A recent outbreak of fungal meningitis was attributed to contaminated steroid injections. While the company manufacturing the contaminated methylprednisolone acetate voluntarily recalled all its products as of October 31, 2012, patients and healthcare consumers continue to express concerns. A review of the CDC's (Centers for Disease Control's) detailed overview of this condition (http://www.cdc.gov/HAI/outbreaks/patients/faq-meningitis-outbreak-patients.html) will refresh healthcare providers' knowledge of the condition and help us in reassuring our patients.

First, fungal meningitis is not contagious. The fungus identified in patients receiving the contaminated steroid injections has been identified as Exserohilum rostratum. This fungus is a common mold found in soils and on plants. The Exserohilum most often causes skin or sinus infections. Other fungi often associated with meningitis include Aspergillus, Coccidioides, Cryptosporidium, and Histoplasma.

Signs and symptoms of fungal meningitis include new or worsening headache, fever, sensitivity to light, stiff neck, new weakness or numbness in any part of the body, slurred speech. Additionally, increased pain, redness, or swelling at the injection site for the contaminated steroid is significant. Diagnosing fungal meningitis requires identifying the fungus in blood or cerebrospinal fluid. This type of infection usually occurs in people with compromised immune systems.

The condition is usually treated with high-dose antifungal medications administered via intravenous infusion. The success of the treatment relates to the immune system status of the patient as well as the type of fungus. It usually occurs in people with compromised immune systems, HIV, cancer, or other immune system disorders, making treating the condition more challenging.

Source: CDC. Fungal meningitis outbreak investigation. Current state. November 8, 2012. Available at http://www.cdc.gov/HAI/outbreaks/currentsituation/. Accessed December 12, 2012.

Submitted by Robin E. Pattillo, PhD, RN, CNL, [email protected].