Fungal Infections Associated with Contaminated Steroid Injections

Author: Elsevier Health Sciences
Published: 2013/06/26 - Updated: 2020/01/21
Contents: Summary - Main - Related Publications

Synopsis: CDC investigators describe pathologic findings from reports of fungal infection in patients given contaminated epidural, para-spinal or intra-articular steroid injections. In September 2012, CDC began hearing multiple reports of fungal meningitis in patients following epidural steroid injections. Researchers, including the CDC's Exserohilum Infections Working Group, report that of 40 cases reviewed, 16 were fatal, and all except two fatal cases had a clinical diagnosis of meningitis.

Main Digest

Unraveling the largest outbreak of fungal infections associated with contaminated steroid injections - Findings suggest black mold targeting the base of the brain, reports The American Journal of Pathology.

Investigators from the Centers for Disease Control and Prevention (CDC) describe pathologic findings from 40 case reports of fungal infection in patients who had been given contaminated epidural, para-spinal, or intra-articular (into joints) steroid injections and correlate these findings with clinical and laboratory data. The report, published in the September issue of The American Journal of Pathology, alerts clinicians and the general public to the catastrophic dangers of contaminated epidural injections.

In September 2012, CDC began hearing multiple reports of fungal meningitis in patients following epidural steroid injections.

Epidural

Also known as Epidural analgesia or epidural anaesthesia, spinal and epidural anesthesia are medicines that numb parts of your body to block pain. They are given through shots in or around the spine. Most of the time this shot will go in your lower back. This area may also be numbed with a local anesthetic. The injection can result in a loss of sensation including the sensation of pain by blocking the transmission of signals through nerves in or near the spinal cord.

By June 2013, 745 people had confirmed infections and 58 had died, making this the largest reported outbreak of infections associated with epidural and intra-articular injections.

After intensive investigation, the contamination was traced to more than 17,000 vials from three contaminated lots of preservative-free methylprednisolone acetate (MPA) originating from a single compounding pharmacy. More than 13,000 people were injected with the potentially contaminated drug. Most cases were attributable to Exserohilum rostratum, a dark-colored environmental mold that rarely infects humans.

Researchers, including the CDC's Exserohilum Infections Working Group, report that of 40 cases reviewed, 16 were fatal, and all except two fatal cases had a clinical diagnosis of meningitis. Autopsy examination showed extensive hemorrhage and necrosis (tissue decay) around the base of the brain and thrombi (clots) involving the basilar arterial circulation.

Tissue specimens from infected individuals showed inflammation of the leptomeninges (thin membranes lining the brain) and blood vessel walls within the brain. Distinctive abnormalities were observed around blood vessels, and fungus was found around and within arterial walls. Interestingly, fungus deep within the brain tissue itself was found in only one case.

Similar pathologic findings were seen at the epidural injection site. Fungus was not found in tissue samples taken from the heart, lung, liver, or kidney. Investigators wondered why fungus injected in the spinal region should target the base of the brain.

"The observation of abundant fungi in the perivascular tissues, but relatively low numbers of fungi inside blood vessels, suggests migration of fungus into, rather than out of, vessels at this location. This supports the hypothesis that Exserohilum migrates from the lumbar spine to the brain through the cerebrospinal fluid with subsequent vascular invasion, rather than migration through the vasculature," suggests Jana M. Ritter, DVM, a veterinary pathologist at the CDC's Infectious Diseases Pathology Branch.

In addition to characterizing the histopathology seen in this outbreak, the authors also provide practical information for pathologists, including an evaluation of various diagnostic methods to detect the fungal infection in tissues.

Poly-fungal immunohistochemistry (IHC) in formalin-fixed paraffin-embedded tissues (FFPE) was found to be the most sensitive method. IHC identified fungus in 100% of cases, compared with 43% by standard hematoxylin-eosin (H&E) and 95% with Grocott's methenamine silver (GMS) stains.

Factors that may affect cellular inflammatory patterns and fungal concentration are discussed, and the authors note that their findings may reflect the simultaneous introduction of the fungus along with the steroid.

Contributors to the investigation also included researchers from the Office of the Chief Medical Examiner, Louisville, KY and the Department of Pathology, University of Michigan, Ann Arbor, MI.

Attribution/Source(s):

This quality-reviewed publication pertaining to our Recalls, Warnings and Advisories section was selected for circulation by the editors of Disabled World due to its likely interest to our disability community readers. Though the content may have been edited for style, clarity, or length, the article "Fungal Infections Associated with Contaminated Steroid Injections" was originally written by Elsevier Health Sciences, and submitted for publishing on 2013/06/26 (Edit Update: 2020/01/21). Should you require further information or clarification, Elsevier Health Sciences can be contacted at the elsevierhealth.com website. Disabled World makes no warranties or representations in connection therewith.

📢 Discover Related Topics


👍 Share This Information To:
𝕏.com Facebook Reddit

Page Information, Citing and Disclaimer

Disabled World is an independent disability community founded in 2004 to provide disability news and information to people with disabilities, seniors, their family and/or carers. You can connect with us on social media such as X.com and our Facebook page.

Cite This Page (APA): Elsevier Health Sciences. (2013, June 26). Fungal Infections Associated with Contaminated Steroid Injections. Disabled World. Retrieved April 16, 2024 from www.disabled-world.com/medical/recalls/fungal.php

Permalink: <a href="https://www.disabled-world.com/medical/recalls/fungal.php">Fungal Infections Associated with Contaminated Steroid Injections</a>: CDC investigators describe pathologic findings from reports of fungal infection in patients given contaminated epidural, para-spinal or intra-articular steroid injections.

Disabled World provides general information only. Materials presented are never meant to substitute for qualified professional medical care. Any 3rd party offering or advertising does not constitute an endorsement.