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What’s the truth about the fungal meningitis outbreak in the US

Posted Oct 30 2012 6:26pm

With the worrying news of the growing number of people in the US affected by the meningitis outbreak caused by steroid shots people had received for relieving back pain, here is some more information about this dangerous illness.

The bad news is that over 300 people have been infected and more than 20 have unfortunately died from it . The people diagnosed with the meningitis are from 15 states, including: Florida, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, New Hampshire, New Jersey, North Carolina, Ohio, Pennsylvania, Tennessee, Texas and Virginia.

The only good news is that this specific type of meningitis is not contagious, so at least it can’t be spread from one person to another.

The pharmaceutical company behind these contaminated drugs The New England Compounding Center of Framingham, Massachusetts is currently being scrutinized by the Food and Drug Administration, the drugs recalled and the company shut down.

So how did it spread? The drugs injected were contaminated, and then distributed to hospitals all over the country.  Now, people who received epidural injections for back pain, as well as those with  infusions during transplantation surgery have been injected with the disease. The fear is that  people who have had any type of injections or infusions with the contaminated drugs may be in risk of contracting this disease. Doctors from around the US are being asked to call back and inform any patients they have injected with drugs from this company, just as a precaution.

The bad news once again is that nobody is exactly sure about the numbers of these patients, who could have potentially been infected.  Health officials fear that the numbers of those infected will rise. It is believed that about 14,000 people, who have received methylprednisolone acetate injections, could be at risk of contracting fungal meningitis.

So, what are the possible reasons for this outbreak? How did these steroid pharmaceuticals produced by the New England Compounding Center in Framingham Massachusetts become contaminated? So, how can a pharmaceutical company where all hygienic, good practices and all other regulations for safety should be followed strictly could have let something like this happen?  These are the questions everybody has been asking.

Even though thorough state and federal investigations are being performed on the Company’s premises, no official information of the possible causes for the contamination has yet been released. Some possible reasons may be the presence of unhygienic conditions, sloppy or insufficient sterilization, broken equipment, the purchase and use of an infected ingredient, a human error, etc. Obviously, the hopes are that this is an internal infection, rather than one caused by an external supplier, which could mean that other companies using the contaminated ingredient could also be producing and selling dangerous products. Also, hopes are that the other products produced by the NECC are not contaminated either.

The problem with this fungal meningitis is that it is so rare, that no or very little research has been done, and the treatment is not that clear-cut.

Meningitis is a dangerous swelling and irritation of the spinal cord and brain meninges (the membranes and clear liquid which cover them).  This is usually due to an inflammation resulting from infection or bacteria, more rarely caused by certain drugs and cancers. In the rare cases people with weakened immune systems caused by HIV or undergoing immunosuppressive therapies are those who would most likely develop fungal based meningitis. With this type of infection, the fungus (yeast, mold, etc.) enters the meninges and through the blood vessels can enter the brain and cause strokes, various complications and even death.

The symptoms of fungal meningitis vary from patient to patient, but in general they include mild to strong (but not extremely severe) headaches, fever, neck stiffness and chills, redness and swelling of the place where the shot what made,  and an overall feeling of being really ill. The period for which each person infected actually develops the symptoms of the disease, and can actually take some time, as opposed to viral or bacterial meningitis which can become full-blown meningitis in a matter of hours. In fact, with this outbreak there have been cases where patients have contracted the illness as long as 48 days after receiving the infected shot.

The problem with the relatively mild symptoms is that in many cases the patient gets diagnosed only after they have already had a stroke caused by the fungal meningitis. Diagnosing fungal meningitis is done with a lumbar puncture (a spinal tap) where a sample of the liquid surrounding the lower spin is collected, cultured and tested for fungus growth. Because this is not 100% sure, the spinal fluid is tested for any other kind of infections apart from the fungi, the white cells are counted, the glucose level and protein content are analyzed.

Unfortunately, the existing meningitis vaccines do not work with this type of fungal meningitis.

The treatment of fungal meningitis is long, the drugs used are in limited availability – Amphotericin B and Voriconazole .  Doctors are worried that there might be shortage of the necessary drugs to treat the outbreak if the number of people infected grows.  The treatment may take a long time, because it doesn’t involve the actual killing off of the fungi, but rather inducing its growth in order to cause the immune system to fight off the infection by itself. Unfortunately, often there are long-term side effects of such an inflammation of the brain and spinal cord meninges, as well as various side effects from the drugs used for the treatment.

This contamination is unforgivable, but surely measures will be taken to sanction those responsible and to prevent from future such contaminations happening.

The most important thing is not to spread panic among people, but rather keep the doctors informed and the get checked up in time, because the earlier the fungal meningitis is diagnosed the earlier it can be treated, and the less the risks of side effects , complications and a fatal ending.

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