Across the country, certain batches of a steroid injection given to relieve back pain in 2012 sparked an outbreak of meningitis – a potentially deadly infection that causes inflammation of the membranes that cover the brain and spinal cord.

Three lots of the drug methylprednisolone acetate – which doctors inject directly into the spine to help manage chronic back pain, pain caused by degenerative arthritis and sometimes nerve pain – were contaminated by a fungus.

At least eight people died and 105 people in at least nine states were infected with fungal meningitis, a form that is not contagious. Thousands of patients could have been affected in the 23 states where the vials were shipped.

The Centers for Disease Control and Prevention, or CDC, is advising people to call their doctor if they have received an epidural steroid injection since July, and are now experiencing fever, headache or they feel worse than normal, with a stiff neck, nausea, light sensitivity, slurred speech or weakness or numbness anywhere in their body.

“For some arthritis patients, it could be quite confusing because some of the symptoms can mimic the pain they have from their arthritis,” says Eric Matteson, MD, chair of rheumatology at the Mayo Clinic in Rochester, Minn. “The things they should look out for after such an injection is a new type of pain – a pain that is new or different from what they have previously experienced.”

The drug’s maker – New England Compounding Center in Framingham, Mass. –  voluntarily shut down and voluntarily recalled the medication. It’s also voluntarily recalled all of its other products as a precaution.
 

“All patients who may have received these medications need to be tracked down immediately,” said Benjamin Park, MD, medical officer of the CDC’s Mycotic Diseases Branch, in a press release. “It is possible that if patients with infection are identified soon and put on appropriate antifungal therapy, lives may be saved.”

According to the CDC website, doctors should have contacted patients who received other types of joint injections with potentially contaminated methylprednisolone to assess them for possible signs of infection. However, the outbreak has been linked only with epidural (spinal) injections of the drug.

Patients who aren’t sure about any new symptoms they’re experiencing should call their doctor. The Hospital for Special Surgery in New York City does not use methylprednisolone acetate or New England Compounding Center for any spinal injection procedures. But Seth Waldman, MD, director of the hospital’s division of pain management, says its phones are still ringing.

“Every person we deal with here has called the office to check, and it’s the right thing to do,” Dr. Waldman says. “Everyone should call if they got an injection to find out what medication they were injected with. It’s important everyone make sure they weren’t injected with the recalled medication or medication from the recalled lots.”

“In general, these types of injections can be considered quite safe,” Dr. Matteson says. “This is a contaminant that caused an infection. It’s reported to be a fungus that apparently is in the preparation, and when the injections are given, people are inoculated with the fungus.”