Thirty-five patients in Tennessee have been infected with a rare form of fungal meningitis, according to the Tennessee Department of Health, and four patients in the state have died.
The infection is thought to be tied to either cervical or lumbar epidural steroid injections at clinics in Nashville and Crossville. Patients at a third facility in Oak Ridge may have been exposed to medication from an contaminated lot, but no cases of illness have been confirmed at that facility.
The Tennessee Department of Health is working with Specialty Surgery Center in Crossville, the PCA Pain Center in Oak Ridge and the Saint Thomas Outpatient Neurosurgery Center in Nashville. The date range for possible exposure includes June 27 to Sept. 28. This is different from the national date of May 21 and reflects when materials were actually received in Tennessee.
Tennessee Health Commissioner John Dreyzehner said in a press briefing, "The continuing investigation has found no significant lapses in processes at any facility. The clinics and their staff are trying their best to treat and improve the lives of patients that come to them in pain, and we respect them and appreciate their efforts. They had no way of knowing of the contamination at the time of treatment. The evidence indicates this is a product issue."
The TDH believes the infection to be fungal, and aspergillus fumigatus has been isolated from one patient. The U.S. Food and Drug Administration found a sealed vial of the drug methylprednisolone acetate contained a fungal contaminant. The drugs came from New England Compounding Center, NECC. These drugs were shipped to 23 states. Three lots of the drug have been recalled and NECC has shut down its operations.
Symptoms of infection vary from mild to severe and may include worsening to severe headache; stiff neck; unsteadiness or falling; back pain; dizziness; slurred speech and other unusual or abnormal symptoms.
Dreyzehner said the Department of Health will continue to follow-up with patients for some time as there is a question of the incubation period.
The Centers for Disease Control have advised ceasing use of all materials compounded and distributed by the company, though there is no evidence to date other products from NECC are implicated in the outbreak. Saturday, NECC voluntarily recalled all products compounded and distributed from its Massachusetts facility.
Cumberland Medical Center released a statement Friday that said the pharmacy director confirmed CMC does not purchase from NECC and does not have any products from them in stock.
"CMC will continue to meet the healthcare needs of all patients who present to our emergency department," CMC said in the statement. "In order to meet those needs, CMC's emergency department is staffed by a physician specializing in emergency medicine and other medical personnel 24 hours a day, seven days a week."
The form of meningitis in these patients is not contagious or transmitted from person to person. Meningitis is a general term for an infection or inflammatory process involving the lining of the brain and central nervous system. The cases under investigation have no relation to the much more common forms of bacterial or viral meningitis.
The TDH and the Tennessee Poison Control Center have partnered to answer questions from the public about meningitis. Call 1-800-222-1222.