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Case Definitions for Meningitis and Septic Arthritis

October 16, 2012 8:00 PM EDT

Probable Case

A person who received a methylprednisolone acetate (MPA) injection, with MPA that was definitely or likely produced by the New England Compounding Center (NECC), and subsequently developed any of the following

  • Meningitis1 of unknown etiology following epidural or para-spinal injection2 after May 21, 2012;
  • Posterior circulation stroke without a cardioembolic source and without documentation of a normal cerebrospinal fluid (CSF) profile, following epidural or para-spinal injection2 after May 21, 2012;3
  • Osteomyelitis or abscess of unknown etiology in the spinal or para-spinal structures at the site of injection following epidural or para-spinal injection2 after May 21, 2012; or
  • Osteomyelitis or worsening inflammatory arthritis of a peripheral joint (e.g., knee, shoulder, or ankle) of unknown etiology diagnosed following joint injection after May 21, 2012.

1 Clinically diagnosed meningitis with one or more of the following symptoms: headache, fever, stiff neck, or photophobia, in addition to a CSF profile showing pleocytosis (>5 white blood cells, adjusting for presence of red blood cells by subtracting 1 white blood cell for every 500 red blood cells present) regardless of glucose or protein levels.

2 Para-spinal injections include, but are not limited to, spinal facet joint injection, sacroiliac joint injection, spinal or para-spinal nerve root/ganglion block, or blood patch.

3 Patients in this category who do not have any documented CSF results should have a lumbar puncture performed if possible.

Confirmed Case

A probable case with evidence (by culture, histopathology, or molecular assay) of a fungal pathogen associated with the clinical syndrome.

Post-ProceduralIinfection in Patients Exposed to Non-MPA NECC Products

A patient who developed an infection in a normally sterile site4 following use of one or more products labeled as sterile and prepared by NECC, excluding MPA.

4 Normally sterile sites include blood, CSF, pleural fluid, peritoneal fluid, pericardial fluid, surgical aspirate, bone, joint fluid, or internal body site (e.g., lymph node or brain).

 
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