-- Puzzled health officials are investigating reports that some fungal
meningitis patients in Tennessee and elsewhere have developed new health
problems, knocking some back into the hospital just when it seemed they
were recovering well from the brain infection.
reportedly have developed epidural abscesses, or pus-filled infections
of the spine's epidural layer, the Centers for Disease Control and
Prevention said Monday. Other patients reportedly have been diagnosed
with arachnoiditis, a painful compression of spinal nerve roots.
The CDC said most of the reports have come from Michigan and Tennessee, but the agency hasn't yet counted or confirmed them.
MORE: CDC map of meningitis cases
trying to get a handle on that," said Dr. Tom Chiller, deputy chief of
the CDC's Mycotic Diseases Branch, which specializes in fungal diseases.
Michigan and Tennessee likely are generating most of the reports because they have the most cases, Chiller said.
states account for nearly half of the 420 people sickened by
potentially contaminated steroid injections that were prepared by a
Massachusetts pharmacy. Thirty have died, with Tennessee on Monday
reporting its 13th death -- the most among the 19 states involved in the
New infections unusual
officials said of the 119 infections in their state, 51 patients had
epidural abscesses. A breakdown of Tennessee's 79 reported infections
was not immediately available.
The Tennessee Department of Health
is investigating reported epidural abscess cases among meningitis
patients but has not yet confirmed any, spokesman Woody McMillin said.
More details might be available later this week, he said.
the 17 meningitis patients who have been treated and released from Saint
Thomas Hospital had epidural abscesses when they were discharged,
spokeswoman Rebecca Climer said. Four have since been re-admitted, not
for abscesses but for other reasons such as intractable pain, stroke,
worsening symptoms and problems with infusing antifungal medication, she
Chiller called the reported abscesses unusual because they
usually precede meningitis, not the other way around. "I have worked
with fungal diseases for many years, and this is a first for me," he
Such abscesses usually are easier to treat because they
affect the dura, the outermost layer of the spinal column, according to
WebMD. If antifungal or antibacterial medicine doesn't work, the abscess
can be drained and the infected tissue removed.
affects a deeper spinal layer called the arachnoid and can result in
debilitating pain, numbness and paralysis. Treatment options are much
more limited but can include surgery.
Chiller said the fact that
meningitis victims are developing other health problems isn't
surprising, because of their weakened immune systems and histories of
back problems. Most of the meningitis patients received epidural steroid
injections for back pain.
suspect they were infected with moldy medicine prepared by New England
Compounding Center, a specialty pharmacy in Framingham, Mass., that has
voluntarily closed and recalled all of its products.
It also has become the target of a federal criminal probe and more than two dozen personal-injury and wrongful-death lawsuits.
two most recent ones, filed in federal court late last week, also seek
to lay blame on NECC's principals and their other businesses, court
The separate suits, filed in Massachusetts and
Texas, contend NECC officials are personally liable because they
negligently operated the pharmacy. They also knew NECC was making
"defective and dangerous" medications, and made false and misleading
claims about the pharmacy's cleanliness and safety of its medications,
the suits say.
Defendants named in both suits are Barry Cadden and
Gregory Conigliaro, NECC's founders; Lisa Conigliaro Cadden, Barry
Cadden's wife and Conigliaro's sister; and her and Gregory Conigliaro's
sister, Carla Conigliaro. All are or were officers of NECC, the suits
The Massachusetts suit also names four other defendants:
Douglas Conigliaro, another sibling; Glenn Chin, an NECC pharmacist;
Ameridose LLC, a larger compounding pharmacy formed by Barry Cadden and
Gregory Conigliaro; and Medical Sales Management Inc., the marketing arm
for NECC and Ameridose that is led by Douglas Conigliaro.
All of the defendants declined to comment, a spokesman said.
Cadden also has been invited to testify at the first congressional
hearing on the outbreak. Officials from the Massachusetts Board of
Registration in Pharmacy and the U.S. Food and Drug Administration,
including FDA Commissioner Dr. Margaret Hamburg, also have been asked to
appear before the House Energy & Commerce Committee on Nov. 14.
The following day, Hamburg is scheduled to appear before the Senate health committee, which is also probing the outbreak.
Where to call for help
For information about meningitis in general: 1-800-222-1222.
For mental health counseling for anxiety related to the outbreak: 1-855-CRISIS-1.
Contributing: The Associated Press