Southlake hospital used steroid linked to meningitis outbreak

Posted Saturday, Oct. 06, 2012  comments  Print Reprints
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For more information

Centers for Disease Control and Prevention website: cdc.gov/hai/outbreaks/meningitis.html

Tarrant County Public Health website: tarrantcounty.com/ehealth

About meningitis

Meningitis is an inflammation of the lining of the brain and spinal cord. Symptoms include a new or worsening headache, fever, stiff neck, sensitivity to light, nausea, slurred speech or loss of balance.

Fungal meningitis is not contagious like the more common forms.

The types of fungus linked to the outbreak are common in the environment but very rarely cause illness.

Fungal meningitis is treated with high-dose antifungal medications, usually given intravenously in a hospital.

Source: The Associated Press

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A Southlake hospital and a back pain management clinic in Dallas are the only two Texas medical facilities on a list released by federal officials Friday of U.S. clinics that received shipments of a recalled steroid medication linked to a deadly outbreak of meningitis.

Texas Health Harris Methodist Hospital Southlake received two shipments of the preservative-free methylprednisolone acetate from a specialty pharmacy in Massachusetts, Tarrant County Public Health officials said.

Hospital records indicate that 114 patients were treated with shots. All have been notified, a hospital official said Friday.

No cases of meningitis associated with the fungus that apparently tainted some of the doses have been identified in Texas.

Federal authorities released the list of about 75 facilities in 23 states that got the recalled medication to help identify everyone who may have gotten sick -- or may still get sick -- in the outbreak.

"All patients who may have received these medications need to be tracked down immediately," said Dr. Benjamin Park of the Centers for Disease Control and Prevention.

"It is possible that if patients with infection are identified soon and put on appropriate antifungal therapy, lives may be saved."

The number of cases of the rare fungal meningitis has reached nearly 50, and the illness has spread to a seventh state, the CDC reported Friday. The number of deaths in the outbreak remained at five.

Alternatives available

Investigators have focused on a steroid medication made by a specialty pharmacy, the New England Compounding Center in Framingham, Mass. The pharmacy shipped 17,676 single-dose vials of the steroid.

Inspectors have found at least one sealed vial contaminated with fungus.

All the people who contracted meningitis had gotten the shots for back pain, a common treatment.

The medical name for the injections is a lumbar epidural steroid injection.

FDA-approved versions of the drug, sold under the brand name Depo-Medrol, are in good supply, so patients who need the steroid shots should not encounter a shortage, the FDA said Friday.

Contacting patients

The Southlake hospital was notified about the steroid recall on Monday and has contacted patients by telephone and certified letter about possible infection and warning signs, hospital President Traci Bernard said Friday.

The patients received injections between July 31 and Sept. 30.

"Obviously, from our perspective this is very disappointing and disturbing," Bernard said. "In my entire career this is the first time I've been a part of something like this. This is unanticipated and unexpected."

None of the hospital's patients have reported any symptoms of meningitis. The hospital has offered free examinations and testing.

"It's good news that no one is ill at this time," Bernard said. "We just want to monitor these patients until we hear something definitive back from the CDC."

The Dallas Back Pain Management clinic, the other Texas facility that received the suspect steroid doses, has not used them, according to state officials.

The medication is a commonly used steroid, Bernard said. The shots are attractive to many patients because they are much less invasive than other therapies that may require surgery, she said.

The use of compounding pharmacies to obtain medications is a common practice nationwide and problems with this type of pharmacy are rare, Bernard said.

Some clinics that use compounding pharmacies say they are a good source of preservative-free steroids, which are less likely to cause a nerve-related complication, The Associated Press reported.

Two types of fungus

In all, 47 people have contracted fungal meningitis, the CDC said. Michigan became the seventh state to report cases, with four. Tennessee's cases now total 29; Virginia, six; Indiana, 3; two each in Maryland and Florida and one in North Carolina.

Three people have died in Tennessee and one each in Virginia and Maryland.

The first known case in the meningitis outbreak was diagnosed about two weeks ago in Tennessee.

On Friday, officials said they have found two types of fungus in nine of the sick patients -- Aspergillus and Exserohilum.

It takes one to four weeks for a person to develop symptoms, said Christine Mann, a spokeswoman with the Texas Department of State Health Services. People who have had no symptoms may still develop them, Mann said.

This report includes material from The Associated Press.

Mitch Mitchell, 817-390-7752

Twitter: @mitchmitchel3

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