MRI Imaging May Spot Meningitis from Tainted Steroids

mri_spots_meningitisResults of new research show that a screening MRI may provide early warning of spinal or paraspinal meningitis in patients who received contaminated steroid injections.

The imaging technique showed abnormalities in 21% (36) of 172 patients screened, according to Dr. Anurag Malani of St. Joseph Mercy Hospital in Ann Arbor, Mich., and colleagues, MedPage Today reports. Of the 36 patients screened, all but one met the Centers for Disease Control and Prevention (CDC)’s definition for probable (17 patients) or confirmed (18 patients) fungal spinal or paraspinal infection. The patients had received methylprednisolone injections from a highly contaminated lot of the steroid, but had not sought medical care related to the injection, the research team reported online in the Journal of the American Medical Association (JAMA).

In 2012, contaminated methylprednisolone injections from a Massachusetts compounding pharmacy were found to be responsible for a multi-state outbreak of fungal illness, which sickened more than 700 people and caused 58 deaths, according to the CDC. Recently, the CDC received reports of 20 infections in three states linked to injectable steroids distributed by a Tennessee compounding pharmacy, though none of these reports involved fungal meningitis.

“Our findings support obtaining contrast-enhanced MRI of the injection site in patients with persistent back pain even when their pain disorder has not worsened,” the authors wrote. Screening and detection by MRI was performed between 2012 and 2013.  The results allowed for early medical and surgical treatment, MedPage Today reports.

The 35 patients whose MRIs showed infection were treated with the antifungal voriconazole, with or without liposomal amphotericin B, and 24 required debridement to remove infected tissue. “At the time of surgery, 17 of 24 patients (71%), including five patients who denied having symptoms, had laboratory evidence of fungal infection,” the authors wrote.

The researchers advocate a  “proactive outreach to patients receiving injections from a highly contaminated lot.” According to MedPage Today, the authors write that MRIs “may detect infection earlier in some patients, leading to more efficacious medical and surgical treatment and improved outcomes.”

Despite the study’s limitations – including small sample size – an editorial accompanying the research results advised, “For patients who received spinal injections with steroids from an unknown lot number, MRI-based screening may be appropriate,” according to MedPage Today.

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