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Ask Dr. Eva: The Meningitis Outbreak

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Dear Dr. Eva,

Can you explain about the current meningitis outbreak? It seems to have something to do with joint infections-can infection move from the knee to the spine? Is there any preventive medication available? Would wearing a face mask prevent infection?

Concerned

Dear Concerned,

“Meningitis” means irritation and swelling of the meninges, the thin, flexible membranes that cover the brain and spinal cord. Meningitis can be caused by many kinds of infections: viral. bacterial, parasitic, and fungal. Some forms of cancer, and some anti-cancer drugs, also can cause meningitis. The viral and bacterial forms of meningitis, which are the commonest types, are contagious, meaning they can be passed from one person to another. The parasitic and fungal types of meningitis, which are uncommon, are not contagious. Because the current outbreak of meningitis is caused by a fungus, it is not contagious and these is no need for preventive drugs or masks.

This particular fungus causing this outbreak is Aspergillis, a mold that grows on fallen leaves. It’s unknown how Aspergillis became a contaminant in a manufacturing pharmacy ( the New England Compounding Pharmacy, or NECC). This pharmacy produced solutions of anti-inflammatory medicine to be injected into inflamed joints, including the vertebral joints in the spine. Once in the body, any infection can travel through the bloodstream to infect areas far from the original site of entry.

As of Oct. 21, the outbreak appears to have resulted in 282 cases of fungal meningitis, stroke due to presumed fungal meningitis, or other central nervous system-related infections. There have also been three non-lethal cases of joint infections (e.g., knee, hip, shoulder, elbow). 16 U.S. states have been affected with 14 of them in the Eastern U.S. According to the CDC (Centers for Disease Control), 14,000 people may have been exposed to the contaminated medication. So far, 23 people have died. Just to re-emphasize: according to the CDC, the infection cannot be passed from person to person.

Dr. Eva

Dear Dr. Eva,

I had a steroid injection into my right knee a few weeks ago. What should I watch for in case I get meningitis? If I do, how is it diagnosed and treated?

Worried

Dear Worried,

First, before you think about this any more, please contact the office of the physician who gave you the injection. Only steroid solutions made by New England Compounding Pharmacy (NECC) have been found to be contaminated. If the solution used for you was purchased from a different pharmacy, there is no risk to you.

But to answer your questions: The symptoms of fungal meningitis include headache, fever, chills, stiff neck, nausea, and just feeling very ill - the same symptoms as other forms of meningitis. With fungal infection, though, the start of these symptoms may be much more gradual, over a period of weeks rather than days. The symptoms may stay mild. However, if untreated fungal meningitis can cause permanent neurologic damage.

Diagnosis is mainly through analysis of the patient’s spinal fluid, obtained through a lumbar puncture (spinal tap). Blood tests may also be done, although these are less definitive in making the diagnosis. Treatment of fungal meningitis is usually a several week course of IV antifungal medication.

Dr. Eva

Ask Dr. Eva is distributed by Healthy Living News. Email comments and questions to dreva@healthylivingnews.org

Updated 1:40 pm, October 26, 2012:
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