Featured Research

from universities, journals, and other organizations

Early clinical observations in the fungal meningitis outbreak

Date:
November 12, 2012
Source:
American College of Physicians
Summary:
A new article describes the diagnosis and treatment protocol established in a Roanoke, Va. hospital to care for dozens of patients presenting with suspected fungal meningitis related to contaminated epidural spinal injections. This unprecedented surge of patients seeking care for a rare central nervous system (CNS) infection required physicians to react quickly with little data to guide treatment decisions. The authors suggest that the data collected from these cases may fill information gaps and inform current and future therapy for fungal meningitis patients.

A new article being published early online in Annals of Internal Medicine describes the diagnosis and treatment protocol established in a Roanoke, Va. hospital to care for dozens of patients presenting with suspected fungal meningitis related to contaminated epidural spinal injections. This unprecedented surge of patients seeking care for a rare central nervous system (CNS) infection required physicians to react quickly with little data to guide treatment decisions. The authors suggest that the data collected from these cases may fill information gaps and inform current and future therapy for fungal meningitis patients.

Since early October, nearly 400 people nationwide have been diagnosed with fungal meningitis linked to contaminated injectable preservative-free methylprednisolone acetate used for epidural steroid injections and more than 14,000 people have been exposed. Currently, there are no clear recommendations for treatment. The Carilion Clinic in Roanoke saw half the fungal meningitis cases reported from Virginia and documented the clinical course.

The hospital established a hotline for patients concerned about infection. One-hundred-seventy-two patients presented to the emergency room and 131 met their exposure criteria for fungal meningitis due to the contaminated epidural steroid injections. After screening using lumbar punctures, 25 patients were diagnosed with fungal meningitis and were managed by Infectious Diseases services, which continually sent data on these patients to the Virginia Department of Health. An additional two patients presented to the hospital moribund following stroke, died, and were diagnosed with fungal meningitis retrospectively.

All patients were treated with IV voriconazole at a dosage of 6 mg/kg every 12 hours and continued on this treatment, unless switched to IV amphotericin-B (if symptoms or side-effects warranted). Patients remained hospitalized until oral voriconazole was available for home therapy, and continue to be seen weekly in a pop-up "fungal meningitis clinic" within the Infectious Disease outpatient clinic.

Roanoke clinicians still have questions about the nature and course of this infection. There were two patients who had symptoms of infection, but had an initial negative screening result at lumbar puncture. They returned later with meningitis, suggesting that patients will need to be followed for an undetermined duration of time. Two other patients presented with stroke and quickly died, while three other patients developed stroke during treatment, leading researchers to suspect that Exserohilum is angio-invasive. Finally, the high number of patients complaining of "word searching" suggests that long-term neurological consequences should be a concern.

The authors of an accompanying commentary acknowledge the risks associated with diagnosis and treatment of this rare CNS infection. The authors note some of the pressing questions physicians face when patients present with exposure or suspected infection. With limited knowledge of this infection, clinicians must rely on quickly evolving practice recommendations being established by the CDC and others gaining first-hand experience with this outbreak. The CDC has convened a committee of "Clinical Mycology Expert Consultants" that will consult on these cases. In the meantime, they will continue to capture data to inform recommendations.


Story Source:

The above story is based on materials provided by American College of Physicians. Note: Materials may be edited for content and length.


Journal Reference:

  1. Thomas M. Kerkering, Marissa L. Grifasi, Anthony W. Baffoe-Bonnie, Ekta Bansal, Dorothy C. Garner, Jean A. Smith, Deborah D. Demicco, Charles J. Schleupner, Rabia A. Aldoghaither, Vipul A. Savaliya. Early Clinical Observations in Prospectively Followed Patients With Fungal Meningitis Related to Contaminated Epidural Steroid Injections. Annals of Internal Medicine, 2012 Nov; [link]

Cite This Page:

American College of Physicians. "Early clinical observations in the fungal meningitis outbreak." ScienceDaily. ScienceDaily, 12 November 2012. <www.sciencedaily.com/releases/2012/11/121112113205.htm>.
American College of Physicians. (2012, November 12). Early clinical observations in the fungal meningitis outbreak. ScienceDaily. Retrieved September 20, 2014 from www.sciencedaily.com/releases/2012/11/121112113205.htm
American College of Physicians. "Early clinical observations in the fungal meningitis outbreak." ScienceDaily. www.sciencedaily.com/releases/2012/11/121112113205.htm (accessed September 20, 2014).

Share This



More Health & Medicine News

Saturday, September 20, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Sierra Leone's Nationwide Ebola Curfew Underway

Sierra Leone's Nationwide Ebola Curfew Underway

Newsy (Sep. 20, 2014) Sierra Leone is locked down as aid workers and volunteers look for new cases of Ebola. Video provided by Newsy
Powered by NewsLook.com
Changes Found In Brain After One Dose Of Antidepressants

Changes Found In Brain After One Dose Of Antidepressants

Newsy (Sep. 19, 2014) A study suggest antidepressants can kick in much sooner than previously thought. Video provided by Newsy
Powered by NewsLook.com
Could Grief Affect The Immune Systems Of Senior Citizens?

Could Grief Affect The Immune Systems Of Senior Citizens?

Newsy (Sep. 19, 2014) The study found elderly people are much more likely to become susceptible to infection than younger adults going though a similar situation. Video provided by Newsy
Powered by NewsLook.com
Jury Delivers Verdict in Salmonella Trial

Jury Delivers Verdict in Salmonella Trial

AP (Sep. 19, 2014) A federal jury has convicted three people in connection with an outbreak of salmonella poisoning five years ago that sickened hundreds of people and was linked to a number of deaths. (Sept. 19) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins