October 4, 2012 — An outbreak of meningitis has been traced to steroid injections commonly used to treat back pain. At least four deaths and 30 illnesses in five states have been confirmed. The number of illnesses is expected to grow, because the incubation period for meningitis can be up to four weeks. Experts are recommending that anyone who has undergone a spinal steroid injection in recent months should watch for symptoms of meningitis, and seek medical attention immediately if symptoms occur.
Early symptoms of meningitis may include:
- Severe or worsening headaches
- Difficulty with balance
- Slurred speech
The type of meningitis implicated in the outbreak is called Aspergillus, an is commonly found in fungus found in leaf mold. It is non-contagious. Once injected into the spine, it can easily spread to the brain and cause a severe, life-threatening infection. The only way to treat this type of meningitis is with powerful intravenous anti-fungal drugs. Infected people must be hospitalized, often in intensive care. Treatment may be necessary for up to six months.
The outbreak was first discovered by Dr. April Pettit of Vanderbilt University. About two weeks ago, she received a sick patient who had a meningitis infection in her spinal fluid. The patient recently had a spinal steroid injection. Once the clinic was ruled out as the source of the outbreak, attention turned toward the spinal injection itself and the company where it was created.
New England Compounding Center, located in Farmingham, Massachusetts, has issued a recall of three lots of steroid injections (methylprednisolone acetate) and ceased production of the products pending further investigation. The company is a compounding pharmacy, which sells mixed medicines to clinics when the products are not commercially available. The company is now working with investigators to determine the source of the outbreak.
The company shipped vials of the steroid injection to at least 23 states. Illnesses have been reported mostly in Tennessee, and also North Carolina, Florida, Virginia, and Maryland. The outbreak has mostly affected one clinic in Tennessee — Saint Thomas Outpatient Neurosurgery Center in Nashville — which received more than 2,000 vials of the contaminated product. The clinic is now closed, pending further investigation.