Multistate Outbreak of Fungal Meningitis and Other Infections

Vials and test tubes on top of a periodic table.

Pathologic Results

December 4, 2012 3:00 PM EDT

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.

Microscopic Gallery

Disease Caused by Fungus in Brain Tissue

A collage of microscopic views of tissues showing evidence of necrotizing or involving a branch of the basilar artery.

Click to view larger image.

Major histopathologic findings in clinical cases of meningitis show evidence of necrotizing, suppurative vasculitis with thrombosis (A and B). These findings are seen in many cases involving a branch of the basilar artery (C), which are consistent with the clinical findings.

Disease Caused by Fungus in Brain Tissue

A collage of microscopic views of tissues showing necrosis and giant cell arteritis.

Click to view larger image.

Another finding in the basilar artery is necrosis (A) and giant cell arteritis (B).

Fungus in Brain Tissue

A collage of microscopic views of tissues showing various ways to visualize fungal hyphae.

Click to view larger image.

Fungal hyphae (black) can be visualized with silver stain within vessel walls (A) and in area of necrosis in basilar artery (B). Using a polyfungal immunohistochemistry reagent, fungal hyphae (red) is also seen in the purulent exudate in spinal meningitis (C).

Fungus in Tissue Surrounding the Spinal Cord

Microscopic views of tissues surrounding the spinal cord comparing the visibility of Arachnoiditis.

Click to view larger image.

Arachnoiditis is a complication present in some of the patients. In tissue obtained adjacent to the affected site, dense collagen-rich soft tissue with no inflammatory infiltrate (A) is seen. Fungal hyphae are seen in this tissue by silver stain (GMS) with modified oxidation times (B).

Fungus in a Hip Joint

Click to view larger image.

In patients with arthritis, fibrin and necrotic debris are seen in affected joints (A). Although rare, immunohistochemistry facilitates the focal detection of hyphae (B) in these areas (red staining).

Top of Page