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News From the Centers for Disease Control and Prevention
November 28, 2012

Multistate Fungal Meningitis Outbreak— Interim Guidance for Treatment

JAMA. 2012;308(20):2074. doi:10.1001/jama.2012.64953

MMWR. 2012;41:842.

CDC and the Food and Drug Administration (FDA) continue to work closely with state and local public health departments on the multistate meningitis outbreak investigation of fungal infections among patients who received a steroid injection of a potentially contaminated product into the spinal area. The investigation also includes possible fungal infections associated with injections in a peripheral joint space. These cases are associated with a potentially contaminated steroid medication prepared by New England Compounding Center (NECC) in Framingham, Massachusetts.

Fungal meningitis pathogens that have been found in the investigation include Exserohilum and Aspergillus. Exserohilum rostratum (a brown-black mold) is the predominant pathogen in this outbreak, and expert opinion and published literature indicate that voriconazole might be effective in treating infections caused by brown-black molds and infections caused by Aspergillus species. CDC interim guidance for treatment of adult patients with central nervous system and/or parameningeal infections associated with injections of potentially contaminated steroid products from NECC and CDC interim guidance for treatment of adult patients with septic arthritis associated with intra-articular injections with potentially contaminated steroid products from NECC recommend empiric antifungal therapy.

Additional information is available at http://www.cdc.gov/hai/outbreaks/clinicians/guidance_cns.html and http://www.cdc.gov/hai/outbreaks/clinicians/interim_treatment_options_septic _arthritis.html.