Fungal Meningitis Prompts Fear Among Steroid-Injection Patients

Oct. 11, 2012— -- Jim McGuire is unlikely to forget waiting in a hospital bed for the results of his spinal tap, as a doctor walked into the room across the hall and told a stranger he'd met earlier in the day that she had tested positive for fungal meningitis. The friend he made as they'd waited all day in the hospital was admitted on the spot.

And McGuire was next in line.

"I saw the doctors go in, and I thought, 'They're talking to her for quite a while,'" he said. "I knew when she got her results that I would be next. "

McGuire, 51, is from Tennessee, the state hit hardest by the recent fungal meningitis outbreak with 44 cases, including six deaths to date. Up to 13,000 pain management patients nationwide were exposed to fungal meningitis if they received compounded steroid injections manufactured by New England Compounding Co. in Massachusetts. It is not spread person-to-person.

McGuire received his first steroid injection for back pain Aug. 28, and learned Monday that his injection was among the three tainted batches NECC distributed nationwide, ultimately sickening 137 people in all and killing 12 of them. McGuire's doctor ordered him to go to the emergency room immediately. It was 9:30 a.m.

"It was kind of a chaos in the emergency room," he said. "The triage for this was incredible. There were beds lined up in the hallway. As soon as one spinal tap was over, they were pushing another one in."

He sat hours in the waiting room next to the elderly woman who would later test positive, anxiously wondering whether he had the deadly inflammatory infection that affects the spine and membrane surrounding the brain, ultimately causing permanent neurological damage and death if left untreated.

Early symptoms can take weeks to appear and include headache, dizziness and slurred speech, but McGuire didn't have those yet. The only way to know for sure was a spinal tap, in which spinal fluid is extracted and tested.

When McGuire finally lay down on his stomach for the test, doctors swabbed his back, and gave him one needle to numb the area and another to extract three vials of fluid. The pain wasn't "ungodly" but he felt it, he said, especially when the needle brushed a nerve and sent an electric feeling down his leg.

When the doctor finally walked across the hall from his friend's room to his, he told McGuire he was meningitis-free. He could go home. It was 5 p.m.

Other steroid injection patients were able to avoid the ER, but they panicked just the same, prompting many to call their physicians for peace of mind.

"There's no question that we're getting a lot of phone calls," said Dr. David Kloth, a pain management physician and board member of the American Society of Interventional Pain Physicians.

He said the Connecticut facility where he works has received hundreds of calls from concerned patients even though no meningitis cases have been reported in the state. Only one facility in Connecticut received the tainted injections.

Jennifer Keene, 38, broke her ankle in May and received a steroid injection to it a month ago. Only spinal injections have caused fungal meningitis thus far, according to the Centers for Disease and Prevention, but Keene didn't know that when she first heard about the outbreak. It's also possible that patients who received the injections to other areas are at risk for health problems.

Shortly after learning that fungal meningitis has a long incubation period, Keene started to feel sick.

"I had a headache I described to my friends as the worst of my life exactly eight days after the injection, and although I now think it was 'just' a migraine, its effects lingered for almost a week," she said. "Looking at the symptoms, I got nervous enough to email my doctor."

He got back to her right away: No worries. We do not use them.

Ross Grossman, 20, is another worried patient, especially given that he had meningitis as a baby and almost died from it.

"It's pretty intimidating to know that something can come from that, whether I was part of the batch or not," Grossman said.

He has had five spinal injections for his herniated disc pain in the past two years, including one in September. He said he hasn't gotten a warning call from his doctor, but he can't help but be nervous.

"There were a couple days where I felt a little weak, had a headache, my stomach was uneasy," he said. "Other than that, I haven't really had many symptoms."