Last issue, Neurology Today reported on the continuing public health threat that left 19 people dead and 247 severely ill with fungal meningitis linked to three contaminated lots of injectable methylprednisolone acetate (MPA). (See “Contaminated Lots of Epidural Steroid Injections Prompt Outbreak of Meningitis Advice on Diagnosis & Treatment from Neuroinfectious Disease: Advice on Diagnosis & Treatment from Neuroinfectious Disease Experts,” http://bit.ly/TYxmZM.)
At press time, the numbers have changed, and will likely continue to rise, given the incubation period for developing meningitis. In updated data, the Centers for Disease Control and Prevention (CDC ) confirmed 377 cases of fungal meningitis and nine peripheral joint infections (e.g., knee, hip, shoulder, elbow) and 28 deaths — all linked to the contaminated MPA lots. As of Oct. 22, the CDC laboratories reported that Exserohilum rostratum had been found in clinical specimens for all but two of the 54 patients with CDC laboratory-confirmed fungal meningitis.
The laboratories have also confirmed the presence of the same fungus, Exserohilum rostratum, in unopened vials from two of the three recalled lots. Testing on the third lot of preservative-free MPA is ongoing. These laboratory test results strengthen the link between preservative-free MPA vials and the outbreak.
The fungi found in both patients and in recalled vials are common in the environment but were not recognized as a cause of meningitis before this outbreak.”
The CDC also identified non-human pathogens Rhodotorula laryngis and Rhizopus stolonifer in two lots, which are not known to cause human disease.
FOR FURTHER READING:
• Lyons JL, Gireesh ED, Trivedi JB, et al. Fatal Exserohilum meningitis and central nervous system vasculitis after cervical epidural methylprednisolone injection. Ann Intern Med 2012; E-pub 2012 Oct. 17.
• Pettit AC, Kropski JA, Castilho JL, et al. The index case for the fungal meningitis outbreak in the United States. N Engl J Med 2012; E-pub 2012; Oct. 19
• Wijeyaratne, CN, Harshalal RS. Aspergillus meningitis in Sri Lanka—a post-tsunami effect? N Engl J Med 2007;356:754–756.