Year: 2012
Type: article
Abstract: A n unprecedented outbreak of fungal infections has been associated with injection of methylprednisolone that was contaminated with environmental molds.The index case, which prompted clinicians at Vanderbilt University to call the Tennessee Department of Health and which brought this event to national attention, was reported by Pettit et al. on October 19, 2012, at NEJM.org and in the November 29, 2012, issue of the Journal. 1 We now summarize our understanding of this outbreak as of June 7, 2013.At the outset of the outbreak, the persistence and progression of neutrophilic meningitis of unknown cause was the trigger for obtaining the history of a recent epidural injection of methylprednisolone.Then events fell into place.After the alarm was sounded about this association, other physicians throughout the country realized that they too had struggled to find a cause for similar cases in recent weeks.What was intriguing about this case report was that the mold causing meningitis was reported to be Aspergillus fumigatus, an organism that has not been detected in any of the subsequent 700-plus cases.It has since been determined that the major culprit is Exserohilum rostratum, a plant pathogen that rarely causes human disease.This mold has been cultured or identified by means of a polymerasechain-reaction (PCR) assay from cerebrospinal fluid or tissues in 152 patients and has been detected in unopened vials from two of the three implicated lots of methylprednisolone.Shortly after the Tennessee Department of Health was notified on September 18, 2012, the implicated lots were quickly identified, all centers that had received the implicated lots were alerted, and patients who had received injections from these lots were notified of the potential for fungal infection.More than 13,400 patients could have been exposed to contaminated methylprednisolone from one of the three implicated lots.The compounding pharmacy producing the drug, New England Compounding Center (NECC), was closed, and all products (not just the implicated lots) were recalled.The Centers for Disease Control and Prevention (CDC) provided timely information regarding appropriate diagnostic testing and treatment on its website (www.cdc.gov).Further epidemiologic studies by the Tennessee Department of Health and the CDC showed that one lot (number 06292012@26) was associated with an increased number of cases, especially when the vials that were used had been manufactured more than 50 days earlier.2,3 Iden t ific at ion of the Mol d E. rostratum is a dematiaceous, or black, mold containing melanin in its cell wall.It is widely found in the environment, on plant debris, in soil, and in water.4,5 Human infection is uncommon and is usually restricted to allergic sinusitis, keratitis, andThe New England
Source: New England Journal of Medicine
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2016120326