If you are one of the 14,000 people who had a spinal or peripheral joint injection on or after May 21, 2012, you may be fretting about your risk for developing meningitis.
The fungal meningitis outbreak of 2012 has been in the news since the first case was discovered in October. Soon after the initial cases were reported, public health officials traced the disease back to three lots of tainted pain medication that had been shipped from a compounding pharmacy in Massachusetts. The medication - preservative-free (PF) methylprednisolone acetate - was sent to pain clinics in 19 states. The 19 states are:
- North Carolina
- New Hampshire
- New Jersey
- New York
- Rhode Island
- South Carolina
As of December 5, 2012, there have been 541 cases and 36 deaths, according to the CDC.
Related: What is Drug Compounding?
If you had an injection during the time frame mentioned above, the big questions are: How do you know if/when you're safe from the disease? Under what circumstances should you seek treatment? And for which symptoms should you be on the lookout?
Symptoms associated with the fungal meningitis outbreak so far have shown up, on average, one to four weeks after the spinal injection containing the tainted medication was administered. Just the same, please note that this one to four week time period between the injection and the onset of meningitis symptoms is not a hard and fast rule. In many cases, the symptoms have been slow to appear. Longer and shorter time periods have been reported.
What this means is that you need to closely and constantly monitor yourself for any of the symptoms discussed below. Monitor for at least six weeks post injection, although several months is preferable, according to the CDC. If there's any good news in all of this, it's that this particular form of meningitis is not contagious.
If you notice any of the following symptoms, contact your doctor for a diagnosis as soon as you can.
Mild, Moderate or Severe - How Noticeable Will Fungal Meningitis Symptoms Be?
A warning is in order. You may have very mild symptoms that are only slightly worse than what you usually experience. For example, many infected patients who received spinal injections with the contaminated substance reported slight weakness, slightly worsened back pain and/or mild headache. Because of this, please remain alert and persistent when monitoring for symptoms. The clue to your health status may not be as obvious as you think.
Related: Take the Meningitis Awareness Quiz
When Should You Seek Treatment?
The doctor who gave you the original injection should have contacted you if she believes the medication you received came from one of the tainted lots. But don't wait for her to take the first action. Be proactive. If you notice any of the above symptoms, contact her for an evaluation immediately.
If you have any of the symptoms on the list, including symptoms of stroke, the CDC suggests your doctor should consider giving you a diagnostic lumbar puncture (LP) - as long as it is not contraindicated in your particular case. A lumbar puncture, also called a spinal tap, is a procedure where cerebrospinal fluid is taken from your spine via an injected needle (yes, another one). The fluid sample is then analyzed by a lab for evidence of the fungus.
The CDC recommends the lumbar puncture be done at a place other than where you had the original spinal injection.
As I've said, given that for many patients the fungal meningitis symptoms are mild monitoring for symptoms requires vigilance. For this reason, and because the CDC recommends it, it shouldn't take much prodding for your doctor to grant you a lumbar puncture. A lumbar puncture is a definitive test, and getting one may give you peace of mind of knowing what, if anything, you are dealing with. And it may save your life.
Remember, the tainted methylprednisolone acetate went into circulation beginning on May 21, 2012. Chances are you did not receive contaminated medication if your spinal injection(s) took place before that date.
CDC. Multistate Fungal Meningitis Outbreak Investigation. Centers for Disease Control and Prevention website. Accessed Dec. 2012. http://www.cdc.gov/hai/outbreaks/meningitis.html
CDC. Multistate Fungal Meningitis Outbreak Investigation - Current Case Count. Centers for Disease Control and Prevention website. Accessed Dec. 2012. http://www.cdc.gov/hai/outbreaks/meningitis-map.html#casecount_map
Tom M. Chiller, MD, MPHTM Fungal Infection Outbreak: What Should Physicians Be Doing? CDC Expert Commentary. Medscape website. Oct 31, 2012 http://www.medscape.com/viewarticle/773493