The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) are coordinating a multi-state investigation of fungal meningitis among patients who received an epidural steroid injection. Several of these patients also suffered strokes that are believed to have resulted from their infection. Fungal meningitis is not transmitted from person to person. These cases are associated with a potentially contaminated medication. Investigation into the exact source is ongoing; however, interim data show that all infected patients received injection with preservative-free methylprednisolone acetate (80mg/ml) prepared by New England Compounding Center, located in Framingham, MA.

As of October 23, 2012 the CDC reports 308 cases of fungal meningitis, stroke due to presumed fungal meningitis, or other central nervous system-related infections.  Death has occurred in 23 of these cases.

None of the reported fungal infection cases have occurred in Washington State.  This may become an issue within Washington’s workers’ compensation system, though, if any cases of infection arise from Washington clinics or if claimants that live out-of-state received an injection of the tainted product in other states.  Under Washington law, a workers’ compensation claim must cover any condition that arises from treatment provided for an industrial injury under an open workers’ compensation claim.  Similarly, if a claim has been closed but such an infection occurs in the course of treating an accepted condition, an application to reopen the claim based on a worsening could, in theory, be filed.

Patients who have had an epidural steroid injection since July 2012, and have any of the following symptoms, should talk to their doctor as soon as possible:

• Worsening headache
• Fever
• Sensitivity to light
• Stiff neck
• New weakness or numbness in any part of your body
• Slurred speech

 

Patients need to remain vigilant for onset of symptoms because fungal infections can be slow to develop.

 

Typically in this outbreak, symptoms have appeared 1 to 4 weeks following injection, but it’s important to know that longer and shorter periods of time between injection and onset ofsymptoms have been reported. Therefore, patients and physicians need to closely watch for symptoms for at least several months following the injection.

As of October 23, 2012 the CDC reports 308 cases of fungal meningitis, stroke due to presumed fungal meningitis, or other central nervous system-related infection meeting the outbreak case definition, plus 3 peripheral joint infections (e.g., knee, hip, shoulder, elbow). No deaths have been associated with peripheral joint infections.

The CDC’s guidance to patients has not changed as a result of the expanded voluntary recall of all NECC products, announced October 6. Patients who feel ill and are concerned about whether they received a medication from one of the NECC products recalled on September 26 should contact their physician.