How Does Meningitis Get into a Syringe Full of Steroids, Anyway?

While authorities are figuring out how this happened, the Chief of Infectious Diseases at Tufts Medical Center has some theories.

colored syringesSyringes photo via Shutterstock

UPDATED November 13 – 5:30 p.m. (This story originally ran on October 10th and has been updated with the most recent information. The CDC just announced that they are investigating patients exposed to products other than the three contaminated lots.)

By now, you’ve seen it on the news or read about it in a newspaper. A compounding pharmacy (where drugs are mixed to create a customized medicine for a patient) in Framingham is responsible for a massive fungal meningitis outbreak. As of today, according to the Centers for Disease Control and Prevention (CDC) there have been 438 cases, resulting in 32 deaths in 17  states. In total, 23 states received the implicated product—including New Hampshire, Rhode Island, and Connecticut, but not Massachusetts.

At this time, authorities do not yet know the original source of the outbreak, but there is a link to an injectable steroid medication. Injections of the contaminated syringes likely started in late May and the disease can take one to four weeks to manifest.

According to the CDC, Aspergillus, one of the fungus associated with this outbreak is something that we all breathe in every single day. Dr. David R. Snydman, chief of the Division of Geographic Medicine and Infectious Diseases, and hospital epidemiologist at Tufts Medical Center says that the fungus is something that can be found in the environment and it is not typically an organism that causes disease. The other fungus is Exserohilum, which is a common mold found in soil, and on plants, especially grasses.

“It is very common in the environment. When you vacuum your carpets, you probably blow Aspergillus around,” Snydman says. “This is a typical environmental mold. Normally it doesn’t cause disease. I think it is because they injected the steroid into the bone or spine.”

So how can something like this happen? While authorities are still trying to figure that out, Snydman is speculating that there could be a couple of possiblities. The first has to do with the air filters. “Typically the way these things would be compounded [there would be a] HEPA filter, [high-efficiency particulate air filter] that provides sterile air in the environment,” Snydman says. “My assumption is that either the filter in the compounding was malfunctioning, or somehow in the packaging, and I don’t know how it was distributed, but somehow in the packaging it got contaminated.”

Snydman says that one of the problems with fungal meningitis is that it can be difficult to recognize, but if you can recognize it, anti-fungal medications can be used to treat and hopefully cure these patients.

Unless you had an injection from this particular lot, you are not at risk. But he says that this is a somewhat justifiable hysteria. “I suspect we are going to see more cases of meningitis, although some might be falsely identified as having been injected with this,” Snydman says. “Given the number of injections that are potentially contaminated, and the number of people that got these injections, its pretty scary. I’ve gotten calls from people whose relatives they know were exposed and they know its the correct lot.”

Even with all the uncertainty and speculation surrounding the outbreak, new regulations and increased oversight will be on the horizon for compounding pharmacies and drug makers in general. But let’s also hope than these pain management centers are given a second look. Where and how they buy their drugs and how easily these drugs are distributed is something that also needs further review.

The CDC wants everyone to know that fungal meningitis is not contagious and everything you could want to know about the outbreak can be found here. For a full list of all products recalled due to possibility of contamination, click here.