A health advisory was received from the Centers for Disease Control and Prevention (CDC) Oct. 4 regarding meningitis and stroke associated with potentially contaminated steroid injection. Centegra Health System does not use the manufacturer for this product, formally known as methylprednisolone acetate.
Patient Information from the CDC:
Is the source of the outbreak known?
CDC is investigating medications and products that are associated with this outbreak of meningitis. At this point, there is not enough evidence to determine the original source of the outbreak, however there is a link to an injectable steroid medication. The lots of medication that were given to patients have been recalled by the manufacturer.
What are the states that received the implicated product?
California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Texas, and West Virginia
What is meningitis?
Meningitis refers to inflammation of the protective membranes covering the brain and spinal cord known as the meninges. The inflammation is usually caused by an infection frequently with a bacteria or virus, but meningitis can also be caused by less common pathogens such as fungi. The severity of illness and the treatment for meningitis differ depending on the cause. Thus, it is important to know the specific cause of meningitis.
What is fungal meningitis?
Fungal meningitis occurs when the protective membranes that cover the brain and spinal cord are infected with a fungus. Fungal meningitis can develop after a fungus spreads through the bloodstream from somewhere else in the body, as a result of the fungus being introduced directly into the central nervous system, or by direct extension from an infected body site next to the central nervous system.
Is fungal meningitis common after epidural injections?
Epidural injections are generally very safe procedures, and complications are rare. Fungal meningitis is an extremely rare cause of meningitis overall, including after epidural injections. The type of epidural medication given to patients affected by this outbreak is not the same type of medication as that given to women during childbirth.
What are the symptoms of fungal meningitis?
Symptoms of fungal meningitis are similar to symptoms of other forms of meningitis, however they often appear more gradually and can be very mild at first. In addition to typical meningitis symptoms, like headache, fever, nausea, and stiffness of the neck, people with fungal meningitis may also experience confusion, dizziness, and discomfort from bright lights. Patients might just have one or two of these symptoms.
On Sept. 25, the New England Compounding Center voluntarily recalled the three lots of the steroid. The manufacturer Centegra utilizes performs its own quality controls and does not outsource its manufacturing of products to the New England Compounding Center.
Centegra’s Director of Pharmacy, Scott Padjen, said in addition to ensuring Centegra pharmacies do not use the potentially contaminated steroid, he has recommended to all Centegra physicians that they check supplies at their respective practice locations to ensure their patients are not being administered the product.
“Additionally, per the CDC and Federal Drug Administration (FDA) it is recommended that physicians do not utilize any New England Compounding products,” Padjen said. “If physicians identify any of these products, it is recommended they stop purchasing and seek other sources.”
For patients who received epidural injection and have symptoms of meningitis or basilar stroke, a diagnostic lumbar puncture (LP) should be performed, according to the CDC.
“Because presenting symptoms of some patients with meningitis have been mild and not classic for meningitis (such as new or worsening headache without fever or neck stiffness), physicians should have a low threshold for LP,” a CDC health advisory said. “While CDC is aware of infections occurring only in patients who have received epidural steroid injections, patients who received other types of injection with methylprednisolone acetate from those three lots should also be contacted to assess for signs of infection (such as swelling, increasing pain, redness, warmth at the injection site) and should be encouraged to seek evaluation if such symptoms exist.”
Centegra Health System is committed to meeting the health care needs of the residents of greater McHenry County and to making services available in multiple and convenient locations, including hospitals in McHenry and Woodstock, Immediate and Physician Care Centers, Centegra Sage Cancer Center, Health Bridge Fitness Centers and more. As the region’s leading health care provider, Centegra Health System continues to bring the latest treatments and technology, along with the skills of nearly 4,000 medical professionals, to meet the needs of the growing McHenry County community. For more information on Centegra Health System visit Facebook and Twitter or call 877-CENTEGRA (877-236-8347).