Clinician Guidance
Information on this site is focused on important clinical findings and guidance related to the outbreak of fungal meningitis and other infections linked to the use of injectable steroids from three recalled lots of preservative-free methylprednisolone acetate (MPA) distributed by the New England Compounding Center (NECC).
For more information on the outbreak, see the Multistate Fungal Meningitis Outbreak Current Situation page. For information about laboratory results on NECC medications other than three lots of preservative-free MPA, see Information about Additional Medical Products (non-MPA) From New England Compounding Center.
Epidural Abscess and Other Complications
Preliminary data, based on MRI findings in Michigan, Tennessee, and North Carolina provide additional evidence that a substantial proportion of patients have developed a localized infection, including epidual abscess, phlegmon, arachnoiditis, discitis, or vertebral osteomyelitis following exposure to contaminated injections from NECC. CDC has released updated clinical guidance based on these data.
Additional information is found in the Clinician FAQs.
Frequently Asked Questions and Answers
- Frequently Asked Questions For Clinicians: Multistate Fungal Meningitis Outbreak Investigation
- What Should Physicians Be Doing?
Health Alert Network
- CDC Health Alert Network (HAN): Update: Notice to Clinicians: Continued Vigilance Urged for Fungal Infections Among Patients Who Received Contaminated Steroid Injections, March 4, 2013
- CDC Health Alert Network (HAN): Update: Multistate Outbreak of Fungal Infections among Persons Who Received Injections with Contaminated Medication, December 20, 2012
- CDC Health Alert Network (HAN): Update: Additional Contamination Identified in Medical Products from New England Compounding Center, December 3, 2012
- CDC Health Alert Network (HAN): Update: Multistate Outbreak of Fungal Meningitis and Other Infections Associated with Contaminated Steroid Medication , November 20, 2012
- CDC Health Alert Network (HAN): Contamination Identified in Additional Medical Products from New England Compounding Center, November 1, 2012
- CDC Health Alert Network (HAN): Voluntary Recall of All Ameridose Medical Products, November 1, 2012
- CDC Health Alert Network (HAN): Issuance of Guidance on Management of Asymptomatic Patients Who Received Epidural or Paraspinal Injections with Contaminated Steroid Products, October 23, 2012
- CDC Health Alert Network (HAN): Update: Multistate Outbreak of Fungal Meningitis and Joint Infections Associated with Contaminated Steroid Medications, October 17, 2012
- CDC Health Alert Network (HAN): Multistate Outbreak of Meningitis and Stroke Associated with Potentially Contaminated Steroid Medication, October 8, 2012
- CDC Health Alert Network (HAN): Meningitis and Stroke Associated with Potentially Contaminated Product, October 4, 2012
FDA Updates
Management and Treatment
As part of its investigation, CDC has posted interim guidance documents below. Development of this clinical guidance has been aided by discussions with a group of experts in fungal infectious disease who have provided their individual input on patient management and treatment. Because of the challenges involved in treating patients with these fungal infections, CDC has advised clinicians to consult with infectious disease medical specialists for further guidance on patient diagnosis, management, and follow up.
- Interim Treatment Guidance for Central Nervous System and Parameningeal Infections Associated with Injection of Contaminated Steroid Products
- Interim Treatment Guidance for Osteoarticular Infections Associated with Injection of Contaminated Steroid Products
- Guidance on Management of Asymptomatic Patients Who Received Epidural or Paraspinal Injections with Contaminated Steroid Products
Case Definitions
Diagnostic Testing
- Diagnostic Testing for Septic Arthritis and Specimen Submission to CDC – Outbreak Associated with Injection of Potentially Contaminated Steroid Products
- Diagnostic Testing and Specimen Shipping for Central Nervous System and Parameningeal Infections
Laboratory and Pathology
COCA Conference Call Page
Upcoming and recent call archive about Multistate Fungal Meningitis Outbreak Investigation
Publications and Resources
CDC Webinar: Update on the Multistate Outbreak of Fungal Meningitis and Other Infections
Data collected in the ongoing outbreak of fungal meningitis and other infections has demonstrated the importance of MRIs in order to diagnose focal infections and has led to CDC recommending new guidelines to clinicians concerning the clinical management of patients. In this webinar, CDC discusses these findings and the updated recommendations.
Medscape Commentary: Clinician Guidance for Fungal Meningitis
Medscape Commentary: Fungal Infection Outbreak: What Should Physicians Be Doing?
CDC expert Dr. Tom Chiller provides clinical guidance related to the multistate fungal meningitis outbreak among patients who received contaminated steroid injections.
CDC Morbidity and Mortality Weekly Report (MMWR)
- MMWR: Multistate Outbreak of Fungal Infection Associated with Injection of Methylprednisolone Acetate Solution from a Single Compounding Pharmacy — United States, 2012
- MMWR: Multistate Fungal Meningitis Outbreak — Interim Guidance for Treatment
CDC Resources
- Frequently Asked Questions for Patients
- CDC Digital Press Kit with Laboratory Photos and Footage
- CDC Fungal Diseases
- CDC Fungal Meningitis
- CDC Information About Additional Medical Products (non-MPA) From New England Compounding Center
- CDC Information About Voluntary Recall of All Ameridose Medical Products
- CDC and Public Health Response to the 2012 Fungal Meningitis and other Infections Outbreak: Statement of Beth Bell, MD, MPH [PDF - 8 pages]
Select Publications
- Bell BP, Khabbaz RF. Responding to the Outbreak of Invasive Fungal Infections: The Value of Public Health to Americans. JAMA. 2013;():1-2. doi:10.1001/jama.2013.526.
- Smith RM, Schaefer MK, Kainer, MA, et al. Fungal infections associated with contaminated methylprednisolone injections – Preliminary Report. New Engl J Med 2012 Dec.
- Kainer MA, Reagan DR, Nguyen DB, et al. Fungal infections associated with contaminated methylprednisolone in Tennessee. New Engl J Med 2012 Nov.
- Lyons JL, Gireesh ED, Trivedi JB, et al. Fatal Exserohilum meningitis and central nervous system vasculitis after cervical epidural methylprednisolone injection. Ann Intern Med 2012 Oct.
- Pettit AC, Kropski JA, Castilho JL, et al. The index case for the fungal meningitis outbreak in the United States. New Engl J Med 2012 Oct.
U.S. Food and Drug Administration (FDA)
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