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.
The Current Outbreak of Fungal Meningitis
The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) are currently coordinating a multistate investigation of fungal meningitis among patients who received an epidural steroid injection with a potentially contaminated product. Several of these patients also suffered strokes that are believed to have resulted from their infection.
Is the source of the outbreak known?
The CDC is investigating medications and products that are associated with this outbreak of 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 epidural medication given to patients affected by this outbreak is not the same type of medication as that given to women during childbirth.
What states received the implicated product?
California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, and West Virginia.
The names of the facilities that have received medication from one of these lots are available at http://www.cdc.gov/hai/outbreaks/meningitis-facilities-map.html.
Are other medications from the New England Compounding Center located in Framingham, Massachusetts associated with infections?
To date, the Centers for Disease Control has not received reports of infections linked to other products from the New England Compounding Center. However, out of an abundance of caution, they recommend 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 are worried they are ill because of use of one of these products, they should seek medical attention.
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.
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 a procedure, first contact the physician who performed their 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. Infected patients have had 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. Patients should watch vigilantly for symptoms if they were injected with potentially contaminated steroids and see a doctor if they have any of the symptoms.
Patients who have had an epidural steroid injection since May 21, 2012, and have any of the following symptoms, should talk to their 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
Patients need to remain vigilant for onset of symptoms because fungal infections can be slow to develop. Typically in this outbreak, symptoms have appeared 1 to 4 weeks following injection, but longer and shorter periods of time between injection and onset of have been reported. Therefore, patients and physicians need to closely watch for symptoms for at least several months after the injection and see a doctor if they have any of the symptoms above
As of October, infections from steroid injections into joints other than the spine (e.g., knee, hip) have not been reported. However, the investigation is ongoing and joint infections may take longer to develop than meningitis. The timeframe is still being investigated. Patients should watch vigilantly for symptoms if they were injected with potentially contaminated steroids and see a doctor if they 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.
Source: Centers for Disease Control (CDC)
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.
The Current Outbreak of Fungal Meningitis
The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) are currently coordinating a multistate investigation of fungal meningitis among patients who received an epidural steroid injection with a potentially contaminated product. Several of these patients also suffered strokes that are believed to have resulted from their infection.
Is the source of the outbreak known?
The CDC is investigating medications and products that are associated with this outbreak of 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 epidural medication given to patients affected by this outbreak is not the same type of medication as that given to women during childbirth.
What states received the implicated product?
California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, and West Virginia.
The names of the facilities that have received medication from one of these lots are available at http://www.cdc.gov/hai/outbreaks/meningitis-facilities-map.html.
Are other medications from the New England Compounding Center located in Framingham, Massachusetts associated with infections?
To date, the Centers for Disease Control has not received reports of infections linked to other products from the New England Compounding Center. However, out of an abundance of caution, they recommend 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 are worried they are ill because of use of one of these products, they should seek medical attention.
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.
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 a procedure, first contact the physician who performed their 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. Infected patients have had 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. Patients should watch vigilantly for symptoms if they were injected with potentially contaminated steroids and see a doctor if they have any of the symptoms.
Patients who have had an epidural steroid injection since May 21, 2012, and have any of the following symptoms, should talk to their 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
Patients need to remain vigilant for onset of symptoms because fungal infections can be slow to develop. Typically in this outbreak, symptoms have appeared 1 to 4 weeks following injection, but longer and shorter periods of time between injection and onset of have been reported. Therefore, patients and physicians need to closely watch for symptoms for at least several months after the injection and see a doctor if they have any of the symptoms above
As of October, infections from steroid injections into joints other than the spine (e.g., knee, hip) have not been reported. However, the investigation is ongoing and joint infections may take longer to develop than meningitis. The timeframe is still being investigated. Patients should watch vigilantly for symptoms if they were injected with potentially contaminated steroids and see a doctor if they 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.
Source: Centers for Disease Control (CDC)
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