Spinal Epidural Abscesses - Meningitis Outbreak

Outbreak of a Virulent Strain of Meningitis

The outbreak of a virulent strain of meningitis due to a tainted supply of steroids was only one of the illnesses in what has become a national health crisis.

Many patients have complained of swelling and pain at the epidural injection site, even after the meningitis symptoms have cleared up. It appears that epidural abscesses have formed on some patients, even after having taken powerful antifungal medications. Epidural abscesses form under the skin; they can only diagnosed with certainty using an MRI. Some cases can be cleared with drug treatments, others require surgical intervention.

Spinal Epidural abscess

An epidural abscess is the collection of pus that can be found either in the skull or alongside the spinal column. Spinal epidural abscesses are typically caused by bacteria, but can also be due to fungal infections, or result from a spinal trauma or surgery. Patients with epidural abscesses typically experience neck or back pain, fever, difficulty with urination or bowel and bladder incontinence.

While it is possible to recover completely from an epidural abscess, it can return even after aggressive treatment. If left untreated, permanent nervous system damage could occur, and even paralysis or death.

The black fungus that infected more than 500 patients nationwide and killed nearly 40 was so prevalent in the vials of medication that it could be seen with the naked eye. The epidural injections left patients vulnerable to conditions such as meningitis, arachnoiditis and epidural abscesses because the slightest slip of the needle could have sent the fungus into the spinal column, which is a welcoming environment for fungus due to the temperature and the nutrient content. The fungus would then be carried in the spinal fluid up to the brain, which has very limited defense mechanisms against infection.

While meningitis was the most common infection resulting from the contaminated drug, there have been a few cases of epidural abscesses without accompanying meningitis. Unfortunately, fungal epidural abscesses are fairly rare, and many hospitals have very little or no experience treating them. While some abscesses can be surgically removed, others are wrapped around delicate nerves and cannot be extracted. Some patients have multiple epidural abscesses.

Patients who have received or are receiving treatment for fungal meningitis must continue to receive evaluations by their physicians for additional infections and complications, even well after the infection appears to have cleared up. It is critically important to address epidural abscesses immediately, before nerve damage sets in that could be irreversible.

Unregulated Status of Drug Compounding Pharmacies

Dangers of Improperly Handled Medications

Compounded drugs are nothing new. Doctors prescribe compounded drugs to treat specific conditions on an individual patient basis. For example, pharmacists compound certain drugs to reduce their potency in order to be administered to children, or change the method of drug delivery from tablet to patch form for patients that have trouble swallowing. However, the unregulated status of drug compounding pharmacies has alerted us to the dangers of improperly handled medications because of the tainted steroid medication that went on to be injected into patients and infect them with aggressive meningitis. It is important to educate ourselves about the ways in which our medications are processed in order to prevent serious infections and even worse.

Do not order drugs from overseas online pharmacies

The high cost of prescription medications has forced many patients to purchase their medicines from unregulated overseas pharmacies. It was reported by the National Association of Boards of Pharmacy that fully 97% of 10,000 online pharmacy websites that were investigated do not operate under United States pharmacy laws and regulations . These medications may seem as though they are the same as those that are acquired through hospitals and licensed clinics, but the batches of drugs distributed from these illegal operations might put users at great risk. Investigators found instances of tampering, improper handling and storage, expired drugs that were re-labled with inaccurate expiration dates and counterfeit medications. If an online pharmacy doesn’t require a prescription or medical history, then that pharmacy is operating illegally.

Ask your physician where the prescription medication came from, and if it was compounded

If you are prescribed medication by your doctor, ask him or her if it was compounded, and why. If there are standard FDA approved drugs available in a form that is ready to use, opt for that instead, although it will be very likely more expensive. Very often, physicians will choose the less expensive compounded form of a drug in lieu of the brand name drug. If your medication must be compounded, ask where it must be done; many hospitals compound drugs on site.

Do not allow a pharmacy to compound drugs for you without a specific doctor’s order

Many pharmacies will suggest compounding drugs that are problematic for the patient. Allowing a pharmacist to mix special versions of a medication that was prescribed by a doctor might have an effect unforeseen by the pharmacist that may compromise either the efficacy of the drug or the patient’s health; an effect a physician might catch if alerted to it. If you are having trouble taking medications for any reason, consult your doctor before allowing a pharmacist to make adjustments.