John R. Perfect, MD
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Author Contributions: Conception and design: J.R. Perfect.
Drafting of the article: J.R. Perfect.
Final approval of the article: J.R. Perfect.
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Abe M. Macher, MD
Volunteer Educator for the American Jail Association, Retired 30-year veteran of the U.S. Public Health Service, Rockville, MD
December 5, 2012
Iatrogenic Fungal Meningitis Outbreak of 2002
To The Editor:
In his October 18 article, Dr John Perfect (1) recalls the 2002 North Carolina outbreak of Exophiala dermatitidis meningitis related to contaminated injectable preservative-free methylprednisolone acetate prepared by a South Carolina compounding pharmacy. Dr Perfect reports that “voriconazole successfully treated these cases of iatrogenic fungal meningitis except for 1 fatality.” In fact, there were 2 fatalities.
In December 2002, the Centers for Disease Control and Prevention [CDC] (2) reported that a 77-year-old woman with E. dermatitidis meningitis died 51 days after hospitalization, and that 3 additional E. dermatitidis meningitis patients were hospitalized. The CDC noted that one of those meningitis patients was a 71-year-old woman who was hospitalized on 8 July 2002, and that she had received epidural methylprednisolone acetate injections at a pain management clinic 82, 55, and 35 days prior to hospitalization.
Clinical Course of the 71-year-old Patient (3,4):
During the first week of July 2002, the 71-year-old woman (a retired dispatcher for the Sheriff’s department) experienced persistent headaches that precipitated hospitalization on July 8. The patient’s symptoms resembled those of a stroke, and after 8 days she was discharged home. Two weeks later, the woman was readmitted with persistent symptoms. On August 20, the patient was transferred to another hospital where fungal meningitis was diagnosed. The patient’s clinical course was marked by debilitating ataxia. Confined to her bed with only enough balance to ambulate to a bedside commode, the patient died on 10 November 2003 at Onslow Memorial Hospital in North Carolina.
Abe M. Macher M.D., Volunteer Educator for the American Jail Association, Retired 30-year veteran of the U.S. Public Health Service, Rockville, Maryland, 20852
1. Perfect JR. Iatrogenic fungal meningitis: Tragedy repeated. Annals of Internal Medicine. Epub ahead of print (18 October 2012).
2. Exophiala infection from contaminated injectable steroids prepared by a compounding pharmacy --- United States, July-November 2002. MMWR Morb Mortal Wkly Rep. 2002;51(49):1109-1112 PMID: 12530707]
3. United States Court of Appeals for the Fourth Circuit (Judge Wilkinson). Pharmacists Mutual Insurance Company versus G. David Scyster. Case Number 06-1334. 7 May 2007. Page 4, paragraph 3. Available at www.ca4.uscourts.gov. Accessed 17 November 2012.
4. Brown D. Previous fungal meningitis outbreak a decade ago resulted in no oversight changes. The Washington Post. 5 November 2012. Available at www.washingtonpost.com. Accessed 17 November 2012.
Perfect JR. Iatrogenic Fungal Meningitis: Tragedy Repeated. Ann Intern Med. 2012;157:825-826. doi: 10.7326/0003-4819-157-11-201212040-00558
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Published: Ann Intern Med. 2012;157(11):825-826.
CNS Infections, Infectious Disease, Neurology.
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