Tainted Steroids: Spine Infections, Meningitis, Debilitating Treatment; Recovery Unclear

While hundreds have been sickened with fungal meningitis following injections with tainted New England Compounding Center (NECC) steroids, a new trend is being seen in connection with the drugs.

In one case, a patient, bedridden for days was taken to the emergency room when pain in her lower back caused her to fall on the bathroom floor, said The Boston Globe. The woman was suffering from an infection that spread to her bone and was caused by black mold that was shot into her spine from an injection of NECC-compounded steroid.

This second wave of fungal infections has been diagnosed in dozens of patients and includes symptoms such as excruciating abscesses or inflamed back nerves. The infections have been difficult to cure, noted The Globe. And, because the infections mimic patients’ original back pain, many might be unaware that they are suffering from a spinal infection, according to a health alert just issued by the federal Centers for Disease Control and Prevention (CDC). The CDC recommends physicians consider MRI scans to screen patients who suffer from ongoing back pain and who received an injection of contaminated steroids.

“People could be walking around with infections and they do not know it,’’ Dr. Varsha Moudgal, head of infectious disease at St. Joseph-Mercy Hospital in Ann Arbor, Michigan, told The Globe. “If they are untreated, they will cause pressure and damage to the spinal cord, and the concern then is about losing function,” she added.

As we’ve mentioned, the NECC mixed at least 14,000 vials of methylprednisolone acetate and shipped the drugs to more than 70 pain management and other health care clinics in 23 states. Testing on sample vials showed that many were contaminated with a fungus responsible for the outbreak of the deadly form of meningitis.

The outbreak appears to have begun in late September when physicians in Tennessee were treating a man with an unusual form of meningitis that did not appear to have a bacterial or viral cause. Evidence of fungal infection was detected and involved the mold, Aspergillus fumigatus. The physicians advised the state’s public health authorities and, soon, injections of a steroid, methylprednisolone acetate, were linked to this first case and to other, subsequent cases. The tainted steroid was injected into patients’ spines or joints for chronic back pain.

NECC was later discovered to be tainted with a fungus that was not Aspergillus; a black mold, Exserohilum rostratum, is believed to be the culprit in the outbreak. That mold is one of several organisms that only rarely cause human disease and has been discovered in some vials containing the steroid and in several of those sickened.

Of those who received steroids laced with black mold from NECC, 39 have died and 690 have back infections, meningitis, or both. Many of the ill have relapsed and have been hospitalized several times, with most suffering devastating treatment side effects, including hallucinations, serious kidney damage, trouble concentrating, upset stomach, swollen feet and ankles, and hand tremors, said the Globe.

Released patients must undergo regular blood testing; electrocardiograms; MRIs; and spinal taps, which are known to be painful. Treated patients likely need medication anywhere from three to 12 months, but physicians remain unclear as to treatment times and are unsure if the fungus will ever be fully eradicated from patients’ bodies, according to patients, lawyers, and infectious disease specialists interviewed by The Globe.

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