Screening MRI may help patients affected by fungal meningitis outbreak

Michigan was hardest hit by contaminated steroid shots

ANN ARBOR, Mich. - The fungal meningitis outbreak caused by contaminated steroid injections that began last fall is still causing problems for affected patients.  Now doctors have discovered a particular test may help identify problems earlier.

The 23 state outbreak of contaminated injections hit the state of Michigan the hardest.  St. Joseph Mercy Hospital in Ann Arbor treated 193 fungal infection patients, more than any other hospital in the country, and their experience in screening for problems before symptoms became severe is now helping get patients treated sooner.

The methylprednisolone was distributed from a compounding center in New England and used in injections for patients at 75 independent pain clinics nationwide. 

Construction worker J.R. Mazure received an injection with the contaminated drug last September and came to the fungal clinic at St. Joseph Mercy Hospital.  The clinic was set up to help treat patients like him.

"I decided it was time to come to the clinic because I couldn't turn my neck or bend my neck down.  I had an excruciating headache," said Mazure.
Mazure was diagnosed with fungal meningitis, but the clinic started seeing other patients who had received the injections but didn't develop meningitis.

"We actually started seeing some patients that only presented with just infection at the injection site," said Dr. Anurag N. Malani.

Malani and her co-authors performed one or more screening MRIs on 172 patients who had received contaminated injections.  Based on these MRIs, 118 patients had no evidence of infection, 18 had equivocal results (not normal, but not clearly showing infection), and 36 had evidence of infection. 

"Of the patients that had abnormal MRIs, 35 of them actually met the Centers for Disease Control and Prevention case definitions for probable or confirmed fungal spinal or paraspinal infection related to this outbreak," said Malani.  "Twenty-four required surgery, and about 70 percent of the patients, or 25 of them, required two-drug therapy."

Researchers said each case is different and can present with or without increased symptoms.

"Over a third of these patients had no change in their chronic pain, but yet were found to have infection,"  said Malani.  "It's important to recognize that we don't fully understand what the incubation period is."

On average, it took about 87 days to detect whether patients developed infections. 

Researchers said pro-active outreach is needed for patients who received the contaminated steroid injections to see whether they have undergone an MRI or have experienced new or increased pain.  The hope is this research will help doctors treating patients in future outbreaks too.

Mazure may have to go back into the hospital for treatment, but he said he has a very supportive wife and is trying to stay positive.

"I hope to stay alive, and I hope to keep the ability to walk," said Mazure. "I am hoping that we can cure this thing."

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