Health Alert
A MULTI-STATE OUTBREAK OF FUNGAL MENINGITIS

The Delaware Division of Public Health (DPH) is issuing this health alert.

Summary

According to the Centers for Disease Control and Prevention (CDC), an outbreak of a rare and deadly form of meningitis has sickened 35 people in six states who received steroid injections mostly for back pain. Four people have died, and more cases are expected. Two of the deaths were in Tennessee while Virginia and Maryland had one each.

According to the CDC, at least 737 people who received lumbar epidural steroid injections for back pain between July 30 and September 20 have been notified of the cluster of rare aspergillus meningitis infections. The Food and Drug Administration identified the maker of the steroid as New England Compounding Center, a specialty pharmacy in Framingham, Mass. Last week, the company issued a recall of three lots of the steroid – methylprednisolone acetate. Delaware did not receive shipments from the company in question but PA, MD and NJ did. State and federal health officials are still conducting investigations.

Symptoms

Symptoms include worsening and severe headache, stiff neck, nausea, dizziness and fever.

Treatment

Confirmed cases can be treated with intravenous high-dose antifungal medications.

Background

The incubation period for aspergillus meningitis is estimated to be between two to 28 days. This type of fungal meningitis is caused by a common fungus often found in leaf mold.  Aspergillus is found throughout nature particularly in decaying vegetation: it can be found in the indoor and outdoor air during all seasons of the year. Water and food can also be contaminated. Fungal meningitis is not contagious like the more common viral and bacterial meningitis. Aspergillus is considered an opportunistic pathogen and usually does not cause disease in people with intact immune systems.

Recommendations

Patients that received epidural methylprednisolone acetate in the past 28 days are to be followed up for symptoms of meningitis, which include worsening and severe headache, stiff neck, nausea, vomiting, dizziness, and fever.

Diagnosis

This can be confirmed by lumbar puncture and the identification of the fungus under a microscope or through fungal culture of the cerebrospinal fluid.

Additional Information

• DPH, Bureau of Epidemiology (24/7): 1-888-295-5156
• DPH webpage on meningitis: http://dhss.delaware.gov/dph/files/meningocfaq.pdf
• Visit CDC’s Fungal Diseases webpage at: http://www.cdc.gov/fungal/aspergillosis/

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