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Saturday, January 19, 2013
Infection Adds Mystery to Meningitis Outbreak.
OCALA — Four months ago, Vilinda York's eyesight went dim, her body dripped sweat and her head throbbed so badly she couldn't hear the paramedics banging on her front door.
Thanksgiving came, then Christmas, then New Year's Day. Today, York remains in the hospital, dealing with the mysterious effects of what should have been routine pain treatments.
York, 64, is one of 678 people sickened in a rare outbreak of fungal meningitis traced to contaminated steroid shots used to treat back and joint pain. The outbreak has killed 44 people, according to the U.S. Centers for Disease Control and Prevention.
Many of those first sickened have left their hospital beds. The story has faded from headlines. But the impact of the outbreak lingers in a new wave of infections, in questions over regulatory gaps and in the lives of patients such as York, a retired clothing saleswoman who has worn nothing but hospital gowns since September.
Day after day, she lies in a bland room at Ocala's Munroe Regional Medical Center. She reads her Bible, watches home improvement shows on television and tries not to think about the mold lurking in her body — or the medications that leave her nauseated and wiped out.
This is an infection so rare, even top experts can't tell York what the future holds. She knew she was sick when she called 911 back in September, but never imagined she'd be in the hospital so long.
"I thought it'd be like the flu," she said, "and in a few weeks you just get up and go."
• • •
On Sept. 18, just days before York landed in the hospital, a Vanderbilt University infectious disease specialist named April C. Pettit notified a longtime associate at the Tennessee Department of Health she had seen something odd: a case of fungal meningitis in a patient whose immune system was normal.
Meningitis is an inflammation of the brain and spinal cord lining, which can range from mild to deadly. Usually, its source is bacterial or viral. To get it from a fungal source is extraordinarily rare, seen only occasionally in patients with immune systems severely weakened by AIDS or cancer, for instance.
At the health department, epidemiologist Marion A. Kainer was intrigued. An interesting detail stood out: The patient recently received a steroid injection at a Nashville clinic.
Kainer's detective work sparked a national investigation into the steroid's manufacturer, the New England Compounding Center.
On Oct. 4, the U.S. Food and Drug Administration verified it had found mold in a sealed vial of the steroids produced at the Massachusetts firm. The business was shuttered and supplies pulled from medical offices around the nation.
But by then, nearly 14,000 people had already received contaminated injections. Most seemed to suffer no ill effects; others were not so lucky.
Rare as fungal meningitis is, these cases were even more unusual, predominantly caused byExserohilum rostratum, a fungus never before seen in meningitis cases, said Dr. William Schaffner, an infectious disease specialist and chairman of Vanderbilt's Department of Preventive Medicine.
That's why nobody is absolutely certain of how to treat the condition.