologist at the Johns Hopkins Health System in Baltimore, who is advising doctors about patients who might have the disease.

Because the fungal-meningitis symptoms have been so varied among patients, federal health officials have urged doctors to set a low bar in deciding whether to test patients who received a steroid injection in their backs. The test requires a spinal tap, which involves a needle inserted in the spinal column to collect spinal fluid.

The CDC has said as many as 13,000 people in 23 states have been exposed to the potentially contaminated steroid injections made by the New England Compounding Center before the products were recalled Sept. 26.
Compounding pharmacies create blends of medicines, including liquid forms of pills.

The agency said patients who have had an epidural steroid injection since May 21, 2012, and are experiencing symptoms such as headache, fever, sensitivity to light, slurred speech or numbness, should contact their doctors as soon as possible.

Officials are most concerned about spinal injections. Those given in other places, such as the knees or hips, are highly unlikely to cause meningitis, though there is the possibility of a local joint infection...

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