Fungal Meningitis Update

It has been a few days since Mike last blogged on this curious but devastating outbreak, and time to mention a few developments. First off, it is now clear that the outbreak isn’t primarily due to Aspergillus, but rather to a little-known soil (or dematiaceious) fungus called Exserohilum rostratum. The Mycology Online site at the University of Adelaide is an excellent quick guide to the gory details of identification (be sure to look carefully for the ellipsoidal to fusiform poroconidia that are formed apically on a sympodially elongating geniculate conidiophore!).

Exserohilum are common environmental molds, and rarely cause human disease. Slow-growing and challenging to identify in the lab, it would be difficult to imagine an agent that would be more insidious and refractory to diagnosis and treatment once injected into an immune-privileged site. This is why the number of cases continues to increase long after the compounding pharmacy responsible for distribution has been shut down (and also why treatment may not be effective by the time a case is recognized).

The CDC website is the best source of authoritative information (as of today, 198 cases and 15 deaths), and this excellent article illustrates the degree to which our CDC and public health colleagues are working to get a handle on this outbreak (a special shout-out to Shawn Lockhart, featured in the photo—Shawn did his clinical microbiology training with us here at Iowa). Those who were exposed to the affected lots of injectable steroids are literally being tracked down one-by-one, using any resources available to state public health authorities (while I was at HICPAC, one public health official described local police knocking on doors to inform those at risk).

Finally, I wanted to highlight the fact that your IDWeek planners have been working overtime to put together a late-breaker session at IDWeek to update all attendees on this outbreak. We will have representation from CDC, a clinical mycologist, and a clinician involved in the care of affected patients. So if you are heading to San Diego please attend!