Front line for meningitis outbreak: the ER

Headache. Stiff neck. Dizziness. Fever. The symptoms could describe anyone with a range of ills, from migraine to the flu, but they're also the defining symptoms for the ongoing outbreak of rare fungal meningitis, and they're making trouble for some emergency room doctors.

Eleven people have died and 119 in 10 states are infected with the rare form of meningitis caused by contaminated pain injections, federal health officials said on Tuesday.

The Centers for Disease Control and Prevention is continuing to gather information about people who had injections of steroids into their necks or spines for back and neck pain and says as many as 13,000 people may have been given medication from a Massachusetts pharmacy, which has now closed and recalled all of its products. That makes 13,000 people who could, potentially, seek help at America's first line of health defense - the emergency room.

Fungus is not usually a cause of meningitis – usually it’s bacteria or viruses – and patients with these fungal infections are not contagious to other people.

But the fungal infection also causes more subtle symptoms than a bacterial infection and is trickier to diagnose, doctors say. CDC says some patients have had strokes. Patients who have had recent steroid injections and who have headache, dizziness, balance problems and other symptoms are being asked to contact their doctors immediately so they can be evaluated.  Some are going to their pain clinics, others to their primary care doctors, but many are relying on the emergency room.

Related story: 10 thing you need to know about the national meningitis outbreak

"About a week ago one of our pain clinics identified that about 600 people in our community were exposed to that injection," said Dr. Lee Benjamin of St. Joseph’s Mercy Hospital in Ann Arbor, Michigan. The clinic called every one of the patients, and apparently told them to visit the emergency department.

They did. "We have seen a tremendous influx of patients over the last week," Benjamin told NBCNews in a telephone interview. Benjamin estimated 50 patients were seen in his hospital's emergency department on Monday alone.

Most are appropriately worried, Benjamin stresses. "I would just remind patients that if they were exposed or they feel ill, the emergency department is always the first line and we are happy to evaluate anyone," he said. 

It just so happens that the American College of Emergency Physicians is holding its annual scientific conference this week in Denver. The outbreak has become a topic of discussion outside the regular sessions on overcrowded emergency rooms and the U.S. dependence on emergency department for first-line health care.

In this case, the CDC and state health departments have been very clear from the beginning -- the meningitis is not contagious, and people don't need to worry unless they got a spinal injection at a pain clinic that received shipments from the one pharmacy identified as the source of the contaminated drugs. Nonetheless, that's a lot of people.

"My facility has a few of the walking worried," said Dr. Ryan Stanton of Good Samaritan Hospital at the University of Kentucky in Lexington. "We were just starting to get inundated with flu cases," Stanton said. "Just about everybody has got headache, symptoms like that."

News stories can sometimes send people flooding ERs, said Dr. Jose Torradas of North Shore University Hospital in Manhasset, New York. "In my hospital, you will see a news story, and within a day there will be an increase," Torradas said. "The ED volumes increase, time pressures, and other issues become very real when stories like these break."

This can strain any ER and sometimes the whole hospital, Benjamin said.

Each patient needs to be interviewed carefully. If someone had a recent steroid injection -- in this case, dating back to May -- if he or she has symptoms, then they have to undergo a procedure called a lumbar puncture to look for signs of meningitis. It's painful, but can show inflammation immediately. "The recommendation is to start treating them," said Dr. James Williams of St. Joseph's Medical Center in Baltimore. 

Patients likely will get antifungal drugs but also antibiotics just in case their meningitis is the highly dangerous, bacterial kind, said Benjamin. It can take a few days to culture a specimen of spinal fluid and confirm that a fungus is causing the infection. The CDC says two different types of fungus, Exserohilum and Aspergillus, have been taken from patients in the current outbreak.

Williams says patients who believe they have may have been injected with the contaminated steroids should not worry about bothering busy emergency departments. "Please don’t be worried about crowding. People think ERs are overcrowded but it’s not true. Particularly in this case, you need to be seen immediately."

 

Related stories:

Eleven dead in fungal meningitis outbreak

One patient's fungal meningitis fears

More than 13,000 may have received posiibly contaminated drugs

 

 

Discuss this post

So - if there were no government regulations - or no government oversight.....more people would die from this outbreak and others like them.

Guess there is a role for government in America after all.

  • 5 votes
Reply#1 - Tue Oct 9, 2012 3:33 PM EDT

People complain about the government, but rely on the government.

  • 3 votes
#1.1 - Tue Oct 9, 2012 3:42 PM EDT

Please, if you're not having truly worrisome symptoms, don't clog up our ER's. They're not for "check-ups" or "just in case" situations. ER's are for EMERGENCIES. Otherwise, make a regular doctor's appointment or go to a same-day or walk-in clinic.

  • 1 vote
#1.2 - Wed Oct 10, 2012 10:20 AM EDT
Reply

Patients need to be given lot numbers and sources of any injections. Sometimes doctors don't have that information, but it should be one of the required records kept by doctors. Strokes are very serious. I agree with the conclusion that people who have had the injections should be checked if they have any pain, stiffness, or dizziness. This entire situation will be much worse if we deregulate all industry.

    Reply#2 - Tue Oct 9, 2012 3:44 PM EDT

    Good idea...

      #2.1 - Tue Oct 9, 2012 4:31 PM EDT
      Reply
      WinxMooDeleted

      Seems many people forget one of the tasks the Consitiution gives the Federal government is promoting the general welfare.

        Reply#4 - Tue Oct 9, 2012 4:07 PM EDT

        There have been regs on the books for decades that should stop this. The FDA tried and was shot down in the courts. Compounding pharmacies are not pharmaceutical companies and the ones like NECC who illegally act like mini-manufacturers should be shut down. There is not a pharma company out there that would not like to see that happen. You should never take a supposedly sterile product from a compounding pharmacy - the controls on what they do are not sufficient (not regulations - manufacturing controls). Essentially, we just need to let the FDA do what they have been empowered to do for a long time.

        • 1 vote
        Reply#5 - Tue Oct 9, 2012 4:51 PM EDT

        So everyone thinks that when they get a shot it came from a sanitized lab. Wow was this ever kept a secret for a long long time. I wonder about vacines now, same thing? The story has been out a while yet no names, no arrests, no information on why all these doctors bought from this place. Cheapest price I suppose? Well in China these people would be killed by the govt and at this point I don't think that would be a bad thing. They also ran a garbage dump in the back of the building.

          Reply#6 - Wed Oct 10, 2012 8:31 AM EDT

          Would Mitt Romney please step forward and make a few remarks about why we don't need strong regulation as part of capitalism to function properly. Dear Mr. Romney , you must live in the World of Oz !

            Reply#7 - Wed Oct 10, 2012 10:12 AM EDT

            BTW this fungal meningitis is not contagious from person to person. So only people who received the steroid shots have to worry.

              Reply#8 - Wed Oct 10, 2012 10:26 AM EDT

              More than 13,000 people may be at risk. I hope only an extremely small fraction of these people end up with meningitis.

              Meningitis is not a trivial affliction. Headaches, sensitivity to light, stroke, and without proper treatment meningitis kills. Some of the drugs they use to cure fungal meningitis are not gentle to the patient and have "been associated with multiple organ damage in therapeutic doses".

              This event could very well turn into a history making medical disaster. Very many doctors have no experience dealing with fungal meningitis. Some patients will have to fight their Health Insurance companies to get them to move fast enough to approve the treatment.

              The only group that will benefit in any way are the lawyers.

                Reply#9 - Fri Oct 12, 2012 5:34 PM EDT

                It is unfortunate that the ER's and the doctors are not more knowledgeable about the two types of meningitis that have been administered to the patients. And why are these pain clinics purchasing medication from facilities when most if not all compounding operations are for a local and at best state level, this just smacks of poor judgement on their parts, I am sure the clinics are well aware of the requirements of these facilities, and that interstate production is illegal in most cases. They are saying the pain clinics are not at fault, true they may not have been the cause of the fungal meningitis, but there willingness to use these medications produced by NECC and have them shipped to there locations should be considered a criminal act and put blame onto them. How much money did the clinics save/make by skirting the law in this fashion?

                  Reply#10 - Fri Oct 12, 2012 9:18 PM EDT
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