Medical case study of early fungal meningitis outbreak victim shows difficulty in diagnosing
Since investigators began narrowing in on the possible source of the deadly fungal meningitis outbreak that, to date, has killed 19 and infected 245 others, doctors have been alerted to test spinal fluid in patients who are exhibiting symptoms of meningitis and have received a steroid injection for back pain. But the first patients to fall ill weren’t as lucky.
The first case to be described in medical detail is of a 51-year-old woman who showed up at the emergency room with a severe headache. A week prior she had been treated for neck pain and fibromyalgia with an injection of a steroid into her neck. These steroid shots are considered safe. But the shot the woman received was one of the first from a batch of nearly 18,000 that were distributed beginning in late May to 73 medical facilities in 23 states. Only weeks ago did health officials discover the shots were the likely source of the fungal meningitis infections.
Headaches are a common side effect of any injection to the spinal cord. As a precaution, emergency room staff did a CT scan on the woman to check for signs of stroke or brain tumor. When neither was found, the woman was sent home. But her symptoms only got worse. By the next morning she was also suffering from double vision, dizziness and nausea – all classic symptoms of meningitis.
Doctors were still baffled. She didn’t have a fever and her blood didn’t show signs of immune system reaction seen with bacterial or viral meningitis. But fungal meningitis is different. It is extremely rare.
Most of the cases have been caused by a slow growing mold called Exhiloserum that has never been known to cause meningitis. Had doctors known what was causing the woman’s symptoms they could have treated her with heavy doses of antifungal medication. If caught early enough she may have survived.
But doctors couldn’t have known to test for the mold. The diagnosis remained a mystery. Doctors performed an MRI to check for viruses or bacteria, but the test came out negative. The woman’s health went steadily downhill. She lost her ability to speak and breathe on her own.
Doctors finally sent the woman to Johns Hopkins for further testing by a new team of medical professionals. There, she was tested for herpes, shingles, Epstein-Barr virus, West Nile, and cytomegalovirus. They also checked for two types of fungus, bryptococcus and histoplasma, but all tests came out negative. It never occurred to the team to test for black mold. Health officials say the tests would likely have come up negative anyway.
Nine days after the woman first went to the emergency room with excruciating headache pain, she fell into a coma. Her brain had become infected and there was swelling in her neck at the site of the steroid injection. Doctors started her on antifungal drugs, but it was too late. She died the next day, just as new tests revealed the Eserohilum black mold had killed her.
Nearly all the people who have received steroid shots from the tainted batches have been contacted and told to seek medical attention if they experience any symptoms of meningitis. Some patients have opted to have painful spinal taps to check for the infection. If caught early, recovery is likely. But untreated, meningitis can cause permanent neurological damage and death.
Source: NBC News
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