Fungus Confirmed in Epidural Steroid Injections: FDA, CDC

Federal health officials have confirmed the presence of fungus in epidural steroid injections, which have been linked to a nationwide meningitis outbreak that has killed 20 people and sickening hundreds more.

The U.S. Food and Drug Administration (FDA) and U.S. Centers for Disease Control and Prevention (CDC) have found that at least 50 unopened vials of epidural steroid injections from the New England Compounding Center (NECC) were tainted with the fungus exserohilum rostratum, which is a fungus associated with grass and rotting wood.

The fungus was found in vials of methylprednisolone acetate, which is a corticosteroid that is typically used to treat inflammation and commonly injected directly into the spine to relieve back pain.

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NECC has recalled nearly 18,000 vials of the steroid, which were administered to an estimated 14,000 people at hospitals and medical facilities in 23 states.

Meningitis Death Toll Rises, 16 States Confirm

According to the latest update provided by the CDC, there are now 257 confirmed fungal meningitis infections reported throughout the United States, with the 20th death nationwide reported on Thursday.

States most heavily impacted by the outbreak include Tennessee (63 cases), Michigan (49 cases), Virginia (37 cases), Indiana (34 cases), New Jersey (13 cases) and Florida (13 cases). However, additional infections have been diagnosed in other states.

New York was the latest to join the outbreak this week, becoming the 16th state to officially confirm a diagnosed fungal meningitis infection.

Of the reported cases nationwide, 254 are related to epidural injections given for back pain. Only three cases are infections of the joints that affect the knee, elbow or hip, according to officials.

Officials from the CDC say they learned about the outbreak on September 21 and have contacted patients injected as far back as May.

Early Diagnosis and Treatment of Fungal Meningitis Crucial

As federal officials are investigating the source of the outbreak, physicians throughout the United States are struggling to notify patients who received the recalled epidural injections.

According to the findings of new research published this week in the Annals of Internal Medicine, early detection and rapid treatment of fungal meningitis is important to limit the continuing death toll from the outbreak. The study outlined the case of an otherwise healthy 51 year old patient whose health declined very rapidly following the injection of the tainted medication on August 31.

Researchers at the Johns Hopkins School of Medicine emphasize early detection, after the patients health declined severely within only 10 days of seeking treatment in an emergency room for a headache.

The epidural injection was the patients first. After seeking help at a local emergency room she was sent home only to return the following day with more severe symptoms. She was then admitted to the hospital where doctors attempted a series of treatments to aid her condition.

Multiple tests were conducted to determine what type of infection she had, all returning negative. Exserohilum was finally confirmed at day 10 as the cause of meningitis and the rapid evolvement of symptoms which caused massive tissue death in her brain and led to her ultimate death.

Fungal meningitis is a non-contagious form of meningitis. The disease causes infection of the fluid surrounding the brain and spinal cord and can also be caused by bacterial infection and parasites.

Symptoms of meningitis following an epidural steroid injection may include fever, headache, stiff neck, nausea, vomiting, increased sensitivity to light and mental confusion. As the disease progresses, symptoms may become severe, resulting in seizures, coma and death.

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