Fungal Meningitis and Steroid Injections

A new disease has been identified by the U.S. Centers for Disease Control and Prevention (CDC). The disease is fungal meningitis caused by fungal-contaminated steroid injections. The disease is linked to a treatment known as epidural steroid injections, a treatment designed to reduce pain and inflammation in a person's back.

Fortunately, fungal meningitis is not contagious. However, in September, the CDC reportedly suspected many more individuals would be detected with fungal meningitis because of the potentially long period of time before some symptoms develop and the large number of exposed patients. This has proven to be accurate because the number of people who have been diagnosed or died has approximately tripled since the CDC first stated its suspicions about detectable infections and deaths. In addition, 10 patients have had peripheral joint infections develop (for example, knee, shoulder, hip, and elbow) but no deaths have been associated with these joint infections to date.

There are now five aspects of fungal meningitis infection that are concerning. First, the infection may take a long time (from two to 28 days; some may take even more time) to begin to develop the symptoms listed above. Second, several of the patients developed strokes due to the infection; and third, the steroid medications suppress inflammation and may make the individual more susceptible to infectious agents. Fourth, fungal meningitis is difficult to treat and usually requires at least two antifungal drugs given intravenously over an extended time period (months). The last or fifth aspect is that a number of patients treated for fungal meningitis may return with an epidural abscess. Consequently, compounded drugs, especially those containing steroids that are contaminated with fungi or bacteria, are likely to be difficult to both diagnose and treat.

Drug compounding centers are not regulated by the high standards that drug producers must meet. Most compounding centers are regulated by state agencies and not by the stricter FDA rules that are applied to drug producers. This current outbreak of fungal meningitis, joint infections, and other infections such as epidural abscesses related to products used to treat patients is likely to change this "oversight or regulation" situation. Currently, several high-ranking politicians are demanding stricter regulations be set up for drug-compounding companies. The FDA commissioner, the NECC cofounder, and the director of the Massachusetts Board of Registration in Pharmacy are scheduled to meet with a congressional panel on Nov. 14, 2012. Confidence in compounded drugs can be brought back to the many doctors and patients who need to use them only if such incidences of contaminated drugs from compounding centers are substantially reduced or eliminated.