Spinal and Paraspinal Infections Associated with Contaminated Methylprednisolone Acetate Injections - Michigan, 2012-2013

• Type of Material: Article
• Authors: Anurag N. Malani, St Joseph Mercy Hosp; Varsha Moudgal, St Joseph Mercy Hosp; Daid Vandenberg, St Joseph Mercy Hosp; Karen M. Speirs, Munson Med Ctr; David Martin, Munson Med Ctr; Carmen Tichendelean, Munson Med Ctr; Dennis Sula, Munson Med Ctr; Chrostopher Ledtke, Munson Med Ctr; Robert A. Heyding, University of Michigan; Tom Chiller, Emory University; Raymund B. Dantes, Emory University
• Language: English
• Date: 2013-05-17
• Publisher: Centers for Disease Control and Prevention
• Publication Version: Final Published Version
• Copyright Statement: All material in the MMWR Series is in the public domain and may be used and reprinted without permission; citation as to source, however, is appreciated.
• License: Creative Commons Creative Commons CC0 1.0 Universal
• Final Published Version (URL): https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6219a1.htm?s_cid=mm6219a1_w
• Title of Journal or Parent Work: MMWR. Morbidity and mortality weekly report
• ISSN: 0149-2195
• Volume: 62
• Issue: 19
• Start Page: 377
• End Page: 381
• Keywords: Public, Environmental & Occupational Health; Science & Technology; Life Sciences & Biomedicine; UNITED-STATES; OUTBREAK
• Research Categories: Health Sciences, General; Health Sciences, Medicine and Surgery

Abstract

As of May 6, 2013, Michigan had reported 167 (52%) of the 320 paraspinal or spinal infections without meningitis associated with the 2012-2013 fungal meningitis outbreak nationally. Although the index patient had a laboratory-confirmed Aspergillus fumigatus infection, the fungus most often identified, including in unopened vials of methylprednisolone acetate (MPA), remains Exserohilum rostratum, a common black mold found on plants and in soil. Exposures have occurred through epidural, paraspinal, peripheral nerve, and intra-articular injection with MPA from contaminated lots compounded by the New England Compounding Center in Framingham, Massachusetts. The Michigan Department of Community Health and CDC conducted case ascertainment to describe epidemiologic and clinical characteristics of Michigan patients and to determine factors that might have contributed to the high percentage of spinal and paraspinal infections reported from Michigan. A distinct epidemiologic or clinical difference was not observed between patients with paraspinal or spinal infection with and without meningitis. Lengthy periods (range: 12-121 days) were observed from date of last injection with contaminated MPA to date of first magnetic resonance imaging (MRI) finding indicative of infection. Clinicians should continue to maintain a higher index of suspicion for patients who received injections with contaminated MPA but have not developed infection.