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Fungal meningitis death toll climbs to 14

New Hampshire Union Leader

October 11. 2012 10:41PM

The death toll from fungal meningitis caused by tainted medicine sent to 23 states, including New Hampshire, reached 14 Thursday, as the type of procedures impacted by the public health crisis has expanded and the waiting period for possible onset of the disease has been extended.

Doctors have now been told to check patients who have had the drug - preservative-free methylprednisolone acetate - injected into their joints for pain relief. That precaution comes in addition to telling people who received an epidural injection near the spine to be checked by a doctor.

Physicians also have been instructed to watch patients for potential meningitis symptoms for several months, rather than the mere weeks initially recommended.

No fully diagnosed cases of fungal meningitis have been reported in New Hampshire, where one facility, PainCare LLC, based in Somersworth, received the medication from New England Compounding Clinic.

Dr. Michael O'Connell, chief executive officer of PainCare, says his practice was in touch with everyone who received the drug in any form, even prior to the revised guidance from the federal Centers for Disease Control and Prevention.

'Our threshold is very low to tell them even if they received a simple joint infection to come and let us look at it,' O'Connell said. 'We also have a low threshold, after looking at their symptoms and patient history, to go ahead and (spinal) tap them.'

The number of people confirmed to have received the steroid injection has reached 14,000, with 169 cases of fungal meningitis now traced to the tainted medicine. The 14 deaths occurred in 11 states.

Compounded medications are not regulated by the federal Food and Drug Administration, but come under the authority of state agencies.

The number of people diagnosed with fungal meningitis has reached 169, federal officials said.

A decision to ask doctors to check on patients who received a joint infection with the NECC drug was made after a patient in Michigan started showing symptoms after an ankle injection.

At first, the follow-up was urged in cases where an epidural injection was given near the spine. Now the advisory covers uses of the drug to alleviate joint pain. 'How does a fungus go from a wrist joint to the spine?' asked O'Connell. 'I'm not an infectious disease doctor, but I have heard of stranger things.'

PainCare removed all NECC drugs from its inventories after the situation developed.

The CDC has identified two different fungal infections in people who have developed meningitis. The fungus Exserohilum has been found in 10 people and Aspergillus in one person affected.

Dr. Todd Weber of the CDC said the fungi are slow-growing and doctors should watch patients for months.

'We're not out of the woods yet,' Weber said. 'Should patients get symptoms of meningitis in the coming week, they should seek medical guidance immediately.'

Officials shed no new light on what happened to cause more than 17,000 doses of potentially infected medicine to be shipped out of a Framingham, Mass., facility.

Dr. Madeleine Biondolillo, director of the Massachusetts Bureau of Health Care Safety and Quality, told reporters Thursday that the NECC laboratories had been subject to inspection by pharmacy inspectors and that the state conducted an inspection in late September.

Massachusetts law requires a prescription for a particular patient prior to production of compounded medications. More than 17,000 doses of the potentially tainted medication were distributed, but during Thursday's news conference, Biondolillo did not address the question of whether the state's pharmacy inspectors ever asked for verification that there was a prescription for every dose as required by law.

Calls to Massachusetts health officials were not returned.

Attempts to corral the meningitis outbreak are complicated by the fact that it is spread through infection with a fungus, which O'Connell said is slow-growing by nature, making it difficult to detect.

His New Hampshire patients are being provided with information about potential symptoms to look for, even after they are evaluated at the clinic, so that if symptoms of meningitis materialize they will be recognized quickly.

'Very rarely do they cause an overwhelming acute infection, and it's the slowness of the growing on culture that makes it difficult to come to a diagnosis,' O'Connell said. 'Honestly, I can tell you your spinal fluid looks pretty good, but it doesn't mean you're out of the woods.'

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