Fungal infections from steroid injections

Last week a patient in Nassau was diagnosed with septic arthritis from a fungal infection, making him the first case in New York State to be infected by contaminated steroids produced in a Massachusetts pharmacy.  There are now 254 patients in 16 states who have developed either meningitis or arthritis.  It is most important to emphasize that these infections ARE NOT contagious or spreadable, but are the direct result of an injection of a contaminated product.

The culprit fungus is Exserohilum rostratum, which has been isolated in vials of a steroid preparation called methylprednisolone acetate prepared by the New England Compounding Company in Framingham, Massachusetts. The Centers for Disease Control estimate that approximately 14,000 patients may have received injections from contaminated lots; the vast majority will not develop an infection.  The investigation has revealed that three sites in New York received the steroid in question; one each in Mineola, Rochester and Mount Vernon.

For those affected patients, symptoms typically begin 1 to 4 weeks following the injection. Meningitis, the most common presenting illness so far, is an inflammation of the lining of the brain and spinal cord. Symptoms of fungal meningitis include fever, headache, nausea, vomiting and stiff neck. Pain and swelling at the injection site may be noted.  Fungal arthritis will present with pain and warmth in the injected joint, loss of motion and fever.

The infections are treatable with antifungal medications given intravenously, usually for a month or longer.

Reassurance is the most important thing to do at this point. There is no contagion and those who have not received steroids have nothing to worry about.