Meningitis patients face secondary infections

Duane Marsteller, The (Nashville) Tennessean | USATODAY

NASHVILLE -- Puzzled health officials are investigating reports that some fungal meningitis patients in Tennessee and elsewhere have developed new health problems, knocking some back into the hospital just when it seemed they were recovering well from the brain infection.

Some patients reportedly have developed epidural abscesses, or pus-filled infections of the spine's epidural layer, the Centers for Disease Control and Prevention said Monday. Other patients reportedly have been diagnosed with arachnoiditis, a painful compression of spinal nerve roots.

The CDC said most of the reports have come from Michigan and Tennessee, but the agency hasn't yet counted or confirmed them.

"We're trying to get a handle on that," said Dr. Tom Chiller, deputy chief of the CDC's Mycotic Diseases Branch, which specializes in fungal diseases.

Michigan and Tennessee likely are generating most of the reports because they have the most cases, Chiller said.

Those states account for nearly half of the 420 people sickened by potentially contaminated steroid injections that were prepared by a Massachusetts pharmacy. Thirty have died, with Tennessee on Monday reporting its 13th death -- the most among the 19 states involved in the outbreak.

New infections unusual

Michigan health officials said of the 119 infections in their state, 51 patients had epidural abscesses. A breakdown of Tennessee's 79 reported infections was not immediately available.

The Tennessee Department of Health is investigating reported epidural abscess cases among meningitis patients but has not yet confirmed any, spokesman Woody McMillin said. More details might be available later this week, he said.

Some of the 17 meningitis patients who have been treated and released from Saint Thomas Hospital had epidural abscesses when they were discharged, spokeswoman Rebecca Climer said. Four have since been re-admitted, not for abscesses but for other reasons such as intractable pain, stroke, worsening symptoms and problems with infusing antifungal medication, she said.

Chiller called the reported abscesses unusual because they usually precede meningitis, not the other way around. "I have worked with fungal diseases for many years, and this is a first for me," he said.

Such abscesses usually are easier to treat because they affect the dura, the outermost layer of the spinal column, according to WebMD. If antifungal or antibacterial medicine doesn't work, the abscess can be drained and the infected tissue removed.

Arachnoiditis affects a deeper spinal layer called the arachnoid and can result in debilitating pain, numbness and paralysis. Treatment options are much more limited but can include surgery.

Chiller said the fact that meningitis victims are developing other health problems isn't surprising, because of their weakened immune systems and histories of back problems. Most of the meningitis patients received epidural steroid injections for back pain.

Lawsuits persist

Authorities suspect they were infected with moldy medicine prepared by New England Compounding Center, a specialty pharmacy in Framingham, Mass., that has voluntarily closed and recalled all of its products.

It also has become the target of a federal criminal probe and more than two dozen personal-injury and wrongful-death lawsuits.

The two most recent ones, filed in federal court late last week, also seek to lay blame on NECC's principals and their other businesses, court records show.

The separate suits, filed in Massachusetts and Texas, contend NECC officials are personally liable because they negligently operated the pharmacy. They also knew NECC was making "defective and dangerous" medications, and made false and misleading claims about the pharmacy's cleanliness and safety of its medications, the suits say.

Defendants named in both suits are Barry Cadden and Gregory Conigliaro, NECC's founders; Lisa Conigliaro Cadden, Barry Cadden's wife and Conigliaro's sister; and her and Gregory Conigliaro's sister, Carla Conigliaro. All are or were officers of NECC, the suits said.

The Massachusetts suit also names four other defendants: Douglas Conigliaro, another sibling; Glenn Chin, an NECC pharmacist; Ameridose LLC, a larger compounding pharmacy formed by Barry Cadden and Gregory Conigliaro; and Medical Sales Management Inc., the marketing arm for NECC and Ameridose that is led by Douglas Conigliaro.

All of the defendants declined to comment, a spokesman said.

Barry Cadden also has been invited to testify at the first congressional hearing on the outbreak. Officials from the Massachusetts Board of Registration in Pharmacy and the U.S. Food and Drug Administration, including FDA Commissioner Dr. Margaret Hamburg, also have been asked to appear before the House Energy & Commerce Committee on Nov. 14.

The following day, Hamburg is scheduled to appear before the Senate health committee, which is also probing the outbreak.

Where to call for help

For information about meningitis in general: 1-800-222-1222.

For mental health counseling for anxiety related to the outbreak: 1-855-CRISIS-1.

Contributing: The Associated Press



