Fungal Meningitis Outbreak: Who's At Risk?

There is a scary new twist in the national meningitis outbreak among patients who received a tainted steroid drug. As fungal meningitis deaths and cases rise across the US, the FDA has announced that two additional drugs could also be culprits in the outbreak.

About 14,000 people are thought to have been exposed to the contaminated steroid. So far, 15 have died and 214 have been stricken, mostly with fungal meningitis, the CDC reports, though some patients developed other fungal infections. The steroid was tainted with a fungus that causes a type of meningitis that can result in stroke.

Now, the FDA is investigating three additional cases of suspected fungal meningitis or other fungal infections in patients who received other injected drugs made by New England Compounding Center (NECC), ABC News reports. “The sterility of any injectable drugs ... produced by NECC are of significant concern,” the FDA warned.

Here’s a closer look at this frightening outbreak.

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What is fungal meningitis?

Fungal meningitis is a rare disease that’s usually sparked when a fungus travels though the bloodstream to the spinal cord. Like other forms of meningitis, which can also be caused by a viral or bacterial infection, the disease causes swelling and inflammation of the meninges, membranes that cover the brain and spinal cord. Unlike bacterial and viral meningitis, fungal meningitis is not contagious.

What causes fungal meningitis?

The most common culprit is a fungus called Cryptococcus, with infections thought to result from inhaling soil particles contaminated with bird droppings. This form of fungal meningitis is among the leading causes of adult meningitis in Africa, according to the CDC.

Most cases in the current outbreak were caused by Exserohilum, which Tennessee state health commissioner Dr. John Dreyzehner calls “a fungus so rare that most physicians never see it in a lifetime of practicing medicine,” according to the New York Times.

What are the symptoms?

Warning signs include headache, stiff neck, lower-than-normal temperature, nausea or vomiting, sensitivity to light, and hallucinations, reports Meningitis Foundation of America, which advises anyone with these symptoms to seek immediate medical attention. 

Unlike viral or bacterial meningitis, which tend to cause symptoms within hours of infection, the fungal form has an incubation period that can be as long as 43 days or more. That’s scary, since patients exposed to the tainted drugs before they were recalled could get sick in the next few weeks or even months.

Who’s at risk?

While anyone can catch fungal meningitis, it’s more likely to strike those with weak immune systems. Ironically, steroid drugs suppress the immune system—and are a known risk factor for the disease—so the combination of steroid medication and fungal contamination may have created a perfect storm of hazards in some patients. 

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Why didn’t everybody who got the tainted injections get sick?

That’s one of the more puzzling questions of the outbreak. Experts point out that some lots of the tainted medication may have been more contaminated than others.

FDA officials state that at least one vial of the drug had so much “foreign matter” floating in the liquid that the contaminants were visible to the naked eye, the New York Times reports. 

In addition, some patients received multiple shots of the drug, while others only got one injection, so were exposed to less fungus. Yet another factor could be the injection technique, since some doctors administering the contaminated drug may have accidentally punctured protective membranes covering the spine, boosting risk for infection in those patients.

How serious is the disease?

Even with prompt treatment, fungal meningitis is a very dangerous disease that can lead to brain damage, hearing loss, learning disabilities, speech impairment, seizures, paralysis, or death. Several of the patients in the current outbreak have suffered strokes and so far, 15 have died.

What’s the treatment?

Fungal meningitis is typically treated with long courses of high-dose antifungal medications. IV therapy with amphotericin B is the most common treatment, according to the Meningitis Foundation of American. An oral medication called fluconalzone can also be helpful at high doses.

What’s the best way to prevent fungal meningitis?

Currently, there is no vaccine for this disease. The CDC suggests that people with weak immune systems (such as those with HIV/AIDS) avoid activities that expose them to soil (such as gardening) or bird droppings.

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