Have you or a loved one been affected by the recent meningitis outbreak? If so, and you live in the state of Pennsylvania we urge you to contact our office.
Last September, news broke of a multi-state outbreak of fungal meningitis among patients who received steroid injections for neck or back pain or in other joints, such as the knee or shoulder. Several weeks have passed since the outbreak was traced to steroids tainted by a fungus found in a certain type of black mold. The number of those infected continues to rise. Now, the New York Times is reporting many patients who fell ill with meningitis are suffering from a second illness called “a spinal epidural abscess.” An epidural abscess is an accumulation of pus that forms within the spinal canal and surrounds the spinal cord. The spinal cord is surrounded by three membranes known as the meninges. The dura mater is the outermost layer of the membranes that compose the meninges. Inflammation of the meninges, whether caused by virus, bacteria, or, in the case of the recent outbreak, a fungus, is known as meningitis. An area of fat within the spinal canal and surrounding the dura mater is often the breeding ground for infection. Pus can accumulate within this potential space, called the epidural space, and form an abscess. The longer an epidural abscess remains undiagnosed or treated, the greater likelihood the abscess will cause compression of the spinal cord or nerves exiting the spinal cord. Patients presenting with a spinal epidural abscess will usually have complaints which include severe, localized back pain, decreased or abnormal sensation in the legs or feet, and problems with bowel or bladder function. If permitted to progress untreated, a spinal epidural abscess can cause progressive loss of motor strength in a person’s legs. A person could suffer paraplegia or other permanent neurologic injuries if surgery to evacuate the abscess is delayed.
Just in the past week, one –third of 53 patients treated for meningitis at St. Joseph Mercy Hospital in Ann Arbor, MI returned to the hospital with an epidural abscess. Michigan was the hardest hit with the meningitis outbreak with 112 people infected. But an official in Tennessee, where 78 meningitis cases were reported, has also had reports of patients returning with an epidural abscess. The reports are especially concerning considering the drug used to treat patients with meningitis was in lab tests found effective against the fungus responsible for the outbreak. This is best explained by the failure of even an appropriate antifungal medication to eradicate an abscess formed before the meningitis was diagnosed and treated.
An MRI is the most effective test for confirming the diagnosis of epidural abscess. Unfortunately, in the general population the diagnosis of epidural abscess is sometimes delayed because the diagnosis is not ruled out of consideration and health care providers neglect to order the appropriate testing, such as an MRI. Even when an MRI is performed, miscommunication among radiologists, some who might interpret the MRI’s from a remote location many miles or time-zones away, and doctors or other healthcare providers can lead to oversight of critical radiographic findings suggestive of an epidural abscess.
Many of the victims of the meningitis outbreak were surely suffering from chronic neck or back pain. Such ailments are often the basis for doctors to recommend steroid injections like the kind that caused this terrible situation. The sad irony for those diagnosed with spinal epidural abscess is that without prompt treatment, they may suffer chronic pain associated with injury to their spine or neurologic deficits that could last for the remainder of their lives. Hopefully, health care officials will continue to keep the public, and especially those with illness tied to the outbreak, well informed, so they can benefit from prompt and thorough medical treatment and avoid serious or permanent injury.