MRI screening may help identify spinal infections from contaminated drug injections

June 18, 2013

Magnetic resonance imaging (MRI) at the site of injection of a contaminated lot of a steroid drug to treat symptoms such as back pain resulted in earlier identification of patients with probable or confirmed fungal spinal or paraspinal infection, allowing early initiation of medical and surgical treatment, according to a study in the June 19 issue of JAMA.

"Fungal contamination of methylprednisolone [a steroid] prepared by a compounding pharmacy resulted in an unprecedented multistate outbreak of meningitis in the fall of 2012," according to background information in the article. "Initially, these injections were complicated by meningitis. Within 6 weeks of the outbreak, meningitis became less frequent and localized spinal and paraspinal infections became the principal manifestations of contaminated . In contrast to the relatively brief period in which meningitis cases appeared, a steady stream of spinal and paraspinal infections continue to present long after the injections were administered. Because received these injections to treat back pain or neuropathic symptoms, the presentation of a slowly developing spinal or paraspinal infection has been obscured."

Anurag N. Malani, M.D., of St. Joseph Mercy Hospital, Ann Arbor, Mich., and colleagues conducted a study to determine if patients who had not presented for medical care but who had received contaminated methylprednisolone developed spinal or paraspinal infection at the site detected using contrast-enhanced MRI screening. There were 172 patients who had received an injection of methylprednisolone from a highly contaminated lot at a pain facility but had not presented for medical care related to adverse effects after the injection. Screening MRI was performed between November 2012 and April 2013.

Of the 172 patients screened, 36 (21 percent) had an abnormality in their MRI. Thirty-five of the 36 patients with abnormal MRIs met the (CDC) case definition for probable (17 patients) or confirmed (18 patients) fungal spinal or paraspinal infection. All 35 patients were treated with antifungal agents; 24 required surgical intervention.

"At the time of surgery, 17 of 24 patients (71 percent), including 5 patients who denied having symptoms, had laboratory evidence of fungal infection," the authors write.

Data were obtained from 115 patients regarding the presence of new or worsening back or neck pain, radiculopathy, or lower-extremity weakness Thirty-five of the 115 patients (30 percent) had at least 1 of these symptoms.

"Our findings support obtaining contrast-enhanced MRI of the injection site in patients with persistent back pain even when their pain disorder has not worsened," the researchers write. "A proactive outreach to patients receiving injections from a highly contaminated lot, especially lot No. 06292012@26, is needed. may detect infection earlier in some patients, leading to more efficacious medical and surgical treatment and improved outcomes," the researchers conclude.

"… Malani et al have demonstrated the possibility of largely asymptomatic fungal infection among patients previously exposed to injection with contaminated lots of ," writes George R. Thompson III, M.D., of the University of California, Davis and colleagues in an accompanying editorial.

"These findings suggest MRI of the injection site may be an effective screening procedure in some patients but should not be widely adopted, particularly for patients who received peripheral joint injections, given the much lower attack rate. For patients who received spinal injections with steroids from an unknown lot number, MRI-based screening may be appropriate. Whether patients with normal initial MRI findings receive reimaging at a later date remains a difficult question in this evolving outbreak."

Explore further: Study examines outbreak of spinal infections in Michigan

More information: JAMA. 2013;309(23):2465-2472
JAMA. 2013;309(23):2493-2495

Related Stories

Study examines outbreak of spinal infections in Michigan

May 21, 2013
(HealthDay)—Factors such as increased case finding may explain why Michigan had half of the total spinal infections associated with contaminated methylprednisolone acetate in the recent fungal meningitis outbreak, according ...

FDA warns of infections tied to Tennessee pharmacy

May 24, 2013
(AP)—Government health officials are investigating several health problems reported with potentially contaminated medications made by a Tennessee specialty pharmacy.

Man relapsed after treatment for meningitis tied to tainted injections

May 29, 2013
(HealthDay)—Since the start of last year's outbreak of fungal meningitis cases linked to tainted steroid injections, federal health officials have recommended three to six months of antifungal therapy to combat potentially ...

Fungal meningitis deaths rise to 24, CDC reports

October 25, 2012
The U.S. Centers for Disease Control and Prevention reported Wednesday that a 24th person had died of fungal meningitis after receiving contaminated steroid injections. The latest victim had received an injection to treat ...

Steroid injection may lead to worse outcomes in patients with spinal stenosis

February 19, 2013
For patients with spinal stenosis, epidural steroid injections (ESI) may actually lead to worse outcomes—whether or not the patient later undergoes surgery, according to a study in the February 15 issue of Spine.

Health warning on new round of fungal infections

December 6, 2012
(AP)—Tennessee health officials are once again alerting patients who received tainted steroid shots after finding that some have infections at the injection site that could lead to fungal meningitis.

Recommended for you

Google searches can be used to track dengue in underdeveloped countries

July 20, 2017
An analytical tool that combines Google search data with government-provided clinical data can quickly and accurately track dengue fever in less-developed countries, according to new research published in PLOS Computational ...

MRSA emerged years before methicillin was even discovered

July 19, 2017
Methicillin resistant Staphylococcus aureus (MRSA) emerged long before the introduction of the antibiotic methicillin into clinical practice, according to a study published in the open access journal Genome Biology. It was ...

New test distinguishes Zika from similar viral infections

July 18, 2017
A new test is the best-to-date in differentiating Zika virus infections from infections caused by similar viruses. The antibody-based assay, developed by researchers at UC Berkeley and Humabs BioMed, a private biotechnology ...

'Superbugs' study reveals complex picture of E. coli bloodstream infections

July 18, 2017
The first large-scale genetic study of Escherichia coli (E. coli) cultured from patients with bloodstream infections in England showed that drug resistant 'superbugs' are not always out-competing other strains. Research by ...

Ebola virus can persist in monkeys that survived disease, even after symptoms disappear

July 17, 2017
Ebola virus infection can be detected in rhesus monkeys that survive the disease and no longer show symptoms, according to research published by Army scientists in today's online edition of the journal Nature Microbiology. ...

Mountain gorillas have herpes virus similar to that found in humans

July 13, 2017
Scientists from the University of California, Davis, have detected a herpes virus in wild mountain gorillas that is very similar to the Epstein-Barr virus in humans, according to a study published today in the journal Scientific ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.