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AP
Nearly six months after injectable steroids made by the New England Compounding Center were implicated in an outbreak of fungal meningitis and other infections, more people are turning up ill, including those who previously tested clear of infection.
Nearly six months after the start of a deadly fungal meningitis outbreak blamed on tainted pain shots, patients who originally tested clear are showing up sick, raising worries that the incubation period for illness may be longer than anyone thought.
Though the flood of patients has slowed dramatically, two or three people each week are still reporting infections caused by contaminated steroids in the outbreak that has killed 48 and sickened more than 700, officials with the Centers for Disease Control and Prevention said.
Among those new patients are people who received mold-tainted doses of the drug methylprednisolone, but who previously got MRIs or lumbar punctures that showed they were free of infection. These slow-growing infections aren't as severe as meningitis, but worrying nonetheless.
“If you had an MRI in October, I don’t know that you’re out of the woods,” said Dr. Anurag Malani, an infectious disease expert at St. Joseph Mercy Hospital in Ann Arbor, Mich., the state that has seen the most cases -- 253 -- in the outbreak.
CDC officials issued a health alert this week urging clinicians to remain vigilant for new infections, even in people who show subtle symptoms -- or none at all.
“We are seeing some patients with very long incubation periods,” said Dr. Tom Chiller, associate director for epidemiological science in the CDC’s division of foodborne, waterborne and environmental diseases. “We expect to see people getting infections months after their injections.”
Nearly 14,000 people in 23 states were exposed to the contaminated drugs produced by the now-shuttered New England Compounding Center of Framingham, Mass. An estimated 11,000 actually received shots for back or neck pain, the CDC says. So far, 720 people in 20 states have fallen ill.
Most of the seriously ill people – those with fungal meningitis infections that caused strokes, for instance – showed up within several weeks or one to two months starting in late September.
Back then, CDC officials told worried patients that the greatest risk for meningitis was likely in the first 42 days -- six weeks -- after the shots, suggesting that they could breathe easy after the first week in November.
But patients have continued to become ill, most often not with meningitis, but with infections at the injection site, with epidural abscesses or with a condition called arachnoiditis, an inflammation of the nerves near the spine.
Though doctors have little experience with such fungal infections, the incubation period appears to be stretching longer than a previous outbreak in 2002, when a patient became ill 152 days – five months – after getting a steroid shot.
“I don’t think at this time we know how long the incubation period is,” Malani said.
That’s worrisome for people like John Horrell, 54, of Nashville, Tenn., who received a steroid shot for back pain from one of three tainted lots in September. He says he’s feeling “remarkably well” these days, with no signs of infection. Health officials told him the biggest worry was after 90 days or so, but now he’s not so sure.
“There’s people still having problems,” said Horrell, who owns a sound system firm. “We just keep our fingers crossed. I try not to worry about it.”
CDC officials want health workers to continue to monitor patients who got shots, particularly those whose have pain that is worse or different from the initial symptoms. But even patients who previously tested negative for infections and those with no apparent symptoms are at risk.
“These infections may be unrecognized because some patients have not continued to receive close clinical follow-up or because they have not recognized symptoms suggestive of a localized infection,” the new alert says.
CDC recommends that health workers have a low threshold for considering MRIs, or magnetic resonance imaging, to detect unseen infections.
Even patients who initially resisted MRIs because they didn’t want them or didn’t think they needed them have turned up with infections, said Malani.
The danger of not detecting the infections is that they only will get worse, Chiller said.
“Any untreated infection can sit there and smolder and spread,” he said, noting it can move beyond soft tissue to bone and the central nervous system, with devastating, even deadly, effects.
That, however, raises the next question in the ongoing meningitis puzzle: How long should infected patients be treated? Some patients say they’ve been told three months, then nine months -- then a year.
The primary drugs used to treat the fungus -- voriconazole and amphotericin B -- are both expensive and toxic, with a host of side effects ranging from hair loss and hallucinations to liver problems.
Margaret Snopkowski, 51, of Fowlerville, Mich., has been on the drugs since early October, when she developed meningitis -- and later, arachnoiditis -- after getting a contaminated shot.
She's back home, but life is hardly back to normal, especially with the high doses of antifungal drugs necessary to keep her infection in check.
“She walks around like a zombie,” said her husband, Tom Snopkowski. “It just knocks her on her butt.”
Family members had hoped she’d be better by now, or at least looking to wean herself from the drugs. But that’s not happening, her husband said. Another MRI is scheduled for next week to see whether the infection has gotten worse.
“Now, they don’t even have an end date for that treatment," he added.
Related:
Pharmacy tied to fungal outbreak files for bankruptcy
Fungal meningitis risk greatest first six weeks after shots, CDC says
Fungal meningitis victim hopes Congress hears: 'It's torturous'
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Yet not one of the managers of the facility has been charged with manslaughter. Just another reason to have no faith in the government of this country. Guy goes to prison for smoking weed and hurting nobody, while pharmaceutical executives create contaminated drugs killing dozens and they get to go about their lives. It's pretty sad that such corruption has become common place in the United States.
Exactly! ---and then they just disappear when we need money for the people, while the big ships from profits are still sitting in Miami harbour, and they are on vacation there most of the year.
I see a picture of a methyl read, and that I would assume no one drinks or eats, since they will be red all over their body, before they die, it is used for staining samples of microbes, or blood cells.
Dear Dan. It's the government that caught it and is doing something about it. Do you really want to get rid of the only agency, the FDA, that looks out for our health? Do you really think the drug companies would have came forward on their own? Look at history before you make judgement. The only reason our air, water, and food is as safe as it is is because of the government. You may not like big government, but this isn't the place to lay blame.
Fungal infections are far more tricky than bacterial, or even viral infections. Fungus is a lot more like a parasite - hiding and growing only when the host conditions are right.
It's once again all about money. These firms that mix these drugs sprang up to fill a void in the medical-drug assembly line and saw a way to make a hefty profit with no one looking over their shoulder to make sure they did anything right. They couldn't be bothered to even maintain a minimum level of sanitary conditions at the site where this originated, now people are dead or living in agony and fear because of their greed.
@John Colorado
Levying a fine or forcing a company out of business is not "doing something about it". There needs to be criminal charges brought against the business owners who knowingly allowed, or even ordered, their managers to bypass numerous safety protocols, which led to this outbreak.
If they simply turned a blind eye to what was happening in their labs, they are at least guilty of Criminal Negligence. If they were the ones issuing policies to force their labs to cut corners, then they are guilty of Depraved Indifference.
Business executives everywhere need to see, that if anything they do (or fail to do) puts the public in danger, they *will* lose everything they have.
Let's put it to you this way: If you or any Average Joe had done something like this, you would be rotting in jail for 3rd degree murder. The executives at this company *KNEW* their product was contaminated, because their own internal tests revealed it. Yet, instead of issuing an immediate recall, they continued to ship contaminated product, and did NOTHING to prevent contamination of future product.
They are guilty of murdering those people. They knew their product was contaminated, they knew it could kill, and they chose to hide it. Every last one of them needs to rot in a cell.
This shows how little of medicine we really know... 200 years from now, society will ask "what were they thinking?"
I find it truly amazing that although technology had advanced mankind immensely, we still don't know a lot about the human body....
Fight one "bug" caused by a contaminated drug with other drugs that have just as severe or more severe side effects. That is what our medical establishment has become. I bet they have done NOTHING to discuss the patient's dietary habits (which can feed fungal infections, as well as any other type of infection) and modified those diets. The human body was designed to heal itself (the word disease is actually dis-ease...the body not in balance). Each individual needs to learn how to read his/her own body and how to make any and all necessary adjustments to allow it to heal itself. Medical personnel can only FACILITATE the healing.
And who will get the bill for those MRIs? I hope the facility that made all that tainted medication has good malpractice insurance.
The way American patients are treated is criminal. First they are essentially poisoned by bad medication and then they are hounded to pay the resulting medical bills. Their peace of mind is destroyed along with their credit.
I'd sue for damages if I were one of those affected.
What the heck is going on in that liberal state, first the terrorists stayed there before attacking NY and now tainted drugs around the country, WHO IS REALLY RUNNING MASSACHUSETTS?
I believe you are mistaking. The 911 hijackers where in Florida with brother Jeb. Had a person use to go to Coral Springs dog park that lived in the same apartment building. They also went to flight school in Florida. Maybe you should read up on this before you make blanket statements.
When will the SHEEPLE (SHEEP/PEOPLE) learn that the modern medicine is NOT meant to heal/cure, only to KILL. The MEDICINE is CONJURED UP like a WITCHES BREW in the PHARMASEUTICAL LABS and keeps you coming back for more medicine to TREAT new SIDE AFFECTS. It is a REVOLVING DOOR that spits you out after your body can take no more and the you are finally 6 FEET UNDER.
It is time for KNOWLEDGE AND UNDERSTANDING. Be RESPONSIBLE for your own TEMPLE (Body). Clean it own and stop filling it with garbage. The garbage is not only what you call FOOD but IMMUNIZATIONS, INJECTIONS (FEAR TACTICS) that are pushed by the PHARMASEUTICAL COMPANIES to INFECT your temples.
Time to stop being SHEEPLE and start being PEOPLE!
what a bunch of bull
see my comment following ... and it was modern meds that got her through it
clueless
wow - spread the word
damn fool
I see a Darwin award in somebodys future.
if any of you show any symptoms at all, shot or not, get the hie to a physician - I know from experience as my wife acquired meningitis this past summer and she had no shot - just got it from somewhere, but have no clue as to where or when. Luckily she pulled thru, but it was touch and go for a few days. Nasty disease. Anyone reading this, please bone up on the symptoms this causes so you are educated about it.
Thanks for listening ...............
"medecine" really is a practice, isn't it ? So much for science and modern medicine. And to think the majority believe their Doctor knows what he's talking about......and he merely practicing his socalled trade. It really doesn't make sense, God says HE's your healer and has lied yet,....not since creation, anyway.
The problem is the intelligence & drive possessed by our doctors. The intelligent, due to their more flexible way of thinking, are easiest to brainwash. Just appeal to their intellect, & vanity does the rest.
Of course, they're the easiest to deprogram too. So brainwashing & mind control have to be practiced continuously. Since medicine is a highly technical science, the competent doctor has to keep up with the latest information, & there are plenty of opportunities to practice brainwashing & exert mind control.
Oops! Did it again. Used "brainwashing" & "mind control". That wasn't very PC of me. I meant, of course, commercials & advertising.
Its a paradox--both of the above posts are each worse than the other
sure, freddy ---- maybe an exorcism or voodoo would be better
believe me, i have seen doctors and nurses and the rest of the staff caring, using meds and she pulled thru
you naysayers should be ashamed - wait until YOU need attention one day and then decide what's what
This is so devastating. Michigan has been the hardest hit. Several patients here are languishing in hospitals for months with abseses on their spinal cord - hoping one or the other improvised anti-fungal treatment will work. You see, it was a plant fungus that was injected into the person's spine, that membrane is tough to cross, and they're just guessing and throwing stuff at it now.
Patients are alive, but no life. You can't keep your job if you're committed to hospital indefinitely. Family and financial stress. So sad -
Perp's should be in jail!
Profit margin trumps prosecution, again.
Today we look back with wonder at the foolishness of our ancestors who thought disease could be cured by bleeding the patient to death. Our descendents will look back upon us with wonder at our foolishness for thinking some pharmaceutical is the answer to every medical question.
Be comforted. Our descendents will believe something just as foolish & ignorant. We're much better at belief than we are at facing facts.
In fact, this spinal injection had very little evidence to support it, and some evidence that it was worthless. There had been only a few small randomized trials, and the largest and best couple of those found that the steroid shot did not improve back pain more than a placebo shot. It sounded to the doctors like it ought to work, and it satisfied the American need to be Doing Something. Anyone who got these shots without giving informed consent has a legal case. Informed consent would have required that partients be told there was little evidence that the treatment would benefit them and that possible (then-known) complications included permanent paralysis. We might be better off if we could convince the MDs to just dance around us with a rattle and charge $2000.
jane,
probably overstating your case a bit
http://www.ncbi.nlm.nih.gov/pubmed/19165299
Did any of you catch the methadone story over on bloombergnews? I have to laugh (and cry at the same time) for the foolishness of the medical "profession" these days. When are they going to wake up and realize that they aren't "curing" a drug addict with methadone? They are simply getting rid of one addiction for another, since according to that story, the patient is kept on methadone for a long period of time, including take-home doses.
Drug commercials on TV, in print, and online always make me wonder at the stupidity of the American public. Why would you take a drug for one condition that has even more severe side effects? Clean up your diet and your environment and your body can do a much better job of healing itself.
BTW, cr, exactly which KIND of meningitis did your wife contract? Remember there are three different kinds...bacterial, viral, and fungal, and this story is about fungal. Bacterial is the most serious, and easily spread. Viral is the more common form and not as "dangerous" or "serious".
http://www.webmd.com/brain/understanding-meningitis-basics
These people (and this 'company') should NOT be allowed to file bankruptcy, so they can change names, locations, etc and keep up the bad work.
They should be held responsible 100%...and if the money runs out, should be 100% responsible for the physical care of each and every person who is still suffering from the effects of their greed.
I actually believe that the State of Massachusettes should be held responsible as well - for allowing such a facility to continue to do business, even after several complaints against it.
That's what the corporate veil is all about; avoiding personal responsibility. The term used to be "public corporation". Business owners were permitted to profit as much as the market allowed, with the clear understanding their operations would be of benefit to the public. If not, they lost it all.
We need to go back to that requirement today.
Jet, what I'm hoping is that they eventually get sent to criminal court. No hiding behind bankruptcy there.
The State of Massachusetts - I see your point. After no more (civil and criminal court) money can be gotten from those responsible, then yes, the State of Massachusetts should foot the rest of the medical and disability costs.
Omg, this is insane. These poor people.
Percutaneous Endoscopic Laser Disceoctomy
cLICK AND CHECK
Too bad the CEOs and owners of these companies were not charged with a crime for killing people-- then we would start seeing companies take proper safeguards.
It is only going to get worse with the anti-government crowd.
That's the way is used to be. See my post #11.1 above. We once had captains of industry & entrepeneurs up the wazoo, but for over a century & a half, they've been eased out in favor of bureaucrats. Those boards of directors & suites of suits who've made life miserable for so many.
Ironically, the theory of rule by bureaucracy, so eagerly & quickly adopted by the CEOs, was first proposed by Karl Marx. The histry of communism is just packed with irony.
This is ridiculous. I would not blame the families of the victims if they marched on this palce and burnt it to the ground.
While I would never condone arson, I would have no problem with loaning them my lighter.
The people that are responsible at the drug compounding facility should be in jail period. They should be left there to rot and starve to death since they killed others that received these injections and others are continuing to suffer everyday. There is little justice in this country anymore when you can literally murder people with these drugs and then do jail time for pot. Our priorities are literally screwed up and so is the importance of a human life.
Starving them is a little extreme, but your sentiments are understandable. How about caging them, but putting them on public display complete with "Please don't feed the animals" signs.
What a nightmare to have to endure! I hope that the people responsible for this nightmare are brought up on criminal charges.
My thoughts and prayers are with the victims and their families.
Senator Paul Ryan cuts the budget; can CDC handle another new cases after being squeezed to out of stage?
Well, as Scrooge said, let them die and decrease the surplus population. Paul Ryan is totally out of touch with the common man, but likely is in with the CEO's and will get millions to run his campaign. This is nothing new, the struggle between the poor and those who want to keep their boot on the poor has been going on as far as recorded history. Recently they have been extending it to middle class, but that backfired in the last election. Still, they haven't learned.
They also need to go after the CEO/Owner/Doctor of whatever healthcare provider gave these people the tainted medicine, knowing that it was in violation of FDA regulations. Compounding pharmacies are only supposed to issue drugs via individual prescriptions. These clinics and doctors were using NECC because it was cheaper than using an FDA regulated drug.