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CDC: Look for hidden fungal infections in patients who got shots

Many of the 13,000 or so people who haven’t been sickened by contaminated pain injections from the pharmacy at the center of the fungal meningitis outbreak may have infections they don’t know about, federal health officials warned on Thursday.

Patients who got steroid injections from one of three contaminated batches should check back with their doctors if they have any symptoms at all, officials with the Centers for Disease Control and Prevention said -- and doctors should consider running magnetic resonance imaging (MRI) scans to check for infections.

Researchers in three of the 19 affected states ran an experiment in which they did MRIs on 128 patients who had not been diagnosed with infections before. They all had new or worsening symptoms such as pain at the injection site. More than half of them -- 52 percent -- had MRI evidence of some type of infection, including abscesses, a type of nerve inflammation called arachnoiditis or even infections of the bone in the spine.

“These findings demonstrate that among patients with no previous evidence of infection, and with new or worsening symptoms at or near the site of their injection, more than 50 percent had findings suggestive of a localized spinal or paraspinal infection,” CDC wrote in a health alert sent to doctors.

The outbreak of fungal meningitis has made at least 620 people sick and killed 39 of them, and CDC says to expect more infections. It’s been traced to a single pharmacy, the New England Compounding Center (NECC) in Framingham, Mass. The pharmacy has been closed and all of its products recalled, but the crisis has prompted a Congressional investigation of how regulators allowed NECC to continue operating.

The Food and Drug Administration says its inspectors have found unsterile conditions and many contaminated products at NECC and has asked for wider regulatory powers for policing such pharmacies.

NECC distributed its products far more widely than it was licensed to, and officials say more than 75 clinics in 23 states got some of the contaminated steroids. Close to 14,000 people received contaminated injections.

Of the 620 who have been infected, 367 had meningitis, a dangerous and often deadly inflammation of the coating that protects the brain and spinal cord. Another 250 have local infections of the spine or the joints where they were injected, such as the ankles or shoulder. All will require weeks or months of treatment with strong antifungal drugs.

Because treatment is so harsh, CDC has held off on saying everyone who got an injection should be treated just to be safe. And CDC’s been conservative on recommending scans to see if there’s an infection that isn’t causing obvious symptoms, in part because MRIs are expensive and often difficult for patients to schedule.

But anyone who has pain or other symptoms should go back to the doctor, CDC now advises.

“CDC is recommending that clinicians should consider obtaining an MRI with contrast of the injection site in patients with persistent but baseline symptoms because the presentation of these spinal or paraspinal infections can be subtle,” the alert says.

“Some patients who received spinal or paraspinal injections with implicated MPA from NECC may currently have an unrecognized, localized spinal or paraspinal infection. CDC is therefore re-emphasizing the need for clinicians to remain vigilant for evidence of fungal infection in these patients.”

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