The number of individuals affected by a rare fungal meningitis outbreak has risen to 91 including seven deaths.  Tennessee is the hardest hit state with 32 cases.  Many more individuals are projected to contract the rare disease over the course of the next few weeks.  What do you as a healthcare provider need to know about the outbreak?

The current outbreak of fungal meningitis was first detected in Nashville, TN.  Patients in Nashville began presenting to area hospitals with symptoms such as headache, fever, neck pain and dizziness.  Once diagnosed with meningitis, these patients did not respond to the antibiotic regimens typically administered for bacterial meningitis.  Dr. April Pettit at Vanderbilt University was the first to identify the offending pathogen as Aspergillus fungus and link these atypical cases to possible contamination in spinal injections.  We now know that the steroid, methylprednisolone, manufactured at the New England Compounding Center in Framingham, Mass is responsible for distributing the contaminated medication.  

As during any outbreak or public health scare, you will see many patients present to your clinic or hospital with concern that they have contracted meningitis.  The good news about this recent outbreak is that this particular pathogen cannot be transmitted from person to person.  It is not contagious.  Many women who have recently given birth are expressing concern that they have received contaminated epidural injections.  These women should be reassured the contaminated medication was not used in epidural injections for labor and delivery and they will not affected by the outbreak.  Aspergillus has a long incubation period and can cause meningitis as long as four weeks after injection.  Any patient who has had a spinal injection since July 2012 should be cautioned to seek medical treatment for all symptoms of meningitis including headache, fever, dizziness, nausea and swelling at the injection site. 

As a nurse practitioner, you must be extremely thorough in educating your patients who have received steroid spinal injections about symptoms of meningitis and proceed with caution in treating patients who present with fever and/or neurological symptoms.  Patients who have received spinal injections presenting with any symptom of meningitis, even if mild, should be referred to the emergency department for lumbar puncture to rule out the diagnosis. 


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