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Spinal and paraspinal infections associated with contaminated methylprednisolone acetate injections - Michigan,

    MMWR. Morbidity and Mortality Weekly Report
    |May 17, 2013
    PubMed

    Insights

    Michigan reported over half of national fungal meningitis cases linked to contaminated methylprednisolone acetate (MPA) injections. Exserohilum rostratum mold was the primary cause, affecting the spine and surrounding areas.

    Area of Science:

    • Epidemiology
    • Infectious Diseases
    • Public Health

    Background:

    • The 2012-2013 fungal meningitis outbreak involved contaminated methylprednisolone acetate (MPA) injections.
    • Exserohilum rostratum, a black mold, was identified as the primary causative agent.
    • Contaminated MPA lots were compounded by the New England Compounding Center.

    Purpose of the Study:

    • To describe the epidemiologic and clinical characteristics of fungal infection patients in Michigan.
    • To identify factors contributing to Michigan's high percentage of spinal infections.
    • To assess differences between spinal/paraspinal infections with and without meningitis.

    Main Methods:

    • Case ascertainment conducted by the Michigan Department of Community Health and CDC.
    • Analysis of epidemiologic and clinical data from affected patients.
    • Review of diagnostic findings, including magnetic resonance imaging (MRI).

    Main Results:

    • Michigan reported 167 (52%) of 320 national paraspinal or spinal infections without meningitis.
    • Exserohilum rostratum was the most frequently identified fungus, found even in unopened MPA vials.
    • No significant epidemiologic or clinical differences were observed between patients with or without meningitis.
    • A significant delay (12-121 days) was noted between MPA injection and MRI-diagnosed infection.

    Conclusions:

    • Clinicians must maintain a high index of suspicion for patients receiving contaminated MPA injections.
    • Delayed diagnosis is common, with infections manifesting weeks to months after exposure.
    • Public health surveillance and investigation are crucial for outbreak containment and prevention.

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