Brote de meningitis por hongo

N Engl J Med October 11, 2012  Vol. 367 No. 15

Fungal meningitis outbreak 2012

Los Centros para el Control y Prevención de Enfermedades (CDC) y la Administración de Drogas y Alimentos (FDA) están llevando a cabo una investigación multiestatal de un brote de meningitis micótica en pacientes que recibieron una inyección epidural de un esteroide potencialmente contaminado de Nueva Inglaterra Compounding Center (NECC) . El CDC ha establecido directrices para ayudar a los clínicos en el seguimiento y tratamiento de pacientes.

Number of Cases Reported

Updates about the investigation, including case counts, are available at http://www.cdc.gov/hai/outbreaks/meningitis.html.

Case Definitions

1. A person with meningitis of subacute onset (1 to 4 weeks) following epidural injection on or after May 21, 2012. Clinically diagnosed meningitis meaning 1 or more of the following symptoms: headache, fever, stiff neck, or photophobia and a cerebrospinal fluid profile consistent with meningitis (pleocytosis +/– low glucose, elevated protein).
2. A person with basilar stroke 1 to 4 weeks following epidural injection on or after May 21, 2012, who has not received a diagnostic lumbar puncture. These people, if possible, should have a lumbar puncture.
3. A person with evidence of spinal osteomyelitis or epidural abscess at the site of an epidural injection diagnosed 1 to 4 weeks after epidural injection on or after May 21, 2012.
4. A person with septic arthritis diagnosed 1 to 4 weeks following steroid joint injection on or after May 21, 2012. Clinically diagnosed septic arthritis meaning new or worsening pain with presence of effusion or new or worsening effusion.

Cause of Infections

The infections are caused by a fungus. At this point, the original source of the outbreak has not been determined; however, all infected patients identified thus far have received preservative-free (PF) methylprednisolone acetate (80 mg/ml) from among the three lots voluntarily recalled by the NECC in Framingham, Massachusetts, on September 26, 2012.