Meningitis Outbreak: How Two Docs Helped Unravel a Medical Mystery

Drs. Marion Kainer and April Pettit helped uncover the meningitis outbreak.

ByABC News
November 14, 2012, 9:31 AM

Nov. 14, 2012— -- As she desperately worked to follow the trail of what would turn into a nationwide fungal meningitis outbreak, Dr. Marion Kainer, an epidemiologist at the Tennessee Department of Health, found there was simply no time to sleep. So she camped out at her Nashville office, grabbing a few hours' rest whenever she could.

"I brought in an exercise mat, with a pillow and a blanket and a change of clothes," Kainer told ABC News.

Her efforts and those of Dr. April Pettit at Vanderbilt University were central to uncovering the cause behind the meningitis outbreak, which has been linked to tainted steroids from a compounding pharmacy in Framingham, Mass. The outbreak has killed 32 people and sickened 438 others in 19 states, according to the Centers for Disease Control and Prevention.

Today on Capitol Hill, Congress holds its first hearing into the deadly outbreak. A host of witnesses are expected to testify, including Food and Drug Administration Commissioner Dr. Margaret Hamburg, and Joyce Lovelace, whose 78-year-old husband, Eddie, died in September after he received one of the tainted steroid injections.

The first hint that something was wrong came in mid-September. Pettit, an infectious disease specialist, was puzzled when a patient she had treated for what doctors believed was bacterial meningitis was readmitted to Vanderbilt University Hospital. The patient was agitated, could barely speak, and complained of a headache and low back pain.

As the patient's condition worsened, Pettit went "the extra mile," according to Dr. William Schaffner, head of preventive medicine at Vanderbilt, and ordered another test of the patient's spinal fluid. But this time "she says to the lab, don't just do your routine, also culture for tuberculosis and fungi," Schaffner said.

Those instructions proved critical. The next day, the lab reported an astonishing result: It had found aspergillus, a type of fungus, in the man's spinal fluid.

Aspergillus meningitis is extremely rare, so Pettit sat down with the patient's family to try to figure out how he might have contracted it. She learned that four weeks before he first became sick, he had received an epidural steroid injection to relieve back pain. Worried about a possible connection, Pettit alerted the state health department. It was Tuesday, Sept. 18.

The email from Pettit ultimately ended up in Kainer's inbox. Kainer, who is in charge of health-care related infections for the state of Tennessee, said she became "quite concerned."

Kainer had two years as a CDC epidemic intelligence officer, a so-called disease detective, under her belt before she joined the Tennessee Department of Health. So she wasted no time in launching an investigation.

By Thursday morning, Sept. 20, Kainer confirmed that Pettit's patient had received a steroid epidural at the Saint Thomas Outpatient Clinic in Nashville. She contacted the CDC to see if it knew of other cases. It did not. But they began to turn up. That afternoon, Kainer learned of two more Nashville patients with suspected meningitis who had also had epidural injections.

"So now my interest really peaked up," Krainer told ABC News.

Still, the cause of the meningitis was not known. Was there mold at the clinic where the injections had been given? Were the drugs or the anesthetic tainted? What about the needles? Kainer was like a detective with a host of suspects but no clear guilty party.