Spinal and paraspinal fungal infections associated with contaminated methylprednisolone injections

Open Forum Infectious Diseases
Varsha MoudgalLakshmi Halasyamani

Abstract

A nationwide outbreak of fungal infections was traced to injection of Exserohilum-contaminated methylprednisolone. We describe our experience with patients who developed spinal or paraspinal infection after injection of contaminated methylprednisolone. Data were assembled from the Michigan Department of Community Health, electronic medical records, and magnetic resonance imaging (MRI) reports. Of 544 patients who received an epidural injection from a contaminated lot of methylprednisolone at a pain clinic in southeastern Michigan, 153 (28%) were diagnosed at our institution with probable or confirmed spinal or paraspinal fungal infection at the injection site. Forty-one patients had both meningitis and spinal or paraspinal infection, and 112 had only spinal or paraspinal infection. Magnetic resonance imaging abnormalities included abscess, phlegmon, arachnoiditis, and osteomyelitis. Surgical debridement in 116 patients revealed epidural phlegmon and epidural abscess most often. Among 26 patients with an abnormal MRI but with no increase or change in chronic pain, 19 (73%) had infection identified at surgery. Fungal infection was confirmed in 78 patients (51%) by finding hyphae in tissues, positive polymerase chain reaction, or ...Continue Reading

References

Oct 29, 2000·Seminars in Neurology·M Gottfredsson, J R Perfect
Oct 23, 2012·The New England Journal of Medicine·Carol A KauffmanThomas F Patterson
Nov 8, 2012·The New England Journal of Medicine·Marion A KainerUNKNOWN Tennessee Fungal Meningitis Investigation Team
Dec 21, 2012·The New England Journal of Medicine·Rachel M SmithUNKNOWN Multistate Fungal Infection Outbreak Response Team
Jun 14, 2013·Journal of Clinical Microbiology·Shawn R LockhartMary E Brandt
Jun 20, 2013·JAMA : the Journal of the American Medical Association·Anurag N MalaniCarol A Kauffman
Oct 25, 2013·The New England Journal of Medicine·Tom M ChillerUNKNOWN Multistate Fungal Infection Clinical Investigation Team

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Citations

Dec 19, 2015·Disaster Medicine and Public Health Preparedness·Kaja M AbbasKerry J Redican
Nov 26, 2015·Surgical Neurology International·Nancy E Epstein
Nov 25, 2014·Current Infectious Disease Reports·April C Pettit, Anurag N Malani
Aug 30, 2016·The International Journal of Pharmacy Practice·Derek MurrellDavid Cluck
Jul 13, 2019·Journal of Fungi·Jon Velasco, Sanjay Revankar
May 27, 2016·Microbiology Spectrum·Carol A Kauffman, Anurag N Malani

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Methods Mentioned

BETA
PCR

Software Mentioned

SAS

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