ASPERGILLUS MENINGITIS - USA (04): MORE CASES, SECOND FUNGUS
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Date: Sat 6 Oct 2012
Source: NBC News [edited]
<http://vitals.nbcnews.com/_news/2012/10/05/14245074-seven-deaths-reported-in-growing-meningitis-outbreak-second-fungus-found?chromedomain=dailynightly&lite>
Federal health officials have widened their recall of drugs suspected
of giving people an unusual type of meningitis that has, so far,
killed 7, and identified 2 different types of fungus they believe are
infecting people. At least 64 cases in 9 states have been diagnosed
with meningitis linked to the contaminated drugs, the CDC reported Sat
6 Oct 2012. Health experts expect more cases will be reported and are
asking anyone who had a recent steroid injection for lower back pain
to be on the lookout for headaches, stiff neck, unsteadiness, and
other classic symptoms of meningitis.
"All patients who may have received these medications need to be
tracked down immediately. Patients can find the names of the clinics
that used these medications on the CDC website," said CDC's Dr.
Benjamin Park, medical officer for the fungal diseases branch. "It is
possible that if patients with infection are identified soon and put
on appropriate antifungal therapy, lives may be saved."
Tennessee state health officials said 4 more people had been diagnosed
there since Thu 4 Oct 2012, bringing that state's total cases to 29,
with 3 deaths. Michigan is the latest to report cases, with 4 there.
People with suspected fungal meningitis have been diagnosed in
Tennessee, Virginia, Maryland, Florida, North Carolina, Michigan and
Indiana.
The drug is question is called methylprednisone and is used mostly to
treat older patients for lower back pain. All the cases so far have
been traced to a single pharmacy in Massachusetts that makes the drugs
to order. The pharmacy has closed, surrendered its license, and
recalled its products, FDA officials said. But they said hundreds of
people could have been injected with contaminated steroids and
possibly other products. The pharmacy could have shipped products to
all 50 states. CDC listed the 75 clinics known to have received
shipments of methylprednisolone from the pharmacy.
Tennessee Health Commissioner Dr. John Dreyzehner said the clinics
that treated the patients are not to blame. "Our continuing
investigation found no lapses in process at the clinics," Dreyzehner
told reporters on Fri 5 Oct 2012. "Evidence indicates these clinics
and clinicians had no way of knowing about the contamination."
"Fungus has been identified in specimens obtained from 9 patients,
including _Aspergillus_ and _Exserohilum_," CDC said. Both types of
fungus are found in back yards; _Exserohilum_ can cause leaf spot, but
it has also been linked to skin and sinus infections. _Aspergillus_
causes lung infections in cancer, HIV, and other patients with
suppressed immune systems. Some kind of fungal contaminant has been
found in at least one vial of drugs made by the pharmacy. Fungi can
grow in drugs that are not stored properly, especially those without
preservatives, like those made by the compounding pharmacy.
"Currently, we think that this type of meningitis is quite severe, as
we have been describing here. The antifungal treatment for this is
intravenous antifungal treatment and requires initial hospitalization.
But the duration of antifungal therapy could be prolonged, possibly on
the order of months," Park said. To be especially careful, health
officials have widened their warning to anyone who got a steroid
injection in the spine between 1 Jul and 28 Sep 2012. "Infected
patients have presented approximately 1-4 weeks following their
injection with a variety of symptoms, including fever, new or
worsening headache, nausea, and new neurological deficits (consistent
with deep brain stroke)," the FDA said in a statement on its website.
"Some of these patients' symptoms were very mild in nature."
The FDA says there will be no shortage of methylprednisone. "There are
FDA approved versions of methylprednisolone acetate injection on the
market, available with or without preservatives," it said.
"Although all cases detected to date occurred after injections with
products from these 3 lots, out of an abundance of caution, CDC and
FDA recommend that healthcare professionals cease use of any product
produced by the New England Compounding Center until further
information is available," the FDA added. Among the other drugs from
the pharmacy being recalled are 3 steroid drugs, betamethasone, a
steroid usually given in creams or as a spray, dexamethasone and
triamcinolone; 2 local anesthetics called lidocaine and bupivicaine;
the blood pressure drug clonidine; and saline.
Compounding pharmacies are not regulated as closely as drug
manufacturers, and their products are not subject to FDA approval.
[Byline: Maggie Fox]
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[As the number of cases continues to frighteningly rise, a 2nd mold,
_Exserohilum_, has been reported to be involved. This environmental
organism is much less common as a human pathogen than _Aspergillus_.
This agent is one of the molds associated with phaeohyphomycosis
(McGinnis MR, Rinaldi MG, Winn RE: Emerging agents of
phaeohyphomycosis: Pathogenic species of Bipolaris and Exserohilum. J
Clin Microbiol. 1986;24:250-259).
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