Fungal Meningitis Facts

October 23rd, 2012  |  The Blog

The latest medical issue in the news is the fungal meningitis outbreak as the result of contaminated methylprednisolone acetate or steroid injections. Regardless of the industrial or commercial origin of the contaminated medication, let us examine the resulting life-threatening illness.

Fungal Meningitis Defined

Fungal meningitis is a rare illness. It is the result of a fungus spreading via the bloodstream to the spinal cord and central nervous system. It is not contagious.

There are a variety of fungi that can cause fungal meningitis. Aspergillus is a common culprit. Exerohilum, a rare finding, has been found in the recent disease outbreak. Another source of this disease is Cryptococcus.

Symptoms typically begin one to four weeks after exposure to the fungus, but there can be a greater period of time before the onset of symptoms. Patients must be monitored for months.

Who Got the Contaminated Medication?

Close to 14,000 patients nationwide have recently received a potentially contaminated steroid injection into the spine or a joint like the knee, shoulder, elbow or ankle for pain control.

The patients who have received a spinal injection of methylprednisolone acetate are at risk of developing fungal meningitis. The patients who have had a peripheral injection are unlikely to develop fungal meningitis but are at risk of developing a joint infection.

Symptoms of developing fungal meningitis include:

  • Fever
  • New or escalating headache
  • Stiff neck
  • Nausea and vomiting
  • Neurological symptoms leading to stroke
  • Photophobia or sensitivity to light
  • Change in mental status
  • Redness, warmth and/or swelling in a treated joint

Headache remains the most common symptom followed by fever, back pain and nausea.

Treatment Protocol

Meningitis is diagnosed through laboratory analysis of blood and cerebral spinal fluid. Once confirmed, the disease is treated with an extended course of antifungal agents administered intravenously.

The Centers for Disease Control and Prevention (CDC) have developed a protocol to treat confirmed cases of fungal meningitis. It includes antifungal two drugs given at a higher than normal dose:

  • Voriconazole 6mg/kg intravenously every 12 hours
  • Liposomal amphotericin B 7.5 mg.kg intravenously once a day

Both of the recommended drugs are prescribed in strong doses and can be difficult for patients to tolerate. The most effective drug dose and length of treatment remains under scrutiny and will be revised by the CDC as more information is accrued from the recent outbreak.

The CDC antifungal protocol is not recommended for patients who have been exposed to the illness but remain asymptomatic. It is also not recommended for symptomatic patients who have a normal lab exam of cerebrospinal fluid (CSF). Instead, the CDC recommends that patients be closely followed for escalating symptoms. Any change in symptoms should be reevaluated by doing a second lumbar puncture.

The Outcome

There have been numerous deaths as a result of the recent fugal meningitis outbreak. Others have been sickened and thousands of exposured patients are being closely followed by their physician during the expected incubation period for signs and symptoms of this life threatening disease.

The CDC will update the statistics and recommendations for treatment as the fungal meningitis outbreak evolves.

 

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