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Aspergillus outbreak expands

The outbreak of nosocomial meningitis due to Aspergillus that we noted yesterday is larger than initially reported. Today's New York Times now reports that there have been 34 cases (4 deaths) that involve patients in 5 states. The cases have been traced to contaminated methylprednisolone solution used for epidural injections that was compounded at a pharmacy in Massachusetts.

CDC is recommending that suspected cases be treated with IV voriconazole and consideration be given to the addition of IV amphotericin B.

Photo:  Janet Carr, CDC.
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  1. Dan DiekemaOctober 4, 2012 at 10:02 AM

    Thanks for posting on this, Mike. One of the big challenges for Aspergillus meningitis is making the diagnosis (which probably means there are many more cases out there that haven't been detected). Direct stains and cultures are notoriously poor, leaving two main options: CSF galactomannan and PCR. Both would be send out tests for most labs, and the experience with CSF galactomannan testing is limited to small case series or case reports. Paul Verweij's group had a nice review in CID of galactomannan experience on body fluids other than blood, and they include a section on CSF testing in that paper:
    http://cid.oxfordjournals.org/content/39/10/1467.full

    The most important aspect of diagnosis (as is often the case) is taking a very careful history for epidural injections, and then if Aspergillus meningitis is a consideration to go ahead and get fungal cultures, but also CSF galactomannan and PCR (serum galactomannan may also be helpful).

    Dan

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