What you should know about fungal meningitis

State epidemiologist brings you facts behind outbreak

Learn more about outbreak

Dr. Mary DiOrio, state epidemiologist for the Ohio Department of Health, recommends going to these websites to learn more about the fungal meningitis outbreak.

  •   www.odh.ohio.gov
  •   www.cdc.gov
  • www.fda.gov

By the numbers

  • As many as 14,000 people received injections from suspect shipments of the steroid treatments linked to the fungal meningitis outbreak.
  • There are 404 cases and 29 deaths in the U.S. as a result of fungal infections linked to the steroid injections, as of Friday, Nov. 2.
  • There are 16 cases and no deaths in Ohio as a result of fungal infections linked to the steroid injections, as of Friday, Nov. 2.

Source: Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention, state and local health departments, and the Food and Drug Administration are working to investigate a multistate outbreak of fungal meningitis and other infections among people who received contaminated steroid injections.

The outbreak is linked to an injectable steroid — methylprednisolone acetate — manufactured by the New England Compounding Center in Framingham, Mass. As many as 14,000 people received injections, which are used to treat back and joint pains, according to the CDC.

The CDC has reported 404 cases and 29 deaths in the United States as a result of fungal infections linked to the steroid injections, as of Friday, Nov. 2. There have been 16 cases and no deaths in Ohio, according to the CDC.

As this outbreak continues to affect people across the country and make national headlines, we asked Dr. Mary DiOrio, state epidemiologist for the Ohio Department of Health, to bring you the facts on fungal meningitis.

Q: What is meningitis?

A: "Meningitis is inflammation of the meninges, the covering of the brain and spinal cord."

Q: What is fungal meningitis, and how is it different than other types of meningitis?

A: "Fungal meningitis is meningitis that is caused by an infection of the meninges with a fungus. Fungal meningitis is rare and cannot be spread person to person. Fungal meningitis infections can be severe. Other types of meningitis include bacterial and viral meningitis, which are both more common than fungal meningitis. Bacterial meningitis infections can be severe, and while most people who develop bacterial meningitis recover, some people may suffer from long-term health effects. … Some types of bacterial meningitis can be spread person to person, such as Neisseria meningitidis which can be spread through the exchange of respiratory and throat secretions [(for example,) kissing]. Viral meningitis is generally less severe than bacterial meningitis and resolves without specific treatment. While many types of viral meningitis can be spread person to person, either through fecal contamination or through contact with the respiratory secretions of an infected person, the chance of developing meningitis after becoming infected with the virus is small."

Q: What are the causes of fungal meningitis?

A: "Fungal meningitis can occur when a fungus spreads through the bloodstream from somewhere else in the body or from an infected body site infection next to the central nervous system. People with weakened immune systems are at higher risk for developing fungal meningitis. In the current outbreak, patients have developed fungal meningitis after having a medication that was contaminated with fungus injected near the spine."

Q: What are the risk factors for developing fungal meningitis?

A: "Certain diseases, medications and surgical procedures may weaken the immune system and increase a person's risk of getting a fungal infection, which could lead to fungal meningitis. The particular fungal meningitis that is involved in this outbreak has only been linked to the contaminated steroid injections sold by the NECC compounding pharmacy."

Q: What are the signs and symptoms of fungal meningitis?

A: "Signs and symptoms of fungal meningitis are similar to those of meningitis from other causes and may include the following: headache, fever, sensitivity to light, stiff neck, nausea and vomiting, and altered mental status. Patients who received the contaminated steroid injections should be aware that even mild symptoms might be a sign of infection, and they should seek medical care right away. Some of the patients who received the contaminated injections have suffered strokes."

Q: How is a person diagnosed with fungal meningitis?

A: "If fungal meningitis is suspected, samples of cerebrospinal fluid (fluid that is near the spinal cord) are collected and sent to a laboratory for testing. To confirm fungal meningitis, specific lab tests need to be performed."

Q: How long does a person typically suffer from fungal meningitis?

A: "This is unknown, but individuals with fungal meningitis may suffer from long-term health issues from their infection."

Q: What are the long-term health effects of fungal meningitis?

A: "Some of the complications that might occur from fungal meningitis specifically are unknown as fungal infections are rare. In general though, meningitis complications can include the following: hearing loss, blindness, memory difficulty, learning disabilities, behavioral changes and brain damage."

Q: How is a person with fungal meningitis treated, and how long does treatment typically last?

A: "Fungal meningitis is treated with long courses of high dose antifungal medications, usually given intravenously in the hospital. Oral antifungal medication may also be used. The length of treatment may vary depending on the individual's underlying medical conditions and the type of fungus that caused the infection."

Q: Do meningitis vaccines protect people from getting fungal meningitis?

A: "There are no vaccines to protect people from getting fungal meningitis. There are vaccines that can protect people against certain types of bacterial meningitis, including vaccines for Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type b. These vaccines are recommended as part of routine vaccination schedules."

Q: What advice would you offer people to help prevent them from getting fungal meningitis?

A: "No specific activities are known to cause fungal meningitis. People with weak immune systems [for example, those with (the) HIV infection] should try to avoid bird droppings and avoid digging and dusty activities, particularly if they live in a geographic region where fungi like Histoplasma, Coccidioides or Blastomyces species exist. People who did not receive the contaminated injections are not at risk of getting fungal meningitis due to this outbreak."

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