Two other drugs made by the New England Compounding Center (NECC) appear to be involved in the fatal meningitis outbreak that has now claimed the lives of 15 people in as many states, the FDA announced Monday.
The FDA said today it is investigating one case of possible meningitis associated with an epidural injection of triamcinolone acetonide and two reports of fungal infection with Aspergillus fumigatus in two transplant patients who were given cardioplegic solution made by the company.
The solution is used to paralyze the cardiac muscle during open-heart surgery.
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The new cases bring the total to 214, an increase of 9 since Sunday, the agency said. Most of the cases are fungal meningitis, but the agency is also reporting that two involve peripheral joint infections.
At this point, an FDA release said, "the sterility of any injectable drugs ... and cardioplegic solutions produced by NECC are of significant concern."
"Patients who received these products should be alerted to the potential risk of infection," the agency said.
So far, there have been no cases of infection linked to any ophthalmic drug made by the company that is either injectable or used in eye surgery, "but FDA believes this class of products could present potentially similar risks of infection," the agency said.
The outbreak has been linked to fungal contamination -- with the mold Exserohilum rostratum -- in three lots of preservative-free methylprednisolone acetate, mainly used to control back pain through spinal injections.
All three lots of the drug have been recalled, along with all other products made by the Massachusetts company. All told, the company shipped more than 17,000 vials of the steroid.
In suspected cases, the CDC is recommending that clinicians collect cerebrospinal fluid for culture and initiate both antibiotic and anti-fungal therapy.