Fungal Infections Associated with Contaminated Methylprednisolone Injections

Kauffman, Carol A.; Pappas, Peter G.; Patterson, Thomas F.

doi:10.1056/nejmra1212617

Cited by 86 publications

(61 citation statements)

References 13 publications

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“…10 Recently, there has been a similar outbreak of fungal meningitis caused by contaminated methylprednisolone used for epidural injections and more than 200 patients were suspected to be involved. 11 Propofol related outbreaks have been reported to cause surgical wound infections or blood stream infections. not for citation purposes Control of outbreak of encephalitis due to contaminated anaesthetic agent Sood et al…”

Section: Discussionmentioning

confidence: 99%

Prompt control of outbreak of potentially fatal iatrogenic encephalitis due to intrinsically contaminated intravenous anaesthetic agent by ESBL producing Klebsiella pneumoniae

Sood

Gupta

Thakur

et al. 2014

Int. j. infect. control

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Iatrogenic meningitis is a serious complication of anaesthesia with an estimated mortality of 35%. The Department of Anaesthesia reported 8 postoperative patients of encephalitis over a period of two weeks. All had received subarachnoid block with 0.5% bupivacaine and within 2-6 hours presented with a typical clinical picture of severe headache and high grade fever. The cerebrospinal fluid (CSF) of three patients was collected by lumbar puncture and sent for culture and sensitivity. The hospital infection control team was notified about these patients. Apart from extensive personal and environmental surveillance, culture of intravenous solutions (5% dextrose and Normal Saline), blood bags and finger tip cultures of doctors and nurses was done. Several vials of 0.5% bupivacaine injections (Injection A and Injection B) of two companies were also collected and processed. Injection B revealed growth of Extended spectrum beta lactamase (ESBL) producing Klebsiella pneumoniae. This isolate was similar to Klebsiella pneumoniae isolated from the CSF of one of the patients in biochemical reactions, antibiotic sensitivity testing and ESBL production. Results were immediately conveyed to Department of Anaesthesia for stopping the use of Injection B. We want to highlight that with proper microbiological surveillance and intervention by hospital infection control team we could save precious lives of patients.

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Section: Discussionmentioning

confidence: 99%

Prompt control of outbreak of potentially fatal iatrogenic encephalitis due to intrinsically contaminated intravenous anaesthetic agent by ESBL producing Klebsiella pneumoniae

Sood

Gupta

Thakur

et al. 2014

Int. j. infect. control

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show abstract

“…The fungal DNA sequence method for rapid identification is important in controlling outbreak, and in assisting clinicians to initiate treatment and further to develop recommendations to manage patients infected by this organism. 8 Furthermore, if empiric antifungals have been initiated, positive cultures may be delayed: the autopsy CSF culture took 3 weeks for growth to be detectable as opposed to the initial CSF culture collected before antifungal treatment, which took 2 days to become positive.…”

Section: Discussionmentioning

confidence: 99%

“…At the present, voriconazole has been recommended as the drug of choice to treat the patients with fungal infections associated with the current outbreak. 8 A limited number of isolates from this outbreak have been tested to date and their MICs of voriconazole ranged from 0.5 to 2 mg/ml. 8 Whether elevated voriconazole MIC correlates with treatment failure is unknown at this point, but will be determined when more clinical information regarding the treatment of these infections becomes available.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Exserohilum infection of the central nervous system: mycological identification and histopathological findings

et al. 2013

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An outbreak of fungal infections has been identified in patients who received epidural injections of methylprednisolone acetate that was contaminated with environmental molds. In this report, we present the mycological and histopathological findings in an index case of Exserohilum meningitis and vasculitis in an immunocompetent patient, who received a cervical spine epidural steroid injection for chronic neck pain 1 week before the onset of fulminant meningitis with subsequent multiple brain and spinal cord infarcts. The fungus was recovered from two separate cerebrospinal fluid specimens collected before initiation of antifungal therapy and at autopsy on standard bacterial and fungal culture media. The mold was identified phenotypically as Exserohilum species. DNA sequencing targeting the internal transcribed spacer region and D1/D2 region of 28S ribosomal DNA enabled further speciation as E. rostratum. Gross examination at autopsy revealed moderate brain edema with bilateral uncal herniation and a ventriculostomy tract to the third ventricle. The brainstem, cerebellum, and right orbitofrontal cortex were soft and friable, along with hemorrhages in the cerebellar vermis and thalamus. Microscopic examination demonstrated numerous fungi with septate hyphae invading blood vessel walls and inducing acute necrotizing inflammation. The leptomeninges were diffusely infiltrated by mixed inflammatory cells along with scattered foci of fungal elements. This is the first report of iatrogenic E. rostratum meningitis in humans. This report describes the microbiological procedures and histopathological features for the identification of E. rostratum (a pigmented vascularly invasive fungi), the cause of a current nationwide outbreak of fatal fungal meningitis.

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“…T he multistate outbreak of fungal infections in the United States following contaminated methyl prednisolone injection has been well reported (1). Meningitis was the most frequent consequence, but other infections included arachnoiditis, with local spinal infection and peripheral joint infections seen in 12% of cases.…”

mentioning

confidence: 99%

Not Over Yet: Fungal Infections following Methyl Prednisolone Injections Smoulder On

Barnes¹,

White²

2014

J Clin Microbiol

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Fungal Infections Associated with Contaminated Methylprednisolone Injections

Cited by 86 publications

References 13 publications

Prompt control of outbreak of potentially fatal iatrogenic encephalitis due to intrinsically contaminated intravenous anaesthetic agent by ESBL producing Klebsiella pneumoniae

Prompt control of outbreak of potentially fatal iatrogenic encephalitis due to intrinsically contaminated intravenous anaesthetic agent by ESBL producing Klebsiella pneumoniae

Iatrogenic Exserohilum infection of the central nervous system: mycological identification and histopathological findings

Not Over Yet: Fungal Infections following Methyl Prednisolone Injections Smoulder On

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