Download Fungal Meningitis - St. Joseph Mercy Ann Arbor

Fungal Meningitis Outbreak
FREQUENTLY ASKED QUESTIONS
I. General questions
II. Patients who received contaminated injections
III. Epidural Abscesses
IV. Hospital Stay
V. Outpatient Clinic
I. General Questions
•
The fungal meningitis outbreak is all over the news.
Why is St. Joe’s seeing more cases than any other
hospital in the country?
Most of the patients who received a contaminated epidural
steroid injection from a pain clinic in Brighton, MI have
been advised by the Centers for Disease Control (CDC) to
come to St. Joseph Mercy Ann Arbor for treatment, so that
care can be coordinated from one place with the CDC and
the Michigan Department of Health.
•
Are fungal infections contagious?
No. This type of meningitis is not passed on from person
to person. It is not contagious.
•
Then how are these people getting infected?
These patients received a tainted epidural steroid injection
that contained a fungus. The Centers for Disease Control
and Prevention (CDC) and the Food and Drug
Administration (FDA) are currently coordinating a
multistate investigation of fungal meningitis among
patients who received an epidural steroid injection made
and distributed by New England Compounding Center.
•
What pain clinics received the bad injections?
The Michigan Department of Health has identified four
facilities in Michigan that received the tainted injections:
Michigan Pain Specialists in Brighton; Michigan
Neurosurgical Institute in Grand Blanc; Neuromuscular &
Rehabilitation in Traverse City and Southeast Michigan
Surgical Hospital in Warren.
Key Points
Fungal infections are not
contagious
St. Joseph Mercy facilities did
not receive or give the tainted
steroid injections that have
sickened hundreds of people.
St. Joseph Mercy Ann Arbor is a
leading hospital in the evaluation
and treatment of rare fungal
infections.
Fungal meningitis and fungal
infections are extremely rare.
Only patients who received
steroid injections from 1 of 4
pain clinics in Michigan are at
risk.
A fungal outbreak clinic provides
ongoing care management for
patients recovering from fungal
infections.
While the risk of fungal
meningitis is reduced, infections
are being found near the point of
the steroid shot. The most
effective way to identify these
abscesses is MRI.
•
Did any St. Joseph Mercy facilities have the bad
injections?
No. We did not receive or give the tainted steroid
injections that have sickened hundreds of people.
•
What is fungal meningitis?
Fungal meningitis occurs when the protective membranes covering the brain and spinal cord are
infected with a fungus. Fungal meningitis is rare and usually caused by the spread of a fungus
through blood to the spinal cord. It not contagious.
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•
Are fungal infections fatal?
Fungal meningitis and fungal infections are very rare and can be fatal if not treated in time.
•
I received an epidural injection last year. Do I need to get checked?
The only patients who are at risk of this rare fungal infection received an epidural injection between
Aug. 9 and Oct. 2, 2012 from one of the pain clinics listed by the Centers for Disease Control and
Prevention (CDC) – www.cdc.gov.
II. Patients who received a contaminated injection
•
Should all patients who were exposed to the contaminated medication be evaluated?
Yes. While the risk of fungal meningitis lessens with each day, many patients have developed
abscesses infected with fungus under the skin, where the steroid shot was given. Even patients with
no symptoms at all may have an abscess. To know for sure, patients should schedule an MRI with
their physician.
•
Are these patients aware of the risk?
The patients who received epidural steroid injections from the affected lots have been notified. They
have been advised to see their physicians and be evaluated for possible exposure to the fungus.
Michigan Pain Specialists also is actively notifying patients who received joint or muscle injections.
•
I was notified that I am at risk. What should I do?
The Fungal Outbreak Clinic at St. Joseph Mercy Ann Arbor is in regular contact with everyone who
has been exposed to the tainted injections from Michigan Pain Specialists in Brighton. If you have a
question or would like to schedule an appointment, contact the clinic at 734-712-1533.
•
I received a joint steroid injection in my joint (hip, knee, shoulder, etc.). Am I at risk?
If you received a joint steroid injection from Michigan Pain Specialists in Brighton between Aug. 9 and
Oct. 2, 2012, or from one of the other three Michigan pain clinics that received the tainted
medications, please contact the Fungal Outbreak Clinic at St. Joseph Mercy Ann Arbor.
•
How are patients evaluated for fungal meningitis?
Generally, patients are first given a Lumbar Puncture test to determine if they have fungal meningitis.
Additionally, an MRI is scheduled to determine if an abscess is growing near the area of the body
where the contaminated steroid injection was given.
•
What are the symptoms of fungal meningitis or fungal infection?
Symptoms of fungal meningitis are similar to symptoms of other forms of meningitis; however, they
often appear more gradually and can be very mild at first. In addition to typical meningitis symptoms,
like headache, fever, nausea, and stiffness of the neck, people with fungal meningitis may also
experience confusion, dizziness, and discomfort from bright lights. Patients might just have one or
two of these symptoms. Some people have pain at the injection site or in the joint, or worsening pain
than before the injection.
.
•
I have none of these symptoms. Am I in the clear?
If you had received a contaminated injection from Michigan Pain Specialists from Aug. 9 – Oct. 2,
2012, you may still be at risk. Even patients with few or no symptoms have been diagnosed with an
epidural abscess, which if left untreated could cause meningitis.
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III. Fungal Infections & Epidural Abscess
•
What is an epidural abscess?
An epidural abscess is an infection growing under the skin. An MRI is the best way to determine if an
abscess is present.
•
What is the treatment for epidural abscess?
For patients with epidural abscess, the recommended course of treatment is to have surgery to
scrape away the fungus.
•
What medications are used to treat fungal infections?
There are 2 types of anti-fungal medications being prescribed: oral voriconazole and amphetericin B.
•
How long will treatment be needed?
Treatment could be a few weeks to a few months or more. Because fungal infections are so rare,
very little is known about the illness and length of treatment. The medications have strong side
effects, therefore the dosages must be adjusted to tolerable levels. Clinical leaders are continually
factoring new information for coordination of our response and the best possible treatment.
IV. Hospital Care for Fungal Meningitis and Fungal Infections
•
Why is a hospital stay necessary?
Because anti-fungal infections have side effects, the treatments require consistent care delivery from
qualified physicians and nurses.
•
What should I expect in while in the hospital?
There are two different anti-fungal medications you may receive during your stay, usually through an
IV line. You will also have blood tests done to check drug levels and monitor you for potential side
effects from the medications. You may also need to have a heart monitor during your stay. Some
people may need pain medication too. Let your nurse know if you are having pain.
•
Does every patient get the same treatment?
Treatment plans vary based on the severity of infection, symptoms and medical history. A health care
team evaluates and recommends what they believe to be the best and safest plan to treat your
infection.
•
How long do fungal infection patients usually stay in the hospital?
Because this is a rare outbreak, the recovery time is unclear. A typical hospital stay can be anywhere
between a week to a few months or longer. The anti-fungal medications have side effects, therefore
the dosages must be monitored and adjusted to tolerable levels.
•
I have a trip planned. Can I travel?
Please consult with your doctor before making travel plans.
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•
What happens after I am discharged?
A Fungal Outbreak Clinic has been established to help manage ongoing care management. Please
schedule and keep your follow-up appointments and continue with your outpatient treatments.
V. Fungal Outbreak Clinic
•
What is the Fungal Outbreak Clinic?
The Fungal Outbreak Clinic was established to help manage ongoing care for patients who have
been discharged from the emergency department or inpatient hospital unit. This clinic is designed to
serve patients requiring ongoing care for fungal meningitis or fungal infections.
•
What patients are served at the clinic?
The clinic serves only patients who were exposed to the contaminated injections.
•
Where is the clinic?
Reichert Health Center - Suite 5016, 5333 McAuley Drive, Ypsilanti, MI 48197
•
How do I make an appointment?
Please call 734-712-1533 or visit www.stjoeshealth.org/fungaloutbreak.
VI. About Steroid Injections
•
Are infections common after epidural injections?
Epidural injections are generally very safe procedures, and complications are rare. Fungal meningitis
is an extremely rare. The source of the contaminated lots is the New England Compounding Center
(NECC) in Framingham, Massachusetts. The CDC and FDA are investigating the NECC.
•
Is this the same pain reliever that pregnant women receive during labor?
No. The type of epidural given to patients affected by this outbreak is not the same type of steroid as
that given to women during childbirth.
•
Is it safe in general to receive an epidural injection anywhere right now?
The current outbreak originated from a contaminated medicine from one compounding facility in
Massachusetts - not the procedure itself. Talk to your physician about epidural injections.
For more information, visit
www.stjoeshealth.org/fungaloutbreak
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