Meningitis Outbreak
Painful Stigma
September 5, 2012Redefining Pain Management 2
December 7, 2012
Fungal Meningitis related to Epidural Steroid Injections
Steroid injections in Kentucky are Safe
The CDC has issued an outbreak notice of fungal meningitis for patients who have received an epidural steroid injection to treat back pain. Fortunately, no cases have been reported in Kentucky and the likelihood of such a case in this state is very low since no facility in the state has received the tainted steroid supply. All cases have been traced to a specific type of steroid prepared by a boutique drug manufacturer (New England Compounding Center), in Framingham, MA.
There are several types of steroids that can be used in epidural injections for back and neck pain. Only one particular formulation, produced by one supplier has been implicated as potentially tainted. Most steroids are industrially prepared and carry far lower risk of any infection.
“At Pain Management Medicine, we take patient safety very seriously,” said Dr. Danesh Mazloomdoost, Lexington-based Anesthesiologist and Pain Specialist, “It is important to balance the risk of an intervention versus avoiding treatment,” Overall, epidural injections and other injections for pain management are extremely safe. The incidence of any complication is less than 1 per 10,000. The infection rate is even lower at 1 per 30,000 cases. By comparison, the risk of dying in a car accident is 1 per 84, or plane crash is 1 per 5,051.
The CDC has issued a recall notice to all 76 facilities that have been supplied with the potentially tainted steroid, none of which are in Kentucky. To date, 91 cases have been reported in nine states with the first case reported in our neighboring state of Tennessee.
The fungal meningitis outbreak is not contagious from person to person and can only be caused by an epidural injection of the specific steroid from the compounding pharmacy in Massachusetts. Meningitis is an infection of the tissue lining around the brain and spinal cord. It presents with back pain, headache, and general signs of infection such as fever or fatigue. In severe cases it can cause mental status changes, loss of consciousness, loss of movement, and even death if untreated. Treatment includes intravenous anti-fungal medication.
Epidural injections are conducted for many reasons. The most common reason is for labor pain, however, steroids are not used in that situation. Epidural steroids are mostly used to diagnose and treat specific causes of low back pain including disc-related pain and pain arising from compression of the spinal cord or nerve roots. Steroids can also be used for joint or muscle injections, but these do not pose the risk for meningitis.
For more information and updates on the outbreak, please visit our website (painmm.com) or the CDC website: http://home/siibjc6c5ijo/public_html.cdc.gov/HAI/outbreaks/meningitis.html
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