A year ago this month, the CDC activated its Emergency Operations Center as part of the response to an outbreak of fungal meningitis. The outbreak was linked to three contaminated lots of preservative-free methylprednisolone acetate produced by the New England Compounding Center.
As of Oct. 23, there were 751 cases of fungal meningitis and other infections associated with the outbreak, with 64 deaths. One new case has been diagnosed since July.
In a clinical paper published in the Oct. 24 issue of the New England Journal of Medicine, researchers with the CDC describe patients who experienced a wide variety of illnesses, including diseases of the central nervous system such as meningitis, stroke, arachnoiditis and epidural or paraspinal infections that ranged in severity from very mild to life-threatening.
The authors wrote that of 328 patients who did not have peripheral-joint infection and were included in the investigation, 265 (81%) had central nervous system infection and 63 (19%) had non-CNS infections only. Among patients with CNS infections, strokes were associated with an increased severity of abnormalities in cerebrospinal fluid.
Non-CNS infections were more frequent later in the course of the outbreak, the authors wrote, and such infections developed in patients with and without meningitis.
Laboratory evidence of E. rostratum was found in 96 of 268 patients (36%) for whom samples were available.
The initial clinical findings from this outbreak suggest that fungal infections caused by epidural and paraspinal injection of a contaminated glucocorticoid product can result in a broad spectrum of clinical disease, reflecting possible variations in the pathogenic mechanism and in host and exposure risk factors, the investigators concluded.
In a statement, the CDC noted the outbreak is the largest of healthcare-associated infections ever reported in the U.S. Since the outbreak began, additional outbreaks have been identified and linked to contaminated products from other compounding pharmacies. These outbreaks show the urgent need to address shortfalls in the oversight and safety of compounded drugs to reduce the inherent risk associated with these products, which have not undergone review and approval by the Food and Drug Administration.
Journal report: http://www.nejm.org/doi/full/10.1056/NEJMoa1304879#t=articleTop