Update: Two more Tennessee cases of fungal meningitis

1:24 PM, Oct 13, 2012   |    comments
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Tennessee health officials have found two more cases of meningitis, bringing the state's total to 52, according to a Saturday morning update.

The Tennessee Department of Health released the update just before noon Saturday, saying that the death toll from the outbreak remains at six. The U.S. Centers for Disease Control has not yet updated the number of nationwide meningitis cases, which as of yesterday totaled 184 with an additional Michigan patient diagnosed as having a joint infection caused by contaminated medicine. The nationwide death toll was 14.

Tennessee health officials said they have determined that a June shipment of methylprednisolone used to treat patients is not among the recalled lots from the New England Compounding Center. There had previously been worries that 111 patients at Saint Thomas Outpatient Neurosurgery Center who received injections with the June steroids may have been injected with the recalled medications. Those patients appear to be in the clear.

"We think that's good news for all those folks," said Woody McMillin, spokesman for the Department of Health. "It appears they are contaminant-free."

Officials say anyone who may have had epidural steroid injection at PCA Pain Center in Oak Ridge, Saint Thomas Outpatient Neurosurgery Center in Nashville and the Specialty Surgery Center in Crossville should call their health care provider. Anyone wanting more information about the outbreak can call the Tennessee Poison Center at 1-800-222-1222.

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The window for potential fungal meningitis infections widened again Friday as officials said Tennessee may have received contaminated steroid earlier than previously thought.

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Continuing coverage of the fungal meningitis outbreak

Saint Thomas Outpatient Neurosurgery Center contacted 111 more patients this week after realizing it received a shipment as far back as early June from the compounding laboratory linked to the nationwide outbreak.

Robert Johnson of East Nashville, a retired Metro employee who suffers back pain from a job injury, got his phone call on Wednesday.

"I asked if they gave me any tainted medicine," Johnson said. "They said, 'We don't really know yet.' "

The outbreak has sickened 50 people and killed six in Tennessee. But the Tennessee Department of Health reported only one new infection and no new deaths on Friday. About 14,000 nationwide possibly received the tainted steroids.

State officials do not believe any new infections will result from this earlier shipment, but "out of an abundance of caution we are now working to contact every person treated with this material," Tennessee Health Commissioner Dr. John Dreyzehner said.

Several states have taken action against New England Compounding Center, the Massachusetts-based company that is the source of the recalled steroid medicine linked to the sicknesses. As of Friday, the company was still licensed to do business in Tennessee.

However, the Tennessee Board of Pharmacy has scheduled a meeting on Monday to consider a license surrender - although the public notice for the meeting doesn't specify which firm's license is at stake.

Antifungals help

Antifungal medications are helping patients recover, especially in cases when the disease is caught early, health officials said. Dr. Robert Latham, an infectious disease doctor at Saint Thomas, said one such patient has been able to go home but is still receiving the drugs intravenously.

Saint Thomas had 31 patients hospitalized on Friday, two of them critically ill. It has screened more than 330 patients for fungal meningitis in its emergency room since Oct. 1.

"Over 275 have required lumbar punctures (spinal taps), an often tedious and difficult procedure to sample the cerebral spinal fluid to allow clear distinction between the presence or absence of any infection," Latham said. "That has to be some type of entry for the Guinness Book of World Records, an entry I wish we could have avoided."

Another patient may be leaving the hospital soon, he said.

Initial white blood cell counts taken from the two patients' spinal fluid indicate they started therapy at an earlier stage of infection than other patients, Latham said.

"They responded very quickly. They are now both into about day 10 or 11 of intravenous treatment," he said.

However, people who are sicker may have to be hospitalized for four to six weeks, Latham said. Two patients hospitalized at Saint Thomas with meningitis have died.
Similar to '70s case

Nationwide, 184 people have contracted fungal meningitis, with 14 deaths, according to the latest report from the U.S. Centers for Disease Control and Prevention. Fifteen new cases were reported on Friday, and Texas joined the list of states reporting infections.

The outbreak is reminiscent of an event that occurred in 1970-71, when a screw-cap for IV bottles manufactured by Abbott Laboratories was linked to blood infections, said Dr. James Hughes, an Emory University professor who is the immediate past president of the Infectious Diseases Society of America.

"It affected patients in eight hospitals in seven states," Hughes said. "There were 150 cases and nine deaths.

"What both of the outbreaks do is they show you the potential threat posed by a contaminated product that is injected or infused into a large number of patients."
Don't fear medicine

Officials with the CDC and the state Department of Health said early diagnosis and early treatment are crucial to fighting off and surviving fungal meningitis.

Doctors have to carefully monitor doses because the drugs can have toxic side effects that may damage the liver or kidneys. However, Dr. David Reagan, chief medical officer for the Tennessee Department of Health, said it is important that meningitis patients not be afraid of a medicine that can save their lives.

"I just don't want to scare people from taking medicines or taking them as long as they need to take them to get over this potentially life-threatening infection," Reagan said.

Some patients will be able to take the antifungal voriconazole orally, he said, once they reach the maintenance stage of therapy.

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