(Repeats story first published overnight)
* Doctors say patients need to be diagnosed, treated early
* Aggressive fungal infection killed quickly, they say
By Julie Steenhuysen
CHICAGO, Oct 18 U.S. doctors in Baltimore said
early diagnosis and treatment of patients at risk of fungal
meningitis is vital, based on the case of an otherwise healthy
woman who declined rapidly after receiving steroid injections
for neck pain.
Writing in the Annals of Internal Medicine, released online
on Wednesday, researchers at the Johns Hopkins School of
Medicine describe the deterioration the unnamed, 51-year-old who
sought care in an emergency room for a severe headache a week
after receiving an injection with tainted medication on Aug. 31.
The widening outbreak has killed 19 people and infected 245,
according to the U.S. Centers for Disease Control and Prevention
The CDC has said it first learned about the fungal
meningitis outbreak on Sept. 21 and health officials have linked
it to tainted vials of injectable steroid methylprednisolone
acetate made by the New England Compounding Center in
Most of the cases have been linked to Exserohilum, a fungus
associated with grass and rotting wood that appears to be
especially aggressive in attacking tissues in the spine and
Fungal infections typically only attack people with severely
compromised immune systems, such as patients who have had bone
marrow or organ transplants. Fungal spores can enter the lungs
of these patients and make their way into the blood stream, and
eventually into the central nervous system.
In the case described by the team at Johns Hopkins, the
injection was the woman's first, and she had no medical history
of having a compromised immune system, nor was she taking any
Doctors found nothing and sent her home, but the woman
returned the next day with more severe symptoms and was admitted
to the hospital, where doctors tried a series of antibiotics and
other drugs as the woman continued to decline.
Tests for a host of infections, including herpes simplex
virus, varicella zoster virus which causes chicken pox and
shingles, Epstein-Barr virus, cytomegalovirus, and West Nile
virus, were all negative, as were tests for cryptococcal fungi,
a known cause of fungal meningitis.
The woman died 10 days after being admitted to hospital, the
same day the team found evidence of Exserohilum in her spinal
fluid. An autopsy showed massive tissue death in the brain stem,
inflammation in the blood vessels and evidence of a stroke.
Based on the case, the researchers urged doctors to be aware
of the signs and symptoms of fungal meningitis and to seek rapid
diagnosis and treatment to prevent "serious complications and
The CDC advises patients who feel ill and are concerned they
were injected with one of the recalled products to contact their
Symptoms of fungal meningitis include new or worsening
headache, fever, sensitivity to light, stiff neck, weakness or
numbness in any part of your body, slurred speech, increased
pain, redness or swelling at the injection site.
(Editing by Louise Ireland)