Tenn. Health Officials Warn Of Local Infection

NASHVILLE, Tenn. — Tennessee health officials will start contacting hundreds of people who received steroid injections for back pain from a pharmacy linked to a fungal meningitis outbreak to warn them about another infection.

Dr. David Reagan, chief medical officer for the Tennessee Department of Health, said Wednesday the new round of calls will start next week to about 900 patients who have not developed fungal meningitis but who may be at risk for a localized infection or abscess near the injection site.

In Tennessee, 84 patients have developed fungal meningitis and 13 people have died after receiving injections from Massachusetts-based compounding pharmacy New England Compounding Center. Nationally, 490 patients have been sickened and 34 have died.

The Centers for Disease Control and Prevention has previously warned that some patients who received injections from NECC developed abscesses or soft tissue infections, but the number of those infections has been increasing as the number of new meningitis cases decline.

“We are seeing more patients without meningitis come in with the infections,” Reagan said.

In Tennessee, 49 patients have developed the localized infections, most of whom have also had fungal meningitis. Fungal meningitis is not contagious.

Reagan said they do not want people do not overlook the symptoms, which include back pain or loss of bowel or bladder control. The infections can be diagnosed with an MRI and are treated with anti-fungal medications, he said.

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  • friend_indeed

    Good to see TN conducting active surveillance for symptomatic abscess, however, we are unlikely to estimate actual incidence without imaging all patients who received injections.  Historically, the the incidence of intrathecal granuloma associated with pharmacy compounded, continuously infused intrathecal pain medication was thought to be very rare.   Such rare occurrence was comforting to physicians and patients, but it was unfortunately incorrect. Here’s another area where public health experts/epidemiologists can assist.   In order for a case to be counted in an incidence estimate, it must first be detected, and confirmed, usually by MRI.  If abscesses are asymptomatic or diagnosed as progression of underlying disease, a “case” may go undetected, and uncounted.  The initially granuloma rate comforting clinicians was not a true incidence rate, it was merely a “reporting rate.”  When studied systematically, using MRI imaging, the actual incidence rate of intrathecal granuloma was much higher.  This may in part explain the disparity in abscess rates reported from state to state, where the difference may be attributed in part or whole to differences in detection/ascertainment of abscess cases. 

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