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UPDATE ON FUNGAL MENINGITIS OUTBREAK

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UPDATE ON FUNGAL MENINGITIS OUTBREAK

Patients affected by this October’s fungal meningitis outbreak are suffering a new set of problems: side effects from what was thought to be successful treatment.  Patients that have been returning to their doctors complaining of two spinal complications: epidural abscesses, and arachnoiditis.

Epidural abscesses are pus-filled sacs of fluid surrounding the spine.  This complication is manageable and more responsive to treatment.  Doctors can start a patient on antifungal medication, and if this doesn’t work, then a surgeon can remove the infected tissue and drain the infection.

Arachnoiditis on the other hand is a more complicated diagnosis.  The arachnoid is a membrane that surrounds and protects the nerves of the spinal cord.  When it becomes inflamed, the patient suffers from severe stinging and burning and even neurological problems.  Other symptoms of archnoiditis include:

  • Intense pain
  • Numbness
  • Paralysis
  • Pins-and-needles sensation, or the feeling of something crawling on the skin
  • Uncontrollable twitching or muscle spasms
  • Shooting pain, like an electric shock sensation
  • Bladder, bowel, and sexual dysfunction

There is no cure for this painful illness, so doctors have to focus on pain management and improving symptoms that have an impact on daily activities.  Surgery has been tried but is controversial because the relief is only temporary.

The outbreak began in early October when the New England Compounding Center distributed steroid shots that were contaminated with a fungus that led to meningitis in hundreds of patients across the country.  So far 29 have died as a result, and over 400 cases of meningitis have been reported.  It remains to be seen how many people come down with these serious disorders.

What is being done to ensure that such a tragedy does not occur again?  A federal criminal investigation is under way, and there is talk of subjecting these compounding pharmacies to the FDA’s regulation.

For now, there is the Pharmacy Compounding Accreditation Board, which is a voluntary accrediting organization.  But because it is voluntary, only 166 pharmacies nationwide have been granted accreditation by the board.  There are over 7,500 such pharmacies in the United States, which means that less than 2% are kept up to the rigorous standards necessary to gain accreditation.  Accreditation takes time, money, and effort, and because it is voluntary, not many compounding pharmacies are willing to go through the process.  However, now that the dangers of these unregulated pharmacies have been made known to the public, perhaps these same pharmacies will find it worth the effort to undergo and maintain accreditation as a way of regaining consumer confidence.

Sources and Further Reading:

http://www.webmd.com/pain-management/guide/pain-management-arachnoiditis

http://www.npr.org/blogs/health/2012/11/03/164253552/despite-anti-fungal-treatment-more-woes-for-some-meningitis-patients

http://tucsoncitizen.com/usa-today-news/2012/11/09/meningitis-crisis-prompts-focus-on-safety/