Journal Article

Spinal and Paraspinal Infections Associated with Contaminated Methylprednisolone Acetate Injections — Michigan, 2012–2013

Nyaku, Mawuili K, Vandenberg, David, Martin, David, MacCannell, Taranisia, Miller, Corinne, Brennan, Brenda M, Chiller, Tom, Coyle, Joseph R, McFadden, Jevon, Arbor, Ann, Heyding, Robert A, Finks, Jennie, Moudgal, Varsha, Tichendelean, Carmen, Fiedler, Jay, Johnson, Shannon, Sula, Dennis, Speirs, Karen M, Ledtke, Christopher, Collins, Jim, Dantes, Raymund

2013

Overview

As of May 6, 2013, Michigan had reported 167 (52%) of the 320 paraspinal or spinal infections without meningitis associated with the 2012-2013 fungal meningitis outbreak nationally. Although the index patient had a laboratory-confirmed Aspergillus fumigatus infection, the fungus most often identified, including in unopened vials of methylprednisolone acetate (MPA), remains Exserohilum rostratum, a common black mold found on plants and in soil. Exposures have occurred through epidural, paraspinal, peripheral nerve, and intra-articular injection with MPA from contaminated lots compounded by the New England Compounding Center in Framingham, Massachusetts. The Michigan Department of Community Health and CDC conducted case ascertainment to describe epidemiologic and clinical characteristics of Michigan patients and to determine factors that might have contributed to the high percentage of spinal and paraspinal infections reported from Michigan. A distinct epidemiologic or clinical difference was not observed between patients with paraspinal or spinal infection with and without meningitis. Lengthy periods (range: 12-121 days) were observed from date of last injection with contaminated MPA to date of first magnetic resonance imaging (MRI) finding indicative of infection. Clinicians should continue to maintain a higher index of suspicion for patients who received injections with contaminated MPA but have not developed infection.

• Publisher: Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services,U.S. Government Printing Office,U.S. Center for Disease Control,U.S. Centers for Disease Control
• Subject: Acetates / Aged / Anti-Inflammatory Agents - adverse effects / Contamination / Corticosteroids / Disease Outbreaks / Drug Contamination / Epidemics / Epidemiology / Female / Fungal infections / Health aspects / Humans / Infections / Injections / Injections, Epidural / Injections, Spinal / Lumbar punctures / Magnetic resonance imaging / Male / Medical diagnosis / Meningitis / Meningitis, Fungal - epidemiology / Meningitis, Fungal - microbiology / Methylprednisolone / Methylprednisolone - adverse effects / Methylprednisolone - analogs & derivatives / Methylprednisolone Acetate / Michigan - epidemiology / Middle Aged / Morbidity / Neurological disorders / NMR / Nuclear magnetic resonance / Outbreaks / Patients / Pharmaceutical industry / Risk factors / Soft Tissue Infections - epidemiology / Soft Tissue Infections - microbiology / Spinal Diseases - epidemiology / Spinal Diseases - microbiology / Spine / Statistical median / Symptoms / United States - epidemiology