Indications of two unusual clinical complications – epidural abscess and arachnoiditis – among a portion of patients undergoing treatment for meningitis associated with injections of a contaminated steroid medication, preservative-free methylprednisolone acetate
During the course of this investigation, CDC has worked closely with a group of fungal infectious disease experts who provided their individual input to help CDC develop interim guidance and other information about clinical aspects of the outbreak, including patient management and treatment. The guidance documents have been updated regularly as CDC and its partners have learned more about the outbreak; the latest versions are available on CDC’s outbreak-related Clinician Guidance webpage at http://www.cdc.gov/hai/outbreaks/clinicians/index.html. CDC has also advised that healthcare providers involved in the treatment of these patients consult with an infectious disease medical specialist because of the diagnostic and clinical challenges presented by these fungal infections.
CDC has recently become aware of reports of epidural abscess and arachnoiditis among a number of patients undergoing treatment for fungal meningitis associated with injections of contaminated steroid. Spinal epidural abscesses are characterized by inflammation and a collection of pus around the spine, sometimes resulting in swelling of the infected areas (though several recently reported patients with this condition had no detectable swelling). Arachnoiditis is caused by inflammation of the arachnoid, one of the membranes that surround and protect the nerves of the spinal cord. Both conditions are normally rare but serious disorders that require prompt medical attention. Most of these early reports have been for patients in Michigan and Tennessee, but other states have reported patients with these conditions as well. CDC is working with clinicians and public health officials to obtain more information and refine its clinical guidance as needed.
For additional information about the outbreak of fungal meningitis and other infections, see CDC’s website at http://www.cdc.gov/hai/outbreaks/meningitis.html.