Sunday, 7 October 2012

Fungal Meningitis Outbreak




If you haven't been following this news, you might not be aware of the fungal meningitis outbreak currently happening throughout the United States. Unfortunately, patients have been falling ill after receiving a epidural steroidal injection to treat for back pain.

Steroids are typically used to treat inflammation and pain in more severe cases where NSAID's (Non-steroidal anti-inflammatory drugs) are not enough. These injections are put into the epidural space which surrounds the dura matter and meninges. This is a very sensitive area due to it's proximity to the spinal cord and CSF.

Epidural diagram showing injection spot
Many of the patients who received steroid injections fell ill including fever, headache, nausea and worst of all, deep brain stroke. After these symtoms presented, a CSF sample was taken and analyzed in the lab.

What you would see in the lab:

When you receive a CSF sample in the lab, it must be processed immediately due to the delicate nature of the specimen and  severity of the disease. CSF is typically only taken if someone is very ill and needs to be analyzed since collecting the sample is invasive and sometimes difficult to achieve.

It was noted in the CDC report that the patient's white count was elevated with predominately neutrophils present.  Neutrophils will typically be elevated in any sort of infection but mostly in a bacterial or fungal infection while lymphocytes will be elevated in a viral infection within the CSF.

Glucose was also low which is significant as it shows there is something within the CSF using up the glucose to replicate and grow. This is again, typically seen within a bacterial or fungal meningitis.

Total Protein was increased within the CSF which is seen due to the microorganisms present. In bacterial meningitis, TP will be elevated even higher than in fungal meningitis.

What was found:

The type of fungal meningitis present in this patients was determined to be Aspergillus fumigatus, a fungus that typically only causes disease in immunocompromised patients. Due to the fact these people were receiving steroid injections, this was most likely suppressing their immune system allowing the fungus to take over.


Aspergillius fuigatus
Aspergillus fumigatus normally is seen as a respiratory infection and causes aspergillosis, a name for the wide range of infections caused by this fungus, but meningitis is not usually one of them. The most common forms are allergic bronchopulmonary aspergillosis, pulmonary aspergilloma, and invasive aspergillosis (Wikipedia). We inhale Aspergillus spores every day but because we have healthy immune systems, we will not become infected. Most infections are seen in immunocompromised patients such as patients with AIDS, Leukemia or someone who has received a stem cell transplant recently.

Right now, more patients are becoming infected due to the contaminated steroid injections and I can only hope that they will stop using all drugs coming from this compounding facility. Unfortunately, the fungus has an incubation time of ~ 1-3 weeks before symptoms can present so I can only expect we will see more and more people falling ill within the next week. If you think you or any of your family members have been exposed to Aspergillus through epidural steroid injection, please contact your local medical professional.

-K

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