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FACTBOX-U.S. states on alert for fungal meningitis outbreak

Source: Thomson Reuters Foundation - Mon, 8 Oct 2012 22:26 GMT
Author: Reuters
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Oct 8 (Reuters) - A rare outbreak of fungal meningitis in the United States has so far killed eight people. Health officials estimate that as many as 13,000 people in 23 states may have received steroid injections linked to the disease.

Below are some facts about the illness:

* Meningitis is inflammation of the membranes, called meninges, around the brain and spinal cord. It is most commonly caused by an infection, usually by bacteria or virus, but can be caused by parasites, cancer, lupus, and pathogens including fungi.

In this outbreak, health officials have not determined whether the fungus got into the steroid injections of methylprednisolone acetate when it was compounded at a Massachusetts facility, or whether it was present in ingredients bought from suppliers to the New England Compounding Center.

* Fungal meningitis, unlike viral and bacterial meningitis, is not contagious. But all forms of meningitis have nearly identical symptoms, starting with a sudden fever, severe headache and stiff neck. Patients can also become nauseous, sensitive to light, weak or numb in any part of the body, and confused. In the current outbreak, some of the infected patients have had only mild symptoms, not the blinding headaches, severe neck stiffness and fever characteristic of meningitis.

* So far, only patients who received epidural injections of the steroids have become infected, but the potentially-contaminated compounded medications were also sold for injections in the knees and other joints. Doctors have been advised to contact any patients who received such shots and to determine if the injection site is warm, red, painful or swollen, all signs of possible infection.

* The only reliable diagnostic test requires a lumbar puncture - or spinal tap - in which cerebrospinal fluid is drawn into a long needle. The fluid is examined in a lab for white blood cells called eosinophils, which attack fungal infections. Health officials are not recommending lumbar puncture for patients who were injected with the potentially contaminated steroid unless they show signs of infections.

Patients showing no symptoms should be closely monitored, "with a low threshold for performing lumbar puncture should the patient become symptomatic."

* Fungal meningitis can take weeks to manifest symptoms. It is treated with high doses of intravenous or injected anti-fungal drugs, including flucytosine and amphotericin.

Source: U.S. Centers for Disease Control and Prevention (Compiled by Sharon Begley)

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