New Fungal Meningitis Cases and Spinal Infections Continue to Baffle Doctors

PHOTO: Shawn Lockhart looks at the meningitis-causing fungus Exserohilum rostratum at the mycotic lab at the Centers for Disease Control and Prevention in Atlanta.
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When Harold Rye came home from his 18-day hospital stay to treat the fungal meningitis he got from a tainted steroid injection, he said he didn't feel any better than he did the day doctors admitted him with the deadly inflammatory disease.

The 73-year-old retired mechanic said he felt weaker with each passing day at home, and two weeks after he was discharged from the hospital, his doctor called him to say that other fungal meningitis patients had come down with secondary spinal infections, or abscesses, and he might have one too.

"They found it on my backbone, and it had gone down to my hips," Rye said.

The discovery of the fungus-and-pus-filled abscess would land Rye back in the hospital for another 25 days and require two more surgeries. Although Rye was discharged on Dec. 5, his journey back to health is far from over. Rye's wife will have to give him intravenous medication three times a day for the next several weeks, and he'll have to swallow a dozen pills a day for the next three to six months.

"It was very scary," he said, adding that his wife was by his side all 45 days in the hospital. She never complained, but one day she lay down on the edge of his bed and cried. "I could feel her sobbing, and she said, 'It just isn't fair.' I know she went through heck with it. She was there with me every minute of the time."

It's been more than a month since the 42-day risk period for contracting fungal meningitis from tainted steroid injections ended on Nov. 7, but new meningitis cases, spinal infections and other complications continue to arise, even for patients who have already been treated and sent home.

"Here's the perplexing issue," said Dr. Tom Chiller, the deputy chief of the Centers for Disease Control and Prevention's mycotic diseases branch. "Why are we getting people that early on who are presenting with rip-roaring meningitis, but now, they're presenting 100 days later with focal infections only? Why the difference? We don't know."

The CDC reported five new meningitis cases, 39 new spinal infections without meningitis, and three new joint infections within the past week. One more person has died over the same time period, bringing the death toll to 37.

Up to 14,000 people received the tainted injections produced at New England Compounding Center in Framingham, Mass, which recalled all products and shut down on Oct. 6. It is now being investigated by the Food and Drug Administration, even though its oversight usually falls under its state's pharmacy board's jurisdiction. NECC's owner Bill Cadden invoked the Fifth Amendment and declined to answer questions before Congress on Nov. 14.

Click here to read our fungal meningitis timeline.

It's not clear how the fungus got in the steroid vials, but an FDA investigation revealed that a quarter of the steroid vials in an NECC bin contained "greenish black foreign matter," according to an FDA form released Oct. 26. The form went on to identify several clean rooms -- where sterile products are produced -- that had either mold or bacterial overgrowths.

The longest fungal infection incubation period the CDC recorded to date was 120 days, Chiller said. However, the longest incubation period from a previous fungal meningitis outbreak was 152 days.

"We hope that's the exception, not the rule," Chiller said. "We hope we're nearing the end of this."

In all, 590 people in 19 states have become ill with meningitis or another infection as a result of the tainted steroid injections manufactured by the New England Compounding Company. Of those, 368 were fungal meningitis and 192 were spinal infections without meningitis. Other ailment categories included strokes and joint infections.

Perplexingly, the fungal meningitis case tally reached 475 cases on Nov. 19, but some cases have been reclassified as spinal infections, Chiller said. The CDC started dividing meningitis cases into meningitis cases and spinal infections only on Nov. 26, causing the meningitis count to drop to 360 (including secondary spinal infections) and the spinal infection count to begin at 128 that day.

Michigan reported about 78 percent of all spinal infections in the nation, largely because doctors there had been performing more precautionary MRIs, said Dr. Varsha Moudgal, an infectious disease specialist at Saint Joseph Mercy Hospital in Ann Arbor.

Most of Moudgal's patients told her they felt increased pain when they developed spinal abscesses, but some said they didn't feel anything different. Many patients already had back and neck pain, which masked the pain from their spinal abscesses. Moudgal and other doctors began using a broader criterion for deciding which patients needed an MRI, and they found more patients with spinal infections.

Of 161 patients treated at Saint Joseph Mercy Hospital who'd received tainted steroid injections, 17 had fungal meningitis only, 65 had fungal abscesses only and 36 had meningitis and fungal abscesses, hospital spokeswoman Laura Blodgett said.

Nov. 17 was the day Saint Joseph Mercy Hospital had its most tainted injection inpatients, Blodgett said. There were 79 of them that day.

The hospital had 54 inpatients last week when Rye and his wife finally left Saint Joseph Mercy Hospital. As Rye was gathering his things to go home, his nurse's eyes welled up. She hugged him, hugged his wife and hugged him again.

"She said, 'I'm going to miss you guys, but it's a good miss,'" Rye said.

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