2012 Fungal Meningitis 2012 Fungal Meningitis OutbreakOutbreakAssociated WithAssociated WithContaminated Steroid Contaminated Steroid InjectionsInjections

Dr. Joan DuwveChief Medical Officer

Indiana State Department of HealthApril 12, 2013

• Clinic notification/assessment• Case investigation/reporting• Advising clinicians• Messaging and media • Laboratory testing• Participating in calls• Requesting CDC Epi-Aid team

• Meningitis: mild symptoms• Posterior circulation stroke• Joint infections• Localized injection site infections

– Epidural abscess– Osteomyelitis– Arachnoiditis/discitis

Illustrations of location and approaches of epidural injection (1a) and location of CNS and parameningeal infections in the spine (1b)

CDC

Operative FindingsOperative Findings

7

Thecal Sac with phlegmonThecal Sac with phlegmon

Photo credit: St. Joseph Mercy Health Systems CDCPhoto credit: St. Joseph Mercy Health Systems CDC

• 11 Total

• 4 Out of State

• Date range from October 2012 to January 2013

• Main outbreak organism

• Found in soil and plants• Warm, humid climates• Rarely causes infection

– Sinusitis– Skin– Eye– Endocarditis– OsteomyelitisPhoto courtesy of CDC

• Rapidly evolving situation• CDC case definition evolved with Outbreak• Unique, little known clinical course• Clinical guidelines were unknown • Harsh treatment regimens• Uncertain disease progression

National Total - 730 cases with 51 deaths

As of 3/28/13

National Data As 3/4/13

Joan Duwve, MD MPHChief Medical Officer, ISDH

jduwve@isdh.in.gov

Tina Feaster, MSInvasive Disease Epidemiologist, ISDH

cfeaster@isdh.in.gov

Jean Svendsen, RN BSChief Nurse Consultant, ISDH

jsvendsen@isdh.in.gov