October 11, 2012 — Experts are warning that fungal meningitis may be difficult to diagnose because the symptoms are often mild and atypical of meningitis caused by a virus or bacteria. Fungal meningitis can also cause strokes, but few doctors think to check for meningitis when treating someone for stroke. Some patients who have fallen ill in a deadly national outbreak had only minor headaches and no fever.
Experts are now recommending that when doctors are evaluating people who have been exposed to contaminated epidural steroid injections or other recalled medications from New England Compounding Center, they should set a low bar for suspecting meningitis based on symptoms.
An estimated 13,000 people have been exposed to the recalled steroid shots, which are commonly used to treat back pain in outpatient clinics. At least 137 have fallen ill, twelve have died, and eleven states are affected. Although the products were recalled on September 26, the outbreak continues to grow because meningitis has an incubation period of several weeks, perhaps even months. Thousands of patients are now waiting anxiously to see whether they develop symptoms of meningitis.
In most cases, meningitis develops within 4 weeks after exposure. However, the incubation period may be longer or shorter. Many doctors recommend that people watch for symptoms for three months after their injection.
The CDC currently does not recommend prescribing anti-fungal medications as a precautionary measure, because the drugs can have serious side effects, especially for kidney and liver function. People who are diagnosed with fungal meningitis are given these powerful medications, often intravenously, for several months. Treating fungal meningitis may involve hospital treatment for up to six months.
Several clinics who administered the tainted products are recommending that all patients come in for an evaluation. The CDC is recommending that patients who have had a steroid injection since May 21, 2012 and show symptoms such as headache, fever, new muscle weakness or numbness, slurred speech, light sensitivity, stiffness in the neck, or other unusual symptoms should seek emergency medical attention. The only way to conclusively diagnose fungal meningitis is with a spinal tap, in which a doctor extracts cerebrospinal fluid and has it tested for fungus.
The CDC has also reported that several people have had strokes due to this fungal meningitis outbreak. Stroke can occur when the fungus invades blood vessels. However, doctors treating patients with stroke symptoms may not think to test for meningitis. The symptoms of stroke include weakness, loss of movement on one side of the body, and other symptoms.
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