YPSILANTI, Mich. — Dr. David Vanderberg admitted three patients to St. Joseph Mercy Ann Arbor hospital Tuesday and called a fourth with news that left her in tears: She had a large abscess deep inside her back, near her spine, and would need surgery as soon as possible.
The patients were part of a second, growing wave of serious infections from the same tainted drug that caused a nationwide meningitis outbreak. The drug, contaminated with a fungus, was injected near the spine to treat chronic back or neck pain.
This public health disaster, in its third month, is far from over. Meningitis seems to have waned, but spinal infections near the injection site are on the rise. They can be dangerous and hard to detect. At least 200 have occurred, and more are expected because nearly 14,000 people had injections from tainted lots of the drug.
On Thursday, the Centers for Disease Control and Prevention urged doctors to look harder for these infections — to consider MRI scans even in patients who did not feel worse after the injection but whose existing back or neck pain simply did not get better. This advice was more aggressive than previous recommendations. The new message could lead to thousands of additional scans and will almost certainly find new cases.
“We know we’re not out of the woods,” said Dr. Tom M. Chiller, the deputy chief of the mycotic diseases branch of the CDC. “People could still be harboring or developing infections in their spines now.”
The disease outbreak, first detected in September, was caused by contaminated batches of a steroid, methylprednisolone acetate, made by the New England Compounding Center in Framingham, Mass. The company was shut down and has been under investigation by state and federal authorities, and on Friday night announced that it had filed for Chapter 11 bankruptcy protection. The filing seeks to establish a fund to compensate individuals and families affected by the outbreak.
So far, 620 people in 19 states have fallen ill, most with meningitis or spinal infections, or both. Infections inside joints have also occurred. Nearly all the illnesses have been caused by a black mold called Exserohilum. The treatment is a long course of antifungal drugs, which can have dangerous side effects.
In many cases, patients cannot distinguish pain that might be due to an abscess from the chronic pain that drove them to seek steroid shots in the first place. But whether the infections cause pain or not, they should be treated with drugs and possibly surgery, doctors say. Untreated, the infections can damage nerves and bone, and the fungus might even eat its way through the protective membranes around the spinal column, invade the brain and cause meningitis.