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More Bad News For Low Back Pain Sufferers: Drug-induced Meningitis

More Bad News For Low Back Pain Sufferers:
Drug-induced Meningitis

The Chiro.Org Blog


SOURCE:   Associated Press ~ Oct 4, 2012

By MIKE STOBBE


Medication Linked to Meningitis Deaths May Have Reached 23 States

The potential scope of the meningitis outbreak that has killed at least five people widened dramatically Thursday as health officials warned that hundreds, perhaps thousands, of patients who got steroid back injections in 23 states could be at risk.


UPDATE: October 09, 2012: The number of identified cases has reached 119, with 11 deaths in 10 different states.


UPDATE: October 11, 2012: The number of identified cases has reached 170, with 14 deaths in 11 different states.


UPDATE: October 12, 2012: from MedScape The number of people exposed to potentially contaminated methylprednisolone acetate produced by the New England Compounding Center (NECC) in Framingham, Massachusetts, is closer to 14,000 — not 13,000 — as originally reported on October 8, federal health officials said today.

“These 14,000 patients received the medication as a steroid injection either into the spinal area or into a joint space such as a knee, shoulder or ankle,” said J. Todd Weber, MD, incident manager of the multistate meningitis outbreak at the Centers for Disease Control and Prevention (CDC). More than 12,000 of these people have been contacted to date, he said.

As of today, the CDC said a total of 170 cases (including the 14 deaths) have been reported across 11 states: Florida (7 cases, 2 deaths), Idaho (1 case), Indiana (21 cases, 1 death), Maryland (13 cases, 1 death), Michigan (39 cases, 3 deaths), Minnesota (3 cases), New Jersey (2 cases), North Carolina (2 cases), Ohio (3 cases), Tennessee (49 cases, 6 deaths), and Virginia (30 cases, 1 death).


UPDATE: October 25, 2012: from MedScape There are currently 328 reported cases of fungal infection, with 24 deaths now reported in 18 states. This includes 5 peripheral joint infections.


UPDATE: November 27, 2012: from Fox News There are currently 510 reported cases of fungal infection, with 36 deaths now reported in 19 states, and another 14 cases of peripheral joint infection reported.

NEW YORK (AP) — The potential scope of the meningitis outbreak that has killed at least five people widened dramatically Thursday as health officials warned that hundreds, perhaps thousands, of patients who got steroid back injections in 23 states could be at risk.

Clinics and medical centers rushed to contact patients who may have received the apparently fungus-contaminated shots. And the Food and Drug Administration urged doctors not to use any products at all from the Massachusetts pharmacy that supplied the suspect steroid solution.

It is not clear how many patients received tainted injections, or even whether everyone who got one will get sick.

So far, 35 people in six states — Tennessee, Virginia, Maryland, Florida, North Carolina and Indiana — have contracted fungal meningitis, and five of them have died, according to the Centers for Disease Control and Prevention. All had received steroid shots for back pain, a highly common treatment.

This is especially disturbing, because

Steroid Injections Offer Minimal Relief for Lower Back Pain

In an alarming indication the outbreak could get a lot bigger, Massachusetts health officials said the pharmacy involved, the New England Compounding Center of Framingham, Mass., has recalled three lots consisting of a total of 17,676 single-dose vials of the steroid, preservative-free methylprednisolone acetate.

An unknown number of those vials reached 75 clinics and other facilities in 23 states between July and September, federal health officials said. Several hundred of the vials, maybe more, have been returned unused, one Massachusetts official said.

But many other vials were used. At one clinic in Evansville, Ind., more than 500 patients got shots from the suspect lots, officials said. At two clinics in Tennessee, more than 900 patients — perhaps many more — did.

The investigation began about two weeks ago after a case was diagnosed in Tennessee. The time from infection to onset of symptoms is anywhere from a few days to a month, so the number of people stricken could rise.

Investigators this week found contamination in a sealed vial of the steroid at the New England company, according to FDA officials. Tests are under way to determine if it is the same fungus blamed in the outbreak.

The company has shut down operations and said it is working with regulators to identify the source of the infection.

“Out of an abundance of caution, we advise all health care practitioners not to use any product” from the company, said Ilisa Bernstein, director of compliance for the FDA’s Center for Drug Evaluation and Research.

Tennessee has by far the most cases with 25, including three deaths. Deaths have also been reported in Virginia and Maryland.

Meningitis is an inflammation of the lining of the brain and spinal cord. Symptoms include severe headache, nausea, dizziness and fever.

The type of fungal meningitis involved is not contagious like the more common forms. It is caused by a fungus often found in leaf mold and is treated with high-dose antifungal medications, usually given intravenously in a hospital.

Robert Cherry, 71, a patient who received a steroid shot at a clinic in Berlin, Md., about a month ago, went back Thursday morning after hearing it had received some of the tainted medicine.

“So far, I haven’t had any symptoms … but I just wanted to double check with them,” Cherry said. “They told me to check my temperature and if I have any symptoms, I should report straight to the emergency room, and that’s what I’ll do.”

The New England company is what is known as a compounding pharmacy. These pharmacies custom-mix solutions, creams and other medications in doses or in forms that generally aren’t commercially available.

Other compounding pharmacies have been blamed in recent years for serious and sometimes deadly outbreaks caused by contaminated medicines.

Two people were blinded in Washington, D.C., in 2005. Three died in Virginia in 2006 and three more in Oregon the following year. Twenty-one polo horses died in Florida in 2009. Earlier this year, 33 people in seven states developed fungal eye infections.

Compounding pharmacies are not regulated as closely as drug manufacturers, and their products are not subject to FDA approval.

A national shortage of many drugs has forced doctors to seek custom-made alternatives from compounding pharmacies. The steroid suspected in the outbreak has been in short supply.

Editor’s Comment: The writer of this article fails to ponder the facts…if steriods were in such short supply (HA!) then how did this confounded pharmacy get hold of them in the first place?

The New England company at the center of the outbreak makes dozens of other medical products, state officials said. But neither the company nor health officials would identify them.

The company said in a statement Thursday that despite the FDA warning, “there is no indication of any potential issues with other products.” It called the deaths and illnesses tragic and added: “The thoughts and prayers of everyone employed by NECC are with those who have been affected.”

A 2011 state inspection of the Framingham facility gave the business a clean bill of health.


Associated Press writers Travis Loller in Nashville, Jay Lindsay in Boston, Randall Chase in Wilmington, Del., and AP chief medical writer Marilynn Marchione in Milwaukee contributed to this story.

5 comments to More Bad News For Low Back Pain Sufferers: Drug-induced Meningitis

  • What is truly amazing is that intelligent people are asking their doctors for medications that they know have serious side effects thinking that it won’t happen to them.

  • schererville doc

    This “outbreak” is more due to medical doctors cutting corners and buying drugs from unregulated sources. Last time I checked menigitis wasn’t a side effect of steroids. It is from second rate physicians and unregulated drug makers trying to save a buck. This incident is the fault of greed.

  • karl

    I’m sure like others here I’ve had patients who got positive results from epidural steroid shot(s). I’ve also had patients that got near zero relief after about a day or so. I’ve also had patients that received epidural shots along with chiropractic care. I’ve seen the gamut but I never have seen or heard of this. I don’t believe this epidural preparation came from a federally regulated dispensary. That’s not a good thing unless your someone who thinks regulation/government are always wrong. Personally, I’m neither for or against epidural shots. I have seen them work for certain patients ie. certain disc type patient scenarios and spinal stenosis so I’m not going bash medicine but I will let patients know there are risks. Chiropractic should be the first path for low back syndrome patients. I’m going to take the road where you say very little but patients/people realize medicine is far from perfect and has risks. Let patients know but do it professionally. It goes a long way as a strategy.

  • I hadn’t heard this about meningitis being associated with these types of injections, but I agree with Karl as well – I’ve seen cases of success with these, and cases of failure. However, in most cases it isn’t a long-term result that these patient’s experience. I still believe chiropractic should always be the first choice in these cases.

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