Fungal Meningitis After a Contaminated Epidural Steroid Injection

At one Virginia hospital, 25 patients with confirmed meningitis were initially treated with voriconazole. Ten were switched to amphotericin B, and 8 improved.

On October 4, 2012, the Centers for Disease Control and Prevention (CDC) issued an alert on epidural steroid injections (ESIs) contaminated with mold. An estimated 673 people in southwestern Virginia received injections with the recalled product. Now, investigators present a case series of 172 patients who received an ESI and then presented to a Virginia hospital with headache, a stiff neck, or back pain.

Of the 131 presenting patients who underwent a lumbar puncture, 25 (19%) had evidence of meningitis, defined as >10 white blood cells (WBCs) per milliliter in cerebrospinal fluid (CSF). The 25 patients with abnormal CSF findings had a median WBC count of 780/mL, with elevated protein and reduced glucose concentrations. All 25 were initially…

Reviewing Author

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)