The News Courier in Athens, Alabama

State and Nation

October 25, 2012

Unprecedented 'black mold' meningitis a challenge

(Continued)

People who got contaminated steroid shots made by a Massachusetts pharmacy have been told to be on guard for months for meningitis symptoms. But the CDC said Wednesday that the biggest risk for getting sick seems to be within 42 days of receiving one of the implicated back injections.

With the tainted shots recalled in late September, that means the period of greatest risk is nearing an end. And it should help doctors bombarded with calls from the worried determine who most needs a spinal tap to look for the very earliest signs of infection. Still, public health officials recall a 2002 meningitis cluster linked to steroid injections contaminated with a different fungus; one of those victims got sick 152 days after the shot.

Fungal infections don't get a lot of attention, but they afflict millions around the world, said David Perlin of the University of Medicine and Dentistry of New Jersey, who is studying better ways to diagnose them. Most are skin infections like athlete's foot, but fungi also can cause pneumonia, sinusitis and other problems.

Serious infections tend to strike people with immune systems weakened because of cancer, AIDS or other problems. Fungus-caused meningitis in particular is extremely rare— especially in otherwise healthy people like in this outbreak — and it's "very bad news," said Michigan's Kauffman.

While the more common bacterial and viral forms of meningitis tend to strike quickly with obvious symptoms, fungal meningitis grows very slowly and is hard to diagnose. Few antifungal drugs are absorbed into the central nervous system, limiting treatment options. Plus, human cells and fungal cells have a lot of similarities, making it hard to attack the fungus without side effects, Kauffman explained.

The main culprit in this outbreak is a black mold called Exserohilum rostratum, common in dirt and grasses. Only 33 human infections previously had been reported, mostly eye or skin infections in people with weak immune systems, Casadevall said.

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