New England Journal of Medicine
Scans from patients with fungal meningitis show evidence of a stroke (left) and arachnoiditis.
New England Journal of Medicine
A year ago, public health officials were scrambling to figure out why people across the country were suddenly coming down with life-threatening cases of meningitis.
The outbreak eventually was traced back to contaminated steroids produced by the New England Compounding Center. All told, 751 people contracted fungal meningitis and other infections from the tainted shots; 64 died.
And it's not over. Some people are still undergoing treatment, and others who thought they were cured have relapsed and are once again fighting infection.
To get up to date, Shots talked with Dr. Thomas Kerkering, section chief for infectious disease at the Carilion Clinic in Roanoke, Va., a hospital where 36 patients have been treated. Two of them had strokes and died almost immediately. A third person died after 101 days of treatment.
Kerkering, an expert on fungal infections, was a co-author of one of two papers published in last week's New England Journal of Medicine on the outbreak. This is an edited version of the conversation.
It's startling to hear that some people are still being treated for these infections a year later. Why does it last so long?
Fungal infections are hard to treat. That's due to the drugs we have, the mechanisms of how the drugs work on the fungus, and our own immune systems. Then there aren't drugs that reach high levels in the central nervous system. And the central nervous system is a much more severe place to be infected than the lungs, for example.
You've been monitoring patients' spinal fluid to see if they're getting better. How do you know when to stop?
We made the decision that we would treat for 30 more days after the spinal fluid was normal, and then to follow up we would do lumbar punctures at one month, three months and six months after completing therapy. We have a few more patients who are awaiting their six month lumbar puncture in November. And we still have two patients on therapy a year later.
One of your patients was treated for 99 days and looked fine. Then more fungus showed up, and she had four more months of intravenous medication. She's not the only patient nationwide who has relapsed. Do you know why?
Not yet. Did they have a second form of fungus, or does the organism just hang out in places that the medication didn't get to and we didn't treat enough? I don't know if any of us have the answers.
A lot of these people were in the hospital for weeks, and then on IV drugs at home. It sounds like it's been rough.
I don't think the public has an idea of all the things that the patients went through. Of course they had headaches and fevers and didn't feel well at all at first. But then some did have strokes. They needed rehabilitation and physical therapy for that. Some of them developed something that we call arachnoiditis. That leads to urinary retention and a whole lot of back pain. The patients were pretty miserable.
And remember these patients all had back problems to begin with. Then they got their shots and they get fungus and we treat them through all that misery, and they get back to where they were originally — they still have back pain. Some have gone on to have surgery and have done very well and have not relapsed. The patients were really troupers on this.
Are there lessons from this experience for those of us who didn't have to endure it?
Challenge is too harsh a word, but patients need to ask their doctors, do I really need this? Even with modern medicine, nothing is risk-free.