One evening a few years back I stepped out of the shower and felt a twinge in my lower back. The twinge became an ache, and the ache pulled me sideways until I stood like a warped kichel. My leg began to burn, and I couldn’t raise my big toe. A large hunk of disc was pressing against a large, important nerve. My surgeon told me that if I could live with a little weakness in my great toe, we could treat this conservatively, with anti-inflammatories, physical therapy, and steroid injections into my back to reduce the inflammation.
A few days later I lay face down on a procedure table, a “C-arm” X-ray machine embracing me. An anesthesiologist inserted a needle into the area around the nerve in my back and injected a dose of steroids. Over the course of a few days, my leg pain improved enough to be able to go to work.
The CDC is reporting that over the last few weeks, this process has gone terribly wrong. A shipment of steroids packaged for injections (usually spine and joint injections) was apparently contaminated by a nasty fungus known as Aspergillus. So far nearly fifty people have developed meningitis, and five have died. Aspergillus doesn’t normally cause meningitis, an often fatal inflammation of the membranes protecting the brain. The fungus is better known for causing disease in people with immune problems, like cancer patients, or causing lung disease in people who are susceptible.
Many of the patients are coming in not with a deadly-appearing illness but with headaches, fevers, or nausea. This can make the disease easy to overlook. It is diagnosed by doing a lumbar puncture (“spinal tap”), and finding the fungus and the white blood cells trying to fight it. When the steroids were injected, the fungus likely went along for the ride. Steroids suppress the immune system’s response to infection, which probably allowed the fungus to set up shop and invade the layer of tissue surrounding the spinal cord and brain. Fungi tend to be slow growing, and may not cause the dramatic picture of a bacterial meningitis, but the disease can be just as devastating.
The story is that of luck, failure and success—but mostly failure. The medications we inject into our bodies have to be manufactured with compulsive sterility, and for Aspergillus—a fungus common in our environment but not in our medications—to cause this sort of contamination is horrifying.
This sort of meningitis is quite rare, and the Tennessee health department reported a case to the CDC. The CDC jumped on the case (presumably via the Epidemic Intelligence Service) and fairly quickly isolated the source of the outbreak. Luckily, this sort of meningitis is not contagious from person to person.
The quick response of health officials is not likely to comfort those who have been sickened or killed by the medication that was supposed to relieve their pain. As the investigation unfolds we may learn some disturbing things about the manufacturer of the drug (New England Compounding Center, Framingham, MA), and perhaps the industry in general.