The patient, described as a male over 60, is hospitalized and receiving aggressive antifungal treatment recommended by the U.S. Centers for Disease Control and Prevention, according to Christine Hahn, Idaho State epidemiologist.
Weve been bracing ourselves since we heard that the contaminated medication was tracked to Idaho, said Hahn, a physician who is overseeing the Idaho investigation of the outbreak. We have been working with doctors and public health experts across the state to identify patients and anyone (treated with the epidural steroids) showing signs of infection.
As many as 39 Idaho patients may have received an epidural injection of preservative-free methylprednisolone acetate contaminated with Aspergillus fumigatus. The CDC and the U.S. Food and Drug Administration tracked the contaminated steroid to the New England Compounding Center in Framingham, Mass. The company has since closed its doors and recalled its products. The CDC and FDA continue to investigate how the fungus took hold in the sealed vials.
Patients are prescribed the injections just outside the spine for severe back and neck pain.
Idaho is one of 23 states where pain centers received contaminated medication. Two Idaho facilities Walter Knox Memorial Hospital in Emmett and Pain Specialists of Idaho in Idaho Falls received the recalled injections. According to state public health officials, four patients from Walter Knox and 35 patients from the Idaho Falls clinic may have received the contaminated injections.
The infected patient had been treated at the Idaho Falls clinic.
Hahn said that she and her colleagues have been working with physicians at both facilities and that all patients have been contacted and told what to watch for.
On Sept. 29, Dr. James Poston, a pain management specialist and anesthesiologist who runs the Idaho Falls clinic, received an urgent fax from the New England Compounding Center saying the contaminated products had been shipped to the Idaho Falls pain facility. The contaminated batches arrived in Idaho Falls July 9.
Dr. Poston has been incredibly proactive, said Cori Anderson, a billing manager at the clinic. All of the patients who are potentially affected have been notified and seen by Dr. Poston. He wanted them to know exactly what to look for and contact our office with any onset of new symptoms.
State and local epidemiologists were at a two-day meeting in Boise when word came in that one of the 39 patients had been admitted to the hospital with a confirmed case of fungal meningitis.
We were all feeling good that there were no cases, Hahn said. We are very concerned for this patient and are working closely with physicians across the state.
So far, it seems as if patients can develop symptoms up to a month or more after the epidural injection, which is why patients are cautioned to be vigilant in reporting any signs, Hahn added. Fungal meningitis is not contagious.
This outbreak is really disturbing, said Karen Roos, MD, the John and Nancy Nelson Professor of Neurology at Indiana University and an expert on meningitis. This fungus is so common in the environment. We breathe it in all the time, but healthy people are never harmed by it. We see infections in patients who are immuno-compromised. The fungus can get into the central nervous system and cause brain abscess, meningitis, stroke and intracranial hemorrhage, she explained.
The fungal infection is rare and generally occurs only in patients whose immune systems are compromised through illness.