Share This Page

Doctors pushed into uncharted territory

| Saturday, Oct. 20, 2012, 9:02 p.m.

The outbreak of fungal meningitis linked to contaminated steroid injections represents a forced march into unexplored medical territory.

Most fungal infections occur on the skin and are easily treated. Inhaling fungus-contaminated dust sometimes causes pneumonia in healthy people. Fungal infections in the brain, however, are almost always confined to people whose immunity has been suppressed by AIDS, cancer, burns or organ transplantation.

What's under way now — a new form of fungal meningitis in 284 otherwise healthy people — is an event without precedent.

To date, 23 people have died. New cases appear every day; the count increased by 13 on Saturday. In all, 14,000 people in 23 states received injections around the spine or a joint with the anti-inflammatory drug methylprednisolone acetate from three contaminated lots distributed by a Massachusetts company.

“This kind of fungal meningitis has not been reported in the medical literature. There is not enough data to say whether it will be more or less responsive to treatment. We don't know what the outcomes generally are,” said Benjamin Park, a physician in the fungal diseases branch of the Centers for Disease Control and Prevention.

“The truth of the matter is that we don't have any experience with this,” said Arturo Casadevall, an expert on fungal infections and chairman of microbiology and immunology at Albert Einstein College of Medicine in New York.

Fungal infections of the brain are as feared as they are rare. They come on slowly and are hard to diagnose. They require at least three months of therapy with often unpleasant drugs. Treatment failure is common. Survivors are often left with disabilities.

As events unfold, physicians and public health officials are keeping in mind a cluster of five cases of fungal meningitis linked to contaminated injections that occurred a decade ago. One person didn't become ill until 152 days after receiving an injection.

“That's obviously making us concerned about this outbreak,” said Tom M. Chiller, a physician with CDC's fungal diseases branch. “We want patients and providers to continue to be vigilant and on the lookout for symptoms months after the injections.”

TribLIVE commenting policy

You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.

We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.

While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.

We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers

We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.

We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.

We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.

We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.