Multistate outbreak of fungal infection associated with injection of methylprednisolone acetate solution from a single compounding pharmacy - United States, 2012.
Level 4 - case-series / case-control
Epidemiological outbreak investigation and descriptive surveillance case series
What was done
The CDC, FDA, and state and local health departments conducted an epidemiological outbreak investigation and active case-finding following a sentinel report of culture-confirmed Aspergillus fumigatus meningitis after an epidural steroid injection. Investigators traced medication exposures, compounding sources, and specific lot numbers among affected patients across multiple states.
What was found
As of October 10, 2012, investigators identified 137 cases and 12 deaths across 10 states linked to this outbreak. The initial 9 cases (1 culture-confirmed Aspergillus fumigatus in Tennessee and 8 clinically diagnosed cases across Tennessee and North Carolina) were all traced to epidural injections from three specific lots of preservative-free methylprednisolone acetate (MPA) compounded by the New England Compounding Center (NECC). No cases were associated with other MPA lots or other NECC products.
Why it matters
This investigation identified the source of a catastrophic multistate fungal meningitis outbreak, enabling the rapid recall of contaminated compounded steroid lots and alerting clinicians to monitor exposed patients for insidious fungal infections.
Limits
The abstract describes an ongoing, preliminary outbreak investigation with incomplete final case counts and mortality data. The total denominator of exposed patients is not provided, and microbiological confirmation details are only specified for the index case.
Cited by
- supports Around 2012–2013, a compounding pharmacy in New England distributed contaminated specimens that caused an outbreak of fungal meningitis.