Almost a year after the multistate outbreak of fungal meningitis prompted New England Compounding Center (NECC)—the manufacturer of methylprednisolone acetate, an injectable steroid—to recall all of its drugs, the healthcare community remains concerned about undiagnosed cases of fungal infections.
In March of this year, a CDC conference call urged healthcare providers to continue screening patients who received contaminated injections. Tom Chiller, Deputy Chief of the CDC Mycotic Disease Branch, expressed concern over reports of infection months after administration of the tainted injection.
On June 19, 2013, the Journal of the American Medical Association (JAMA) published the results of an MRI study that determined whether patients exposed to NECC’s contaminated methylprednisolone who had not presented for medical care developed spinal or paraspinal infection at the injection site. Of the 172 patients screened, 21% had abnormal MRIs. All but one of the 36 patients with abnormal MRIs met the Centers for Disease Control and Prevention (CDC) definition for probable or confirmed fungal spinal or paraspinal infection. The CDC defines probable spinal or paraspinal infection as MRI evidence of “osteomyelitis, abscess, or other infection (e.g., soft tissue infection) of otherwise unknown origin in the spinal or paraspinal structures, at or near the site of epidural or paraspinal injection with contaminated methylprednisolone.”
The physicians who performed the MRI study gathered data from 115 patients regarding the following symptoms: new or worsening back or neck pain, radiculopathy (a condition caused by a compressed nerve in the spine), or lower-extremity weakness. Thirty percent of the patients had at least one of these symptoms. Nearly 10% of the patients reported none of the symptoms but had an abnormal MRI. Of these patients, seven underwent surgery and five were documented as having fungal infection. In light of these findings, the physicians urge patients and healthcare providers to be proactive and to strongly consider using an MRI to detect undiagnosed infection.
Other symptoms of spinal infection include:
- Drainage near injection site
- Redness, swelling, or tenderness near injection site
- Fever
- Chills
- Weight loss
- Muscle spasms
- Weakness of voluntary muscles
- Painful or difficult urination
- Bowel dysfunction
- Neurological deficits
- Nerve root pain radiating from the infected area
- Severe back pain with local tenderness in the spinal column
We encourage consumers and loved ones who have been affected by NECC’s contaminated injections to contact us for a free case evaluation at www.andrewsthornton.com or toll free at 1-800-644-1734.
