TUESDAY, Oct. 16 (HealthDay News) -- The nationwide meningitis
outbreak linked to contaminated steroid injections has so far been
focused on back pain patients.
Far less attention has been paid to those patients who got
injections of methylprednisolone acetate to ease chronic pain in
joints such as knees, shoulders and hips.
The U.S. Centers for Disease Control and Prevention is now
reporting that two people who received a steroid injection for pain
in a joint -- rather than the back -- may have come down with a
One case is in Michigan, the other New Hampshire, but it will
take time to confirm they are fungal infections, agency spokeswoman
Melissa Dankel said Monday.
People with chronic pain in ankles, knees, shoulders, hips and
thumbs commonly get injections of methylprednisolone acetate in the
troubled joint to relieve inflammation that causes discomfort and
Unlike the spinal injections that have been associated with
meningitis -- an infection of the protective membranes of the brain
and spinal cord -- any joint infections tied to the contaminated
steroids aren't likely to be fatal, experts said.
But they can be risky, they added.
"Fungal infections in a joint can be extremely difficult to
treat and can be quite devastating," said Dr. Sanjeev Suratwala, a
spinal reconstructive surgeon at Glen Cove Hospital in Glen Cove,
N.Y. "Typically, these patients need several months of antibiotics
and are prone to relapses, and may even require surgical
Suratwala said that while the waiting period for meningitis in
the spine or brain has been about one to four weeks, joint
infections can take longer to appear. "Fungal infections can be
masked, so it may take a longer time to present itself," he
And because joint injections are far more common than epidural
injections to the spine, these first cases of infection in people
who received the steroid for joint pain suggests many more patients
could be at risk, Suratwala said.
As of Monday, the toll from the meningitis outbreak stood at 15
dead and 212 people infected. All of the patients were thought to
have been injected with methylprednisolone acetate manufactured at
the New England Compounding Center, in Framingham, Mass. Health
officials in the 23 states that received shipments of the drug have
been able to contact about 11,000 patients so far, CDC officials
Methylprednisolone acetate is used to control joint pain for a
variety of reasons, said Dr. Neil Roth, an orthopedic surgeon at
Lenox Hill Hospital in New York City. "It's a widely available
soluble type of cortisone that doesn't erode cartilage or tendons
and gives a quick dosing effect."
Roth said he expects to see fungal infections particularly in
people who had injections to the knee, because "the knee joint is
the most common injection done in the orthopedic setting."
CDC officials said they've just released interim guidelines for
doctors on how to treat fungal joint infections. They're also
recommending that doctors treat people suspected of having fungal
meningitis, even if tests initially come back negative, because the
fungus linked to these infections -- called Exserohilum rostratum
-- can be tough to identify.
The CDC recommends that patients who received joint injections
with methylprednisolone acetate seek medical care if they have
signs of infection, such as swelling, increasing pain, redness or
warmth at the injection site.
Roth said people scheduled to get steroid injections for joint
or back pain should ask their doctor where the steroid came from.
He also suggested that patients find out whether their physician's
office or clinic has been associated with any meningitis or fungal
"As a patient, you have a right to know where the medication is
coming from," he said.
Dr. John Tongue, president of the American Academy of
Orthopaedic Surgeons and an orthopedist in Tualatin, Ore., said he
wanted to highlight the safety of steroid injections for pain.
"I would hope this would not deter people from getting steroid
injections to the joints," he said.
Tongue said millions of steroid injections into joints are done
every year without infections. "It's kind of bread-and-butter
orthopedics," he said.
He added that the American Academy of Orthopaedic Surgeons
doesn't have a guideline or policy against using compounding
pharmacies such as the one in Massachusetts. "This is a new issue
to me. We'll have to look at it," he said.
Compounding pharmacies "combine, mix, or alter ingredients to
create unique medications to meet specific needs of individual
patients," according to the U.S. Food and Drug Administration. The
customized drugs are frequently required to accommodate special
cases, such as a smaller dose, or the removal of an ingredient that
might cause an allergy in a patient. Sometimes compounding
pharmacies also produce drugs when FDA-approved manufacturers are
unable to meet demand, as during drug shortages, the agency
Also Monday, the FDA issued warnings about additional drugs
produced by the Massachusetts company.
The agency said it was investigating a report of a meningitis
infection in a patient who got a different steroid than the one
linked to the nationwide infections.
The FDA also said it was checking reports of fungal infections
in two heart transplant patients who got a cardiac solution made by
the New England Compounding Center. The solution is used to
paralyze heart muscle to prevent injury to the heart. It's
possible, however, that the infections came from a source other
than the solution, the agency said.
The CDC has more on the