Since the pathogens associated with this outbreak have not been identified, as of Wednesday, October 10, 2012, the CDC is directing physicians to perform a through diagnostic work-up on patients with meningitis or septic arthritis. In addition to basic tests, the CDC has developed an algorithm to help clinicians during this outbreak, and is asking physicians to collect a large sample of Cerebrospinal fluid (CSF) and perform (in addition to the gram stain and bacterial cultures) a fungal culture, which can be done at the hospital or at the state lab. The rest of the CSF (minimal 1 ml, preferred 5 ml) should be sent to the CDC. The CDC is asking that physicians only send CSF samples on patients that have abnormal CSF results. Other tests that can be helpful are conducting an AFB culture and collecting infected fluids such as aspiration of the epidural abscess or synovial fluid. Relevant tissue samples from patients (including post mortem patients) can be reviewed for fungal infections.
Avoiding Fungal Meningitis
The FDA and the CDC advise that clinicians should stop using all products from the New England Compounding Center until further notice. Clinicians also need to contact patients that received any of the preservative-free methylprednisolone acetate (80 mg/mL) from the September 26, 2012 recall, and all patients that suspect meningitis should seek medical care immediately.
U.S. Food and Drug Administration. New England Compounding Center (NECC) Potentially Contaminated Medication: Fungal Meningitis Outbreak. October 4, 2012. Accessed October 10, 2012.
Centers for Disease Control and Prevention. Multistate Meningitis Outbreak Investigation. October 10, 2012. Accessed October 10, 2012.
Centers for Disease Control and Prevention. Fungal Meningitis. October 5, 2012. Accessed October 10, 2012.
Centers for Disease Control and Prevention. Instructions for clinical teams regarding diagnostic testing and specimen submission to the CDC – outbreak associated with injection of potentially contaminated steroid products. October 8, 2012. Accessed October 10, 2012.
Mugoyela, V; and Mwambete, K. Microbial contamination of non-sterile pharmaceuticals in public hospital setting. Therapeutics and Clinical Risk Management. October 5, 2010. Accessed October 10, 2012.
New England Compounding Center. Voluntary Nationwide Recall of All Products. (2012). Accessed October 10, 2012.
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