Multistate Outbreak of Fungal Meningitis and Other Infections

Vials and test tubes on top of a periodic table.

Laboratory Guidance Overview

Information on this site is focused on important laboratory 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.

Background

Three laboratories at CDC are working in coordination with state public health departments and clinicians to find out more about fungal infections in patients exposed to three lots of recalled preservative-free MPA.
Several laboratory experts and offices are working together on reviewing laboratory findings. All of these laboratories use a number of sophisticated testing methods including electron microscopy, polymerase chain reaction (PCR) amplification and sequencing of DNA, and MALDI-TOF mass spectrometry analysis.
- The Mycotic Diseases Branch Fungus Reference Laboratory is conducting tests to detect fungal agents in CSF, joint fluid, and tissues from patients, and is confirming the identification of fungi isolated from patient specimens.
- The Infectious Diseases Pathology Branch laboratory is examining tissues from biopsy and autopsy materials to confirm the presence of fungi and to document the pathology in human tissues.
- The Clinical and Environmental Microbiology Branch laboratory has conducted sterility testing on various products from the NECC and Ameridose pharmacies.
Little information is known about the disease and pathogenesis caused by Exserohilum, the predominant pathogen associated with this outbreak.

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During the multistate meningitis outbreak, a plate shows results of susceptibility testing to the antifungal drug amphotericin B. The drug inhibits growth of Exserohilum in the clear area where the amphotericin drug has diffused into the medium. Exserohilum is growing elsewhere on the plate.