You may have read in the news or heard on TV about an ongoing outbreak of meningitis caused by epidural corticosteroid injections using three separate batches of corticosteroid products contaminated by an unusual fungal organism Aspergillus fumigatus. This is a fungus that almost never causes meningitis naturally, but apparently can lead to severe meningitis and complications including stroke when it is injected adjacent to the spinal cord as a contaminant of this methylprednisolone acetate product. There have been 7 deaths and at least 64 cases of Aspergillus meningitis reported to date, and although the news reports have discussed that deaths have occurred in several states, and that 23 states had the contaminated lots of compounded corticosteroid distributed, I had to look a bit harder to see if Washington, where I work, was among the states with patients at risk. For my patients the good news is no, the known contaminated product was not distributed here. The states where patients could be at risk include:
- North Carolina
- New Hampshire
- New Jersey
- New York
- Rhode Island
- South Carolina
- West Virginia
Tennessee (29), Michigan (11) and Virginia (8) are the states with the most cases, likely because more of the contaminated product was used there. Fortunately situations like this are quite rare, and hopefully this epidemic will end soon as it is very likely no more contaminated material is being used. The type of meningitis involved is not a type where person-to-person spread is even remotely possible.
Aspergillus fumigatus is known to cause uncommon infections primarily in immunosuppressed persons in situations other than the current outbreak. The most common situation is a lung infection in HIV, organ transplant or chemotherapy patients with severely suppressed immune systems. Even in these cases the infection is usually localized and limited to the lungs, not spreading systemically except rarely in the most severely immunocompromized patients. Some other types of fungi, most commonly Cryptococcus, are prone to cause meningitis in immunosuppressed patients.
It will be interesting to see how this outbreak plays out and if a lesson can be learned from the investigation of the compounding pharmacy.