published Saturday, October 20th, 2012

Tennessee's high fungal meningitis infection rate questioned

Health care facilities that received recalled lots of steroids

• Forsyth Street Ambulatory Surgery Center, Macon, Ga.

• PCA Pain Care Center, Oak Ridge, Tenn.

• Specialty Surgery Center, Crossville, Tenn.

• St. Thomas Outpatient Neurosurgical, Nashville

Source: Centers for Disease Control and Prevention

Fungal Meningitis

Meningitis is swelling of the protective membranes, or meninges, covering the brain and spinal cord. The swelling is usually caused by an infection with a bacteria or virus, but meningitis can also be caused by a fungus, which is called fungal meningitis.

Symptoms of fungal meningitis are similar to symptoms of other forms of meningitis; however, they often appear more gradually and can be very mild at first.

Source: Centers for Disease Control and Prevention

Symptoms of fungal meningitis

If you had an epidural steroid injection since May 21, 2012, and have any of the following symptoms, talk to your doctor as soon as possible:

• New or worsening headache

• Fever

• Sensitivity to light

• Stiff neck

• New weakness or numbness in any part of your body

• Slurred speech

• Increased pain, redness or swelling at your injection site

Source: Centers for Disease Control and Prevention

The president-elect of the state medical association said officials must look closely at why the Volunteer State has so many cases of fungal meningitis that have claimed the lives of eight Tennessee residents.

"Why do we have so many of these procedures being done?" Dr. Chris Young, of Chattanooga, asked Friday about the meningitis outbreak. "We need to make sure the right procedure is being done on the right patient."

Of the 271 people diagnosed with the deadly infection, 66 were in Tennessee, the highest of any state. Neither Georgia nor Alabama had any cases diagnosed as of Friday afternoon.

Sixteen states have reported cases of meningitis, and 21 people have died, although there have been deaths in only six states -- Tennessee, Michigan, Florida, Indiana, Maryland and Virginia. Tennessee leads the death toll with eight, while Michigan is second with five.

Young said Tennessee health care providers administer some of the highest numbers of spinal injections in the nation.

Those diagnosed with fungal meningitis received a spinal steroid injection of a contaminated product from the New England Compounding Center in Massachusetts. Tests completed this week confirmed the link between the two, officials said Thursday.

Not everyone who received the contaminated medicine will get sick, said Tennessee's top medical official.

Dr. David Reagan said the most important factor determining who does get sick seems to be how much fungus was contaminating the particular vial of medication they received, not their age or even how healthy they were.

"It's not predictable," Reagan told The Associated Press.

Reagan said the rate of new infections appears to be dropping in Tennessee, although he expects to see new infections and likely more deaths.

Young and Rae Bond, executive director of the Chattanooga and Hamilton County Medical Society, said they are not aware of any cases in the Chattanooga area.

Only three facilities in Tennessee and one in Georgia received shipments from three lots that contained tainted products. Those three lots were shipped to 23 states, with as many as 14,000 people receiving a shot.

However, the Food and Drug Administration has recalled all products from the compounding center, a move that affects a wider group of health facilities.

Tennessee has 74 facilities, Georgia has about 150 and Alabama has 44, according to state health officials. Alabama released the names of those facilities -- including DeKalb Regional Medical Center in Fort Payne, Gadsden Regional Medical Center and Huntsville Hospital in Northeast Alabama -- but Georgia and Tennessee have not done so.

During a news conference Friday to address the outbreak, Georgia officials said the FDA is expected to release the names of the health facilities soon.

Georgia state epidemiologist Cherie Drenzek stressed that products included in the wider recall and the majority of facilities have not been found to be contaminated, and the recall is simply being done as a precaution.

Drenzek called the outbreak "unprecedented."

"We are learning as we go," she said.

Young, who will take over leadership of the Tennessee Medical Association next year, said the meningitis outbreak is a unique occurrence, but it serves as a reminder of how many spinal injections are given in state clinics, many without a great deal of oversight.

The state also ranks among the top in the nation for the number of prescriptions written, oxycodone and hydrocodone sales and drug overdose deaths.

A law that goes into effect next year requires that patients who receive invasive pain management procedures such as spinal injections get the care from either a physician or a provider under direct physician supervision.

"This is an invasive procedure -- not like providing primary care," Young said.

The Associated Press contributed to this report.

about Mariann Martin...

Mariann Martin covers healthcare in Chattanooga and the surrounding region. She joined the Times Free Press in February 2011, after covering crime and courts for the Jackson (Tenn.) Sun for two years. Mariann was born in Indiana, but grew up in Pennsylvania, Tennessee and Belize. She graduated from Union University in 2005 with degrees in English and history and has master’s degrees in international relations and history from the University of Toronto. While attending Union, ...

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