First Meningitis, Now Spinal Infections

Nov 9, 2012 | Katharina Schwan | Outbreak News

Victims of the meningitis outbreak in the U.S. can’t seem to catch a break. Various hospitals recently revealed that large numbers of patients who survived an initial bout of meningitis are now returning to the emergency room with two associated infections – epidural abscesses and arachnoiditis. Both are painful and may require intensive long-term treatment.

Michigan and Tennessee, the two states with approximately half of all meningitis cases nationwide, have reported the highest number of these secondary infections.

Spinal epidural abscesses are collections of pus that form between the outer covering of the spinal cord and the spine. These infections are often caused by bacteria, and sometimes fungi. They cause swelling and pain in the infected area, yet no other symptoms are visible, which can make diagnosis difficult. An MRI or CT scan is usually necessary to identify the condition. In many cases, if antibiotics or antifungals are ineffective, a neurosurgeon will drain, clean, and remove the abscess.

On the other hand, little can be done for patients who develop arachnoiditis. Patients with this condition develop severe inflammation of the arachnoid, the membrane that surrounds the nerves of the spinal cord. Inflammation can be caused by bacteria, fungi, or viruses, damage to the membrane during surgery, or injury. The inflammation can lead to numbness, tingling, and muscle spasms in the lower back and legs. In severe cases, arachnoiditis may cause paralysis of the lower limbs. Surgery is not usually an option, and can actually worsen the patient’s condition if further nerve damage occurs. Therefore, treatment usually consists of a combination of pain relief, physiotherapy, and exercise.  

Thus far, patients with these complications do not fit a certain profile and therefore it has been impossible to predict who is at risk and might develop the abscesses or arachnoiditis. One potential indicator is that the majority of infections are in patients who also suffered from meningitis, although this is not a definite precursor.

The U.S. Meningitis Outbreak

Fungus- contaminated methylprednisolone acetate has been identified as the steroid drug responsible for this widespread and fatal meningitis outbreak. Over the past two months, 424 cases and 31 deaths have been reported. Seventeen thousand vials were transported around the country, and approximately 14,000 Americans received injections for neck and back pain, and arthritis. Several more meningitis cases are expected, however the peak of the outbreak has passed and fortunately, cases will likely taper off throughout November. 

The New England Compounding Center, the Massachusetts-based company responsible for manufacturing the contaminated drug, as well as its sister site, Ameridose, have been shut down and their products recalled. Federal inspectors discovered extensive fungal and bacterial contamination in various drugs produced by the two companies. A comprehensive criminal investigation is under way and affected families have already begun filing civil suits against the company. 

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