2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health.

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

[email protected]

Tina Feaster, MSInvasive Disease Epidemiologist, ISDH

[email protected]

Jean Svendsen, RN BSChief Nurse Consultant, ISDH

[email protected]