Oct 10, 2012 (CIDRAP News) – The number of patients sickened in a fungal meningitis outbreak linked to steroid injections for back pain rose to 137 today, including one more death, and clinicians are facing tough decisions about how to manage patients in light of unusual features of the outbreak.
In its latest update, the US Centers for Disease Control and Prevention (CDC) said it has received reports of 18 more cases since yesterday, along with news of another fatality, which raises the number of outbreak-related deaths to 12. The number of states reporting cases remained the same at 10.
A CDC conference call for clinicians today drew 2,000 participants, which the presenters called an “overwhelming response.” Two of the CDC’s experts were on hand to share the latest information on the illness and field many questions from health workers, ranging from pain clinic employees worried about their patients to an emergency department physician overwhelmed by the number of patients exposed to the recalled drug who are experiencing symptoms and need lumbar punctures to check for evidence of fungal meningitis.
The CDC experts included Melissa Schaefer, MD, a medical officer who works on ambulatory care and healthcare-related infection issues, and Tom Chiller, MD, MPH, a medical epidemiologist whose study emphasis has included fungal diseases. Both are with the CDC’s National Center for Emerging and Zoonotic Infectious Diseases.
Schaefer said the CDC is coordinating active outreach to patients exposed to one of the three recalled lots of preservative-free methylprednisolone acetate that have been implicated in the outbreak. She said 75 facilities in 23 states received the medication and that about 13,000 patients had at least one injection from one of the lots.
Some patients also received joint-space injections with the recalled steroids, but she said so far the CDC hasn’t received any reports of infections related to those procedures.
The CDC’s investigation and clinical guidance are evolving quickly, and she advised health workers to consult the CDC’s outbreak Web page for daily updates.
Chiller said testing so far has confirmed that 10 of the infections involve Exserohilum, a type of black mold. “A rare and unique mold—not something we have seen causing meningitis previously,” he said. Tests have also identified Aspergillus fumigatus in one patient’s samples.
He said officials still don’t know if other types of mold are involved in the outbreak, a factor that—combined with unusual Exserohilum meningitis infections—makes it a challenge to craft treatment recommendations. For now, the CDC is recommending powerful doses of two antifungal drugs for infected patients that can penetrate the central nervous system and provide broad coverage against a range of fungi.
The CDC officials said experts are also wrestling with what to tell clinicians about the incubation period. Some patients have gotten sick after just 4 or 5 days, while others clearly started having symptom beyond 4 weeks, which was initially thought to be the outer limit of the incubation period.
“We know that fungi can be indolent and progression can be slow,” Chiller said.
Health officials are still collecting and analyzing information about the illnesses, Chiller said, but so far, the most common presenting symptoms seems to be headache, neck pain, nausea, and new neurologic deficits.
For the fatal cases, they said so far the most frequent cause of death is stroke or a complication of stroke. Schaefer and Chiller emphasized that the analysis of cases is still in the early stages, so it’s difficult to make definitive statements about the illness features and treatment protocols.
As the clinical picture continues to evolve, they urged clinicians to aggressively seek a diagnosis in suspected cases and to check the CDC’s Website each day for changes in recommendations as the outbreak and its investigation unfold. ———————————————————————Thursday, Oct 11, 2012
ReutersHONG KONG – A 46-year-old woman has died in Hong Kong and three others are fighting for their lives following a beauty parlour treatment that involves blood transfusion, highlighting a lack of regulation in the city’s cosmetic industry.The cases have prompted an investigation by police and medical authorities, and renewed calls by health experts for tighter regulation of Hong Kong’s beauty industry.“Yes, the woman aged 46 died (Wednesday morning) of septic shock,” a government spokeswoman said. Three others, aged 56, 59 and 60, were in hospital with the eldest in critical condition. Septic shock is normally caused by bacterial infection and can result in respiratory and organ failure, even death.
The four had recently undergone a complicated blood transfusion procedure at the DR beauty chain, according to government statements, in a treatment that was meant to boost their immune system and appearance.
The women paid around HK$50,000 (S$7,933) for the procedure, which experts say is at best an experimental treatment for cancer patients and which has not shown to have any aesthetic application so far.
DR said in a statement on Wednesday that the procedures were carried out by a doctor who was not employed by the parlour.
The procedure required their blood to be taken to isolate and culture certain types of immune cells.
These”cytokine-induced killer cells” were then injected back into the women together with their own blood plasma.
The four quickly fell ill with fever, dizziness and diarrhoea. In an earlier blood sample taken from the woman who died, health officials found Mycobacterium abscessus, a superbug that is notoriously difficult to kill.
Someone is passing wrong information about research to increase their youth to so call “quark doctor” to perform illegal operations which will kill a person, do not go for any surgery that is not handled by a qualified practitioner or you will lose your money and your life. Similarly, there are doctors who have been bribed to conduct illegal experiments, if the doctor is not able to clearly explain the procedures in a qualified hospital, my advice is temporary postpone your operations if it is not life threatening, there are too many incidents of strange things happening all because of corruption and money. This problem has crashed the economy, where many will have no money and jobs, but I have rectified everything, nothing will happen during my watch.
– Contributed by Oogle.