Published Date: 2002-10-02 23:50:00
Subject: PRO> Fungal meningitis, contaminated drug - USA: alert
Archive Number: 20021002.5444

FUNGAL MENINGITIS, CONTAMINATED DRUG - USA: ALERT
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A ProMED-mail post
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ProMED-mail, a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Tue, 1 Oct 2002 11:40:52 -0400
From: John P Maher <jmaher@chesco.org>
Source: North Carolina Department of Health and Human Services [edited]

Patients being notified that injected medication may have been contaminated
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In the past 2 months 3 patients treated at pain clinics in North Carolina
have developed meningitis due to a contaminated batch of the drug
methylprednisolone. One died. A fourth case is under investigation.
Methylprednisolone is a corticosteroid administered by injection to treat
joint pain [by decreasing inflammation - Mod.LL]. All 3 of the patients who
developed meningitis had received an injection of the drug in their spine
between April and July 2002. A total of 3 North Carolina facilities
received shipments of the contaminated drug: FirstHealth Moore Regional
Hospital Pain Clinic in Pinehurst, Wayne Memorial Hospital in Goldsboro,
and Johnston Pain Management in Jacksonville. (The drug supply was not used
at FH Moore Regional Hospital but was limited only to the hospital's pain
clinic.) The 3 facilities are contacting all of their patients who may have
been treated with the drug, either through spinal injection or injection
into a joint or trigger point area.
Physicians investigating the cases traced the cause of the infections to
the drug, which was provided by a single supplier in South Carolina. The
drug was contaminated with _Wangiella dermatitidis_, a fungus. An
investigation is being conducted to determine how the drug became contaminated.
The drug was shipped to clinics and hospitals in 5 states, including North
Carolina. The drug from that manufacturer is no longer being used; that
pharmacy has issued a recall on 17 Sep 2002 and no longer manufactures the
product.
Patients were injected with the recalled drug as recently as 12 Sep 2002.
One of the cases developed meningitis 10 weeks after the injection, so it
is possible that new cases may subsequently develop.
Patients who may have been infected through an injection into other parts
of their body, such as their knee or other joint, may experience symptoms
of a localized infection: pain, redness, a joint that is hot to the touch,
swelling, or difficulty with movement of the joint. Patients of any of the
3 facilities who are experiencing any of these symptoms, or who suspect
that they may be developing an infection, should immediately contact their
primary care physician, the pain clinic where they were treated, or the
nearest hospital emergency department.
--
ProMED-mail
<promed@promedmail.org>
[Wangiella is a dematiaceous, cosmopolitan fungus that inhabits the soil
and plant material. Wangiella may cause various infections in humans. The
only species included in the genus Wangiella is _Wangiella dermatitidis_.
The taxonomic position of this species is not fully consistent. While some
authorities classify it in the genus Wangiella as _Wangiella dermatitidis_,
others prefer to classify it in the genus Exophiala as _Exophiala
dermatitidis_. _Wangiella dermatitidis_ is an occasional causative agent of
phaeohyphomycosis. Subcutaneous phaehypomycosis is the commonest clinical
picture. The infection develops after traumatic implantation of the fungus
through the skin. _Wangiella dermatitidis_ is a neurotropic fungus. Central
nervous system infections have been reported. It may also cause keratitis,
otitis, pneumonia, and endocarditis. Disseminated infections may develop
particularly in immunocompromised patients. _Wangiella dermatitidis_ may
cause bovine abortion and still birth. - Mod.TG
_Wangiella dermatitidis_ has been associated with various human infections,
usually related to traumatic or iatrogenic wounds. Infections have been
associated with such risks as peritoneal dialysis, intravenous catheters,
and keratoplasty. The source of the contamination in this incident is as
yet unknown. The cases of meningitis reported, given the delayed onset,
were probably related to spread to the subarachnoid space from a
parameningeal occult infection with the organism. - Mod.LL]
................ll/tg/pg/sh
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