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Fungal meningitis clues may predict who gets sick

Harrison Mcclary / REUTERS

Tonya Snyder, a mycology specialist in the Vanderbilt Clinical Microbiology Lab for patient care shows a sample of Aspergillus fumigatus, the first fungus diagnosed in the fungal meningitis outbreak sweeping the United States. Health officials are trying to find clues about which of 14,000 patients who got contaminated steroid shots may become ill.

Some 14,000 patients who received tainted pain shots tied to a growing outbreak of fungal meningitis soon could have better clues about whether they’re likely to get sick, health officials said.

Of three lots of contaminated steroids linked to the outbreak that has sickened 297 people and led to 23 deaths in 16 states, at least one lot appears to be more associated with illness than the others, judging by the state with the most victims.

That, and other telling elements, could soon help predict which patients really need to worry about developing meningitis or other infections after an incubation period that might last weeks -- or even months.

“CDC is currently examining if there are data that can better define the risk for individuals who may have been exposed to a contaminated product,” said Dr. Benjamin J. Park, who is leading the meningitis investigation for the Centers for Disease Control and Prevention. "This may include the specific lot they received, or even other factors."

That would be a great relief to patients like James Lefebvre, 50, of Milford, N.H., who said that he’s been waiting and worrying about the effects of the tainted steroid shots he said he received in September from PainCare, a New Hampshire clinic.

“I had a tremendous headache Friday all day. I was getting headaches every day now for the last week,” said Lefebvre, who was notified earlier this month that he had received the contaminated injections and is awaiting test results. “Please do not overlook the terrible suffering us victims are going through.”

Part of CDC’s information includes records from Tennessee, the state with 69 infections and nine deaths – the most in the nation -- tied to contaminated lots of epidural steroid injections produced by the New England Compounding Center of Framingham, Mass.

In that state, one of three contaminated lots of methylprednisolone acetate -- Lot  No. 06292012@26 -- sickened more patients than the other two lots, said Woody McMillin, a spokesman for the Tennessee Department of Health.

“Yes, Lot 06 was the source of infection in the majority of our patients,” McMillin said. 

It wasn’t immediately clear, however, exactly how many patients had received shots from that lot versus the other two: Lot No. 05212012@68 or Lot No. 08102012@51. 

Health officials have confirmed three kinds of fungus from NECC drugs, including Exserohilum rostratum, which has caused most of the illnesses, but also Aspergillus and Cladosporium. All products from the compounding pharmacy have been recalled and the Food and Drug Administration has advised doctors to check on the health of any patient who received NECC drugs. The contaminated drugs were sent to health centers in 23 states. 

On Monday, the FDA released lists of all clinics and other sites that received drugs shipped on or after May 21 by NECC. A second list includes specific products and quantities shipped and the shipping date. 

Whether patients become ill -- and how sick they get -- may depend on how much fungus was in the contaminated drugs they received, said Dr. John Perfect, chief of the infectious diseases division of the mycology research unit at Duke University Medical Center.

“There might be an association with the lots and maybe some of them are getting a higher burden of organism,” said Perfect, who investigated a similar 2002 outbreak and is consulting with the CDC.

Officials are working hard, but it’s still too early for state and federal health officials to pin down the precise incubation period or rate at which patients who got the shots will become ill, Perfect said.

In the previous outbreak of fungal meningitis and other infections in 2002, a patient became ill 152 days -- five months -- after receiving a steroid injection. Perfect thinks the incubation period for this outbreak will turn out to be less -- weeks, rather than months, based on patterns so far, he said.

Still, that’s nerve-racking for the 14,000 patients who received the shots who may be reviewing every ache and pain for signs of fatal meningitis.

Anti-fungal drugs are being administered to those with the most serious symptoms, but CDC officials are not recommending that they be given to people with no signs of illness because, in part, of the risk of side effects.

That means that patients will have to work closely with their doctors to monitor symptoms and determine if and when they become sick enough to require treatment.

“We’re trying and it’s not that we have all the answers,” Perfect said. “The physician himself and the patients themselves are going to have to use that information and adapt to the individual circumstances of the patient.”

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The International Academy of Compounding Pharmacists estimates there are 3,000 pharmacies in the United States providing medicines like the steroid injection that is believed to be the source of a fungal meningitis outbreak. NBC's Rehema Ellis reports.