Boston globe 10 17 12 fungal infection treatment

of 4

Metro
Fungal infection poses challenges to
patients, officials
By Liz Kowalczyk | GL O BE ST AF F O CT OB E R 17 , 20 12

CHERYL SENTER FOR THE BOSTON GLOBE

Matthew Spencer still suffers from occasional headaches.

Two weeks after Matthew Spencer received a steroid injection for back pain, he was feeling
even worse, suffering from an aching head, stiff neck, nausea, and stabbing back pain. Finally,
he drove himself to the emergency room.

Doctors suspected fungal meningitis. Test results were not definitive, but the steroid had been
made by the Framingham pharmacy linked to an expanding national outbreak of the rare and
dangerous disease.

http://www.bostonglobe.com/lifestyle/health-wellness/2012/10/16/mayor-matthew-spencer-antifungal-dru... 10/17/2012

of 4
After seven days in the hospital, the part-time mayor of Somersworth, N.H., was back home
Tuesday, where a machine pumps a powerful antifungal medication into his veins five hours a
day. The drug causes liver inflammation, and for the first 30 minutes of each treatment,
images flicker across his eyes.

Spencer’s situation illustrates many of the challenges public health officials, physicians, and
patients are grappling with in the outbreak: Fungal meningitis is usually exceedingly difficult
to diagnose, and the treatment is risky and arduous.

“It’s like going to a supermarket and buying a bottle of water and finding out it’s Windex,’’ said
Spencer, 42, about receiving a steroid potentially contaminated with fungus. “It’s
unfortunate.’’

Spencer waited more than two weeks after his epidural injection on Sept. 19 to seek medical
care. In part, that was because he and his doctors attributed his initial symptoms to the
injection itself, which he received to ease pain from spinal stenosis caused by an old Coast
Guard injury.

“I know people who have been called” by health officials “and still haven’t gone to get tested,’’
Spencer said in a telephone interview. “I want to encourage them to do that.’’

Doctors often have to make the diagnosis without laboratory test results positively identifying
fungus in the spinal fluid, as they did with Spencer.

Dr. Paul Sax, an infectious disease specialist at Brigham and Women’s Hospital in Boston, said
spinal fluid often is negative for fungal contamination, because fungus grows very slowly and
common tests are not always sensitive enough to detect it. Repeated testing is often required,
and even then, spinal fluid sometimes never shows up positive.

As a result, the Centers for Disease Control and Prevention is advising doctors on conference
calls and its website to start treatment when patients exhibit meningitis symptoms, have a
high white blood cell count, and have been exposed to sterile injectable steroids made by New
England Compounding Center.

On Monday, the Food and Drug Administration expanded its advice to health care providers,
saying they should evaluate patients who have received any injectable drug made by the
company and who have symptoms of meningitis or infection at the site of a joint injection.

“Fungal meningitis is a very serious problem,’’ Sax said. Treatment should be started before
“definitive evidence if you have a suspected case, because the longer you wait, the longer the
infection has to become severe.’’


of 4
The CDC, however, has stopped short of recommending that patients without symptoms
receive intravenous therapy, at least for now, because the risks include liver and kidney
damage. In the case of liver inflammation caused by the antifungal voriconazole, it is usually
reversible if the drug is stopped before the symptoms are too severe, Sax said.

Some patients with severe cases will be on intravenous drugs for months. No one knows the
optimal length of therapy because fungal meningitis is so rare, doctors said.

“The burden of treatment is unclear; therapy could go on for years,’’ said Dr. James P. -
Rathmell, chief of pain medicine at Massachusetts General Hospital, who earlier this week was
on a panel in Washington, D.C., discussing the outbreak. Doctors “just don’t know, because
this is a new phenomenon,’’ he said.

The CDC said the number of infected patients grew to 233 Tuesday; 15 patients have died. The
FDA has expanded the potentially contaminated drugs to include two injectable steroids made
by New England Compounding, though most patients infected received injections of
methylprednisolone acetate, and a solution used during heart surgery. On Tuesday, the agency
sent criminal investigators to the offices of the company, suggesting the growing seriousness
of the situation.

The outbreak has focused attention on a little-known corner of drug-making called
compounding that some critics argue has fallen through the regulatory cracks.

Jeffrey Montpetit, a lawyer in Minneapolis, filed a class action lawsuit last week on behalf of
Minnesota residents injected with potentially tainted steroids.

Lead plaintiff Barbe Puro developed a headache, stiff neck, and nausea, classic signs of
meningitis, soon after her Sept. 17 spinal injection. But she first thought her symptoms were
due to her back condition, Montpetit said. It was not until the state health department -
informed her a week later that she had been exposed to a tainted steroid that she went to her
doctor to be evaluated for fungal meningitis.

“I don’t know that anybody has a solid handle on what to tell people and when to tell them
‘you are all clear,’ ” said Montpetit. “There are no definitive answers. The most difficult issue
for people is the uncertainty, wondering whether or not I am going to get fungal meningitis —
and die.”

Spencer said he has had recurring back pain dating to his 20 years in the Coast Guard. He
retired in 2009. “That’s the nature of being on a small patrol boat’’ he said. “It rocks and rolls
and pitches. Your body gets really tortured.”


of 4
Kay Lazar of the Globe staff contributed to this report. Liz Kowalczyk can be reached at
kowalczyk@globe.com.

© 2012 THE NEW YORK TIMES COMPANY


Boston globe 10 17 12 fungal infection treatment

Recommended

Recommended

More Related Content

Similar to Boston globe 10 17 12 fungal infection treatment

Similar to Boston globe 10 17 12 fungal infection treatment (20)

More from mzamoralaw

More from mzamoralaw (20)

Boston globe 10 17 12 fungal infection treatment