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Thursday, October 11th 2012

Fungal Meningitis After Epidural Steroid Injections

While only level II evidence through the literature I am a firm believer in epidural steroid injections for the short term relief of radicularesque pain. As most etiologies of this type of pain over the long term improve with or without surgery, epidural steroid injections can be a part of controlling symptoms in the short term while the disease process itself, usually a nerve pinched by a disc, improves. I refer plenty of patients, with symptoms that are very young or symptoms that are poorly localized or symptoms I think otherwise may be poorly responsive to decompressive surgery, to pain specialists for consideration of injections.

While hematoma, intravascular embolic events, and infection are all well reported after epidural steroid injections the procedure generally has a low complication rate; seemingly lower than a minimally invasive surgery for decompression of a nerve root. So while I know that reasonably this recent outbreak of fungal meningitis associated with contaminated compounded steroid used in epidural steroid injections does not raise the risk for any patient I refer for such in the future, and should not likely in anyway influence a referal for such, it is still a little scary.

About 13,000 people may have been exposed to the tainted steroid that has been linked to a growing outbreak of fungal meningitis, a spokesman for the Centers for Disease Control and Prevention said.

[...]

The company that made the drug, the New England Compounding Center in Framingham, Mass., has shut down, surrendered its license and recalled all its products, not just the steroid.

The disease centers said that the company began shipping potentially contaminated lots of the drug on May 21, and that people who had the treatment for back pain — called a lumbar epidural steroid injection — after that date should seek medical attention if they develop symptoms like severe or worsening headache, fever, stiff neck, dizziness, weakness, sensitivity to light or loss of balance.

The death toll from the exerohilum and aspergilis meningitis has risen to 14. That’s about a 10% mortality so far considering just under 170 cases have been reported. The CDC has a website listing recommendations for those afraid they may have been exposed, as well as a list of the facilities which used the recalled methylprednisolone. It is scary and a reminder that even the simplest procedures hold inherent risks, but it shouldn’t move us off rationally judging those risks and continuing to use effective treatments when warranted.

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