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Frequently Asked Questions for Patients: Multistate Fungal Meningitis Outbreak Investigation

October 14, 2012 4:30 PM EDT

About the Outbreak

Background
The Centers for Disease Control and Prevention (CDC) with state and local health departments and the Food and Drug Administration (FDA) are investigating a multistate meningitis outbreak of fungal infections among patients who have received a steroid injection of a potentially contaminated product into the spinal area. This form of meningitis is not contagious. The investigation also includes fungal infections associated with injections in a peripheral joint space, such as a knee, shoulder or ankle. See Current Situation Update

Physician Consulting with PatientHow many cases have been reported?
Updates about the investigation, including case counts, are available at http://www.cdc.gov/hai/outbreaks/meningitis.html.

Is the source of the outbreak known?
CDC is investigating medications and products that are associated with this outbreak of fungal meningitis. At this point, the original source of the outbreak has not been determined. However, injectable steroid medication has been linked to the outbreak. The lots of medication that were given to patients have been recalled by the manufacturer.

The type of spinal epidural medication given to patients affected by this outbreak is not the same type of medication as that given to women during childbirth.

Which states received the implicated product?
Twenty-three states have received medication from the New England Compounding Center. A list of states and facilities that have received medication from one of these lots can be found on the Current State Facility page.

Are other medications from the New England Compounding Center located in Framingham, Massachusetts associated with infections?
To date, CDC has not received confirmed reports of infections linked to other products from the New England Compounding Center. However, out of an abundance of caution, CDC recommends that patients cease use of any product produced by the New England Compounding Center until further information is available. A list of products produced by the New England Compounding Center can be found through the FDA website at http://www.fda.gov/Drugs/DrugSafety/ucm322734.htm.

If patients have taken or used medications from New England Compounding Center, and they are worried that they are ill because of use of one of these products, they should seek medical attention. Again, CDC has not received any confirmed reports of infection linked to other products from New England Compounding Center.

What is a compounding pharmacy? Why are these medications compounded when they are also commercially available?
Compounding pharmacies create special formulations of medications in order to fit patients’ healthcare needs. For example, they may change the dose or change the formulation of a medication from a solid to a liquid.

Where can I find updates and additional information on this outbreak?
For complete information and updates on this outbreak, visit www.cdc.gov/hai/outbreaks/meningitis.html.

Patient Guidance: Fungal Meningitis

Are patients who did not receive an injection at risk?
No. Fungal meningitis is not transmitted from person to person. These infections are associated with a potentially contaminated medication that is injected into the body.

What should patients do?

  • Find out if you received a potentially contaminated medication. If you are concerned about which product was used in your procedure, you should first contact the physician who performed your procedure.

    The facilities who received one of the lots recalled on September 26, 2012, are actively contacting patients to find out if they are feeling well. The list of facilities that received medication from one of these three lots is available at http://www.cdc.gov/hai/outbreaks/meningitis-facilities-map.html.
  • If you have received a potentially contaminated medication, seek medical attention if you have symptoms. You may have very mild symptoms that are only slightly worse than usual. For example, many infected patients have had slight weakness, slightly worsened back pain, or even a mild headache. Patients with infections have typically developed symptoms within 1-4 weeks after their injection. However, shorter and longer timeframes between injection and onset of symptoms have been reported. The timeframe is still being investigated. You should watch vigilantly for symptoms if you were injected with potentially contaminated steroids and see a doctor if you have any of the symptoms of fungal meningitis or joint infection.

I was contacted because I received a spinal epidural injection with one of the potentially contaminated steroid medications but I feel fine. Do I still need to be concerned? Yes. You should remain vigilant for onset of symptoms because fungal infections can be slow to develop. In this outbreak, symptoms typically have appeared 1 to 4 weeks following injection, but it's important to know that longer and shorter periods of time between injection and onset of symptoms have been reported. Therefore, you should closely watch for symptoms for at least several months after the injection and see a doctor if you have any of the symptoms below, even if they have been previously evaluated.

Symptoms of fungal meningitis
If you had an epidural steroid injection since May 21, 2012, and have any of the following symptoms, talk to your doctor as soon as possible:

  • New or worsening headache
  • Fever
  • Sensitivity to light
  • Stiff neck
  • New weakness or numbness in any part of your body
  • Slurred speech
  • Increased pain, redness or swelling at your injection site

CDC will provide updated guidance as more information becomes available.

Also See: Clinician Guidance

Patient Guidance: Joint Infection

I was contacted because I received a joint injection with one of the potentially contaminated steroid medications but I feel fine. Do I still need to be concerned?
This investigation is ongoing and joint infections from fungus may take longer to develop than fungal meningitis. Patients who have had steroid medications injected in joints only are not believed to be at risk for fungal meningitis but could be at risk for joint infection. Watch vigilantly for symptoms if you were injected with potentially contaminated steroids and see a doctor if you have any of the following symptoms.

Symptoms of joint infections
Watch vigilantly for symptoms if you were injected with potentially contaminated steroids and see a doctor if you have any of the following symptoms:

  • Fever
  • Increased pain
  • Redness, warmth, or swelling in the joint that received the injection or at the injection site

CDC will provide updated guidance as more information becomes available.

Also See: Clinician Guidance

Fungal Meningitis

What is meningitis?

Meningitis is swelling of the protective membranes, or meninges, covering the brain and spinal cord. The swelling is usually caused by an infection with a bacteria or virus, but meningitis can also be caused by a fungus. Meningitis caused by a fungus is called fungal meningitis. The severity of illness and the treatment for meningitis differ depending on the cause, so knowing the specific cause of meningitis is important.

What is fungal meningitis?

Fungal meningitis occurs when the protective membranes covering the brain and spinal cord are infected with a fungus. Fungal meningitis is rare and usually caused by the spread of a fungus through blood to the spinal cord.

Is fungal meningitis common after epidural injections?
Epidural injections are generally very safe procedures, and complications are rare. Fungal meningitis is an extremely rare cause of meningitis overall, including after epidural injections. The type of epidural medication given to patients affected by this outbreak is not the same type of medication as that given to women during childbirth.

What are the symptoms of fungal meningitis?
Symptoms of fungal meningitis are similar to symptoms of other forms of meningitis; however, they often appear more gradually and can be very mild at first. In addition to typical meningitis symptoms, like headache, fever, nausea, and stiffness of the neck, people with fungal meningitis may also experience confusion, dizziness, and discomfort from bright lights. Patients might just have one or two of these symptoms.

Resources and Links

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