Health officials investigating the national fungal meningitis outbreak caused by tainted steroid injections had thought that the worst was over. The number of new cases was dwindling. Then came patients like Anna Adair. An avid gardener and dog-breeder, Adair was rolled into a Michigan emergency room in a wheelchair Nov. 15. She had been bedridden for days, and that morning a bolt of pain in her lower back had caused her to tumble to the bathroom floor. Doctors quickly reached a disturbing realization: An infection caused by black mold had infiltrated her spine, near where she had received an injection made by a Massachusetts pharmacy, and spread into the bone. It was not the meningitis that sickened hundreds of others in late summer and early fall, but part of a frightening second wave of fungal infections caused by contaminated drugs. Dozens more people have now been diagnosed with excruciating abscesses or inflamed nerves in their backs that are proving formidable to cure. In a health alert issued Thursday, the federal Centers for Disease Control and Prevention said it is worried that some patients with spinal infections may not even be aware of their condition because the symptoms mimic the very back pain they originally sought to treat with steroids. The agency is now recommending that doctors consider performing MRI scans to screen all patients who have persistent back pain and received steroids from one of three contaminated batches. Previously, it advised scanning just those with new or worsening pain. “People could be walking around with infections and they do not know it,’’ said Dr. Varsha Moudgal, head of infectious disease at St. Joseph Mercy Hospital in Ann Arbor, Mich., where Adair was hospitalized. “If they are untreated, they will cause pressure and damage to the spinal cord, and the concern then is about losing function.’’ Doctors at St. Joseph Mercy are scanning every patient with routine back pain who received a contaminated injection and have discovered infections among 14 percent of them. Among patients with new or worsening pain in Michigan, Tennessee, and North Carolina, MRIs have turned up infections in more than half. Since Nov. 29 alone, states have reported to the CDC at least 90 cases of spinal infections in patients who have not had meningitis. The unexpected back infections add another element of worry for the nearly 14,000 patients across the country who received steroids laced with black mold from New England Compounding Center, amid what has been a trying 2½ months for many of them. While 39 patients have died, another 555 who have back infections, meningitis, or both, are facing an uncertain future. Many have relapsed and been hospitalized two or three times. Most have suffered debilitating side effects from antifungal drugs, including hallucinations. At St. Joseph Mercy, where 30 patients are still hospitalized with meningitis or spinal infections, several patients have significant kidney damage caused by amphotericin, the drug Adair received during her third hospital stay. Even those who have gone home must undergo regular blood tests, electrocardiograms, MRIs, and painful spinal taps so doctors can closely monitor their condition. Particularly distressing is that doctors do not know how long patients will require medication — estimates range from three months to a year — and whether the drugs will ultimately eliminate the fungus from their bodies, said a dozen patients, attorneys, and infectious disease specialists interviewed by the Globe. Dr. John Perfect of Duke University Medical Center, a leading fungal disease specialist, said the medical profession “is flying by the seat” of its pants. At the same time, investigators from the CDC and Food and Drug Administration are still searching for firm answers to basic questions about why the outbreak has progressed the way it has: Why did some states, such as Michigan and Tennessee, see a higher percentage of patients given the contaminated steroids get sick? And why is the number of patients with spinal infections still growing? “The doctor has been really honest,’’ said Michael Mullins of High Point, N.C., who was diagnosed with meningitis on Oct. 5 and now has two small spinal abscesses. “We know meningitis can kind of linger. You can get sick later on in life. Whether this fungal meningitis will do this we don’t know. The only people who have lived through this kind of thing are those who are here now.’’ Adair, called Penny by her family and friends, had her first steroid injection from a contaminated batch Aug. 16 at a pain clinic near her home in rural South Lyon, about 20 miles north of Ann Arbor. She experienced terrible pain for weeks afterward, but doctors believed it was due to her degenerative disc disease, and she had a second contaminated steroid injection on Sept. 17. Continued
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