Localized spinal infections from NECC compounding disaster persist

December 20, 2012

Patients who received spinal or paraspinal injection with contaminated methylprednisolone from the New England Compounding Center (NECC) and have new or worsening symptoms at or near the injection site may have an unrecognized, localized infection there, according to a CDC Health Alert Network (HAN) message issued Dec. 20.

CDC and its state partners analyzed preliminary data based on recent magnetic resonance imaging (MRI) studies among patients who have these injections but had no previous evidence of infection, the health alert said.

“More than 50% had findings suggestive of a localized spinal or paraspinal infection, including epidural abscess, phlegmon, arachnoiditis, discitis, or vertebral osteomyelitis,” the statement noted.

“CDC is therefore re-emphasizing the guidance from the November 20 HAN advisory that recommended clinicians remain vigilant for evidence of fungal infection in these patients and use an assertive approach for clinical management and follow-up of these patients.”

Clinicians should recommend an MRI in patients with new or worsening symptoms at or near the injection site. Also, clinicians should also encourage MRIs for those individuals with persistent baseline symptoms because infections are often subtle and hard to distinguish from a patient’s baseline chronic pain, CDC said.

From Dec. 3-17, a total of 80 news cases, mostly spinal and paraspinal infections, have been reported to the CDC from the states. As of Dec. 20, the cases of fungal infections have climbed to 620, and 39 individuals have perished following this multistate fungal meningitis outbreak.

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