Philadelphia, November 12, 2012 A new article being published early online in Annals of Internal Medicine describes the diagnosis and treatment protocol established in a Roanoke, Va. hospital to care for dozens of patients presenting with suspected fungal meningitis related to contaminated epidural spinal injections. This unprecedented surge of patients seeking care for a rare central nervous system (CNS) infection required physicians to react quickly with little data to guide treatment decisions. The authors suggest that the data collected from these cases may fill information gaps and inform current and future therapy for fungal meningitis patients.
Since early October, nearly 400 people nationwide have been diagnosed with fungal meningitis linked to contaminated injectable preservative-free methylprednisolone acetate used for epidural steroid injections and more than 14,000 people have been exposed. Currently, there are no clear recommendations for treatment. The Carilion Clinic in Roanoke saw half the fungal meningitis cases reported from Virginia and documented the clinical course.
The hospital established a hotline for patients concerned about infection. One-hundred-sixty-four patients presented to the emergency room and 133 met their exposure criteria for fungal meningitis due to the contaminated epidural steroid injections. After screening using lumbar punctures, 25 patients were diagnosed with fungal meningitis and were managed by Infectious Diseases services, which continually sent data on these patients to the Virginia Department of Health. An additional two patients presented to the hospital moribund following stroke, died, and were diagnosed with fungal meningitis retrospectively.
All patients were treated with IV voriconazole at a dosage of 6 mg/kg every 12 hours and continued on this treatment, unless switched to IV amphotericin-B (if symptoms or side-effects warranted). Patients remained hospitalized until ora
|Contact: Megan Hanks|
American College of Physicians