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Posted on Sat, Nov 24, 2012 : 5:59 a.m.

Fungal meningitis update: Epidural abscesses contribute to challenges of outbreak

By Amy Biolchini

Adding to the challenge of caring for the largest patient population in the country with fungal meningitis, staff at St. Joseph Mercy Ann Arbor also are seeing a number of previously discharged patients returning to the hospital for inpatient treatment.

About 30 percent of fungal meningitis patients that have been discharged from the Ann Arbor hospital return with an epidural abscesses, according to Joyce Young, chief nursing officer.

“What we are finding is truly remarkable,” Young said.

The hospital has had to grapple with an ever-fluctuating population of fungal meningitis patients, and its inpatient beds are nearly at capacity. Because of the specialized, around-the-clock care and monitoring needed for the fungal meningitis patients, St. Joseph Mercy Ann Arbor has opened a previously vacant wing of rooms.

The state of Michigan granted emergency approval for the new beds, and fast-tracked the licenses for a number of nurses from other Trinity Health System hospitals brought in to relieve the hard-working staff in Ann Arbor.


Joe Swedish

Courtesy photo

Tuesday, Trinity Health President and CEO Joe Swedish visited the Ann Arbor hospital to thank and commend staff members for their response to the outbreak.

“Saint Joseph Mercy Health System is at the epicenter of the outbreak, treating more than a quarter of the nation’s patients,” according to a written statement from Swedish. “The medical staff, nurses, and all associates have set the standard in how to effectively manage this unprecedented outbreak. They are the unsung heroes who have risen to a challenge that is rarely felt by hospital systems. Their swift and proactive response demonstrates steadfast commitment to our mission and values of delivering high quality, compassionate and patient-centered care.”

St. Joseph Mercy Ann Arbor quickly emerged as one of the nation’s hospitals dealing with an influx of patients in an outbreak of fungal meningitis that the Centers for Disease Control and Prevention began investigating in the beginning of October.

The CDC pinpointed the New England Compounding Center in Framingham, Mass. in its investigation, a compounding drug manufacturer that reportedly distributed batches of injectable steroids that had been contaminated with fungus to numerous clinics across the country.

Four clinics in Michigan received contaminated batches of the steroids, which were used as injections for pain relief. One of those clinics was Michigan Pain Specialists in Brighton. Many physicians that practice at St. Joseph Mercy Ann Arbor also privately practice at the Brighton facility, hospital staff has said. The Ann Arbor location is serving as the treatment hub for all of the Trinity Health System hospitals in Southeast Michigan.

St. Joseph Mercy Ann Arbor was caring for 49 patients in connection with the fungal meningitis outbreak as of Friday, down from 74 patients that had been hospitalized Tuesday. The patients that could be discharged from the hospital for Thanksgiving were allowed to go home, said Laura Blodgett, spokeswoman for St. Joe’s.

All of the patients currently being treated at St. Joseph Mercy Ann Arbor received the initial steroid injection for pain in a Michigan facility.


A fungal meningitis patient holds one of the pills she takes twice a day for treatment Nov. 8 in her Minnesota home. Some patients that have been treated for fungal meningitis are readmitted to the hospital after developing an abscess of infection at the injection site.

Ben Garvin | The Associated Press

The hospital has cared for 133 of the 167 patients in Michigan connected with the fungal meningitis outbreak. Of those 133 patients, 75 of them developed what hospital staff call “epidural abscesses.”

An abscess is a collection of infection. For fungal meningitis patients, the abscesses are located at the site of their injections.

Patients are often screened for epidural abscesses in an MRI, where hospital staff looks for fluid collection or other changes in the patient’s bone that would suggest an infection.

Meningitis, the inflammation of the brain or spinal cord, is rarely caused by a fungal infection and so the course of treatment is not well established. More commonly, meningitis is caused by a virus or by bacteria. Symptoms include fever, neck pain and headaches.

Patients with fungal meningitis are treated with extremely toxic drugs intended to treat fungal infections, and each person reacts to the medication differently.

The drugs are extremely hard on the patients’ blood vessels and veins when administered intravenously, and cause numerous side effects including hallucinations. When a patient no longer has negative side effects from the medication and is well enough to go home, they are discharged and given the medication in an oral format.

Thursday, Michigan health officials reported that the number of resident deaths attributed to fungal meningitis had risen to 13, a figure that includes three Michigan residents that received injections for pain at facilities in Indiana.

Across the country, 490 people have been infected in connection with the fungal meningitis outbreak, including 34 deaths. Amy Biolchini covers Washtenaw County, health and environmental issues for Reach her at (734) 623-2552, or on Twitter.


Caroline Petrie

Sat, Nov 24, 2012 : 10:38 p.m.

The Meningitis Foundation of America (MFA), a national organization, would like the public & media to know that information is available regarding the diagnosis, treatment & prevention of meningitis. MFA was founded in 1997 by parents whose children were affected by meningitis. In addition to supporting vaccination & preventing meningitis, the MFA provides information to educate the public & medical professionals so that the early diagnosis, treatment &, most important, prevention of meningitis, will save lives. Meningitis is a dangerous & often times fatal inflammation of the brain &/or spinal cord that can leave survivors with serious life-long physical problems MFA would like to be considered as a news resource for the disease. For further information, visit the MFA website at www musa org. Thank you, MFA Box 1818 El Mirage AZ 85335 480 270 2652 World Meningitis Day 24 April 2013 www comoonline org Educate~Vaccinate~Eradicate

music to my ear

Sat, Nov 24, 2012 : 8:21 p.m.

my friend on her third stay, had to have this operation. that fungus likes to hang around , the vertebrates ,they are watching her close ,they cant even give her a going home date. it is so sad to see her family going through this. all because of negligence.


Sat, Nov 24, 2012 : 4:36 p.m.

The Use of Steroids : We have been reading the same story with small variations. I would be happy if Joyce Young, the Chief Nursing Officer tells our readers the reason for the development of an epidural abscess at the site of the steroid injection. It must be explained that the steroid medication is formulated in a special manner to let steroid remain at the local site to exert a very prolonged effect on the tissues of the injected site. This has some advantages and some disadvantages that we have clearly recognizing now. I would like to hear that the patients have been duly warned about the possibility of such untoward reaction from using the steroid medication. In a different story, Associated Press has reported that brown or black specks of fungus were seen by naked eye examination in the vials that have been recalled and returned to the compounding facility.


Mon, Nov 26, 2012 : 1:50 a.m.

"Even if the medication is sterile, the person must know that there is a risk involved in case of exposure to an infectious agent while on steroid medication. Sterile = No infectious agent = No risk of exposure


Sun, Nov 25, 2012 : 4:10 a.m.

Thanks for that response. I am speaking about the dangers involved in the use of corticosteroids in relation to a person's immune response. Even if the medication is sterile, the person must know that there is a risk involved in case of exposure to an infectious agent while on steroid medication. I have read several stories and there is this rush to use steroid for providing pain relief. Now, I would like to ask as to how would they approach the problem of pain management in these infected patients. Could they persist with sterile, steroid injections???


Sat, Nov 24, 2012 : 9:16 p.m.

"I would like to hear that the patients have been duly warned about the possibility of such untoward reaction from using the steroid medication." Don't you think that the patients would have been "advised" before the injections if it had been known that the steroids were tainted??? I would suspect that most patients would have declined a tainted injection, don't you? The key thing here is that the steroids were contaminated and not sterile, as expected by doctor and patients alike.


Sat, Nov 24, 2012 : 2:53 p.m.

I'm so sorry this has happened. I have one question that I haven't seen answered. Many stories have reported that a dark substance was visible (to the naked eye) in the vials. Is this true?

Rich Snyder

Sat, Nov 24, 2012 : 7:50 p.m.

Yes it was - there were fungal elements - dark substance is conidia/spores and white filamentous substance is hyphae. Haven't heard the results of cultures of unopened vials other than they found the same fungi as what caused meningitis (though I think they didn't find aspergillus or cladiosporium yet - "only" one case of each). Similar substances were found growing on the louvers of an air return duct behind an autoclave. NECC was full of fungus - likely pulled in from bad air filtration of contamination from the nearby recycling yard.

Dr. Fate

Sat, Nov 24, 2012 : 4:59 p.m.