Hidden Fungal Infections from Recalled Epidural Injections Spotted on MRI

Doctors from Michigan indicate that magnetic resonance imaging (MRI) tests could be used to spot fungal infections caused by tainted epidural steroid injections to the spine.  

The findings were published in the Journal of the American Medical Association (JAMA) on June 19, coming as a result of tests conducted to help deal with a fungal meningitis outbreak that began last year and has sickened more than 700 people and killed nearly 60 nationwide.

Researchers from St. Joseph Mercy Hospital in Ann Arbor say that the technique could be used to detect fungal infections in patients before they start to show any symptoms and in patients who remain asymptomatic for a long time after receiving the injections.

The outbreak of fungal infections that led to the research has been linked to a single compounding pharmacy in Massachusetts, the New England Compounding Center (NECC), which was shut down after recalling all of its supposedly sterile products. The company declared bankruptcy in the wake of a growing number of fungal meningitis lawsuits filed by individuals who received the tainted injections, and criminal charges could be brought as a result of the conditions at the pharmacy that led to the widespread contamination.

As part of this latest study, researchers screened 172 patients who had received NECC epidural steroid injections. They found abnormal MRI results in 36 of them. All but one were later diagnosed as having confirmed or probable fungal spinal or paraspinal infections. All 35 received antifungal treatment as a result.

“Screening MRI led to identification of patients who had minimal or no symptoms of spinal or paraspinal infection and allowed early initiation of medical and surgical treatment,” the researchers concluded.

The outbreak has resulted in a new focus on the practices at many compounding pharmacies, which traditionally serve the needs of local hospitals and doctors by creating medications on a per-prescription basis. However, NECC was mass-producing medications and had sales representatives in several states, resulting in an estimated 14,000 patients receivoing the potentially contaminated epidural steroid injections.

While the fungal meningitis outbreak is winding down, there were still new cases being discovered as recently as April. Also, the discovery comes less than two weeks after the FDA issued a recall for all sterile products distributed by Main Street Pharmacy in Tennessee. According to federal investigators, there have been a number of infections of patients who received epidural steroid injections from Main Street Pharmacy. Investigators found vials of steroids contaminated with fungus and bacteria.

There have been no reports of fungal meningitis linked to the Main Street Pharmacy recall. Injection site infections linked to the compounding pharmacy’s drugs have been described as skin and soft tissue infections.