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Chapter 19 : Fungal Infections Associated with Contaminated Steroid Injections

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Fungal Infections Associated with Contaminated Steroid Injections, Page 1 of 2

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Abstract:

By late September 2012, several cases of fungal meningitis were reported from different states. Investigation by the Centers for Disease Control and Prevention (CDC) quickly led to the discovery that the causative organism was a rare, usually nonpathogenic brown-black mold, , and that infection was associated with epidural injection of methylprednisolone acetate that had been contaminated at the compounding center at which it was produced. Although the contaminated lots of methylprednisolone were recalled as soon as the link was discovered, a total of 17,675 vials of potentially contaminated methylprednisolone acetate had been shipped to 76 facilities in 23 states ( ). It is estimated that as many as 13,534 patients had been exposed to this product before the recall went into effect.

Citation: Kauffman C, Malani A. 2016. Fungal Infections Associated with Contaminated Steroid Injections, p 359-374. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0005-2015
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Figures

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Figure 1

Epidemiological curve of fungal infections associated with injection of contaminated methylprednisolone acetate manufactured by the NECC. Reproduced from reference with permission.

Citation: Kauffman C, Malani A. 2016. Fungal Infections Associated with Contaminated Steroid Injections, p 359-374. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0005-2015
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Image of Figure 2
Figure 2

Sagittal T1 fat-saturated, postcontrast image of the lumbar spine shows dorsal intradural enhancement (arrow). Axial T1 postcontrast image shows intradural enhancement and clumping (arrow) in the thecal sac, consistent with arachnoiditis. Operative pathology from the intradural abscess shows fungal hyphae by Gomori methenamine silver staining.

Citation: Kauffman C, Malani A. 2016. Fungal Infections Associated with Contaminated Steroid Injections, p 359-374. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0005-2015
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Figure 3

Sagittal T2-weighted image of the cervical spine shows a dorsal epidural fluid collection consistent with a phlegmon or abscess. Tissue obtained at surgery showed fungal hyphae. Linear endplate enhancement consistent with diskitis or osteomyelitis of the lumbar spine. Coronal T1 fat-saturated, postcontrast image shows edema and enhancement in the left femoral head and acetabulum consistent with septic arthritis or osteomyelitis.

Citation: Kauffman C, Malani A. 2016. Fungal Infections Associated with Contaminated Steroid Injections, p 359-374. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0005-2015
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Figure 4

Whole-body bone scan of a woman who had been on voriconazole for 4 months for meningitis and arachnoiditis shows uptake in the left and right ribs posteriorly consistent with periostitis.

Citation: Kauffman C, Malani A. 2016. Fungal Infections Associated with Contaminated Steroid Injections, p 359-374. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0005-2015
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References

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Tables

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TABLE 1

CDC case definitions of probable and confirmed fungal infections associated with contaminated methylprednisolone injection

Citation: Kauffman C, Malani A. 2016. Fungal Infections Associated with Contaminated Steroid Injections, p 359-374. In Scheld W, Hughes J, Whitley R (ed), Emerging infections 10. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.EI10-0005-2015

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