Nosocomial Aspergillus meningitis outbreak

This morning's New York Times reports on an alarming outbreak of Aspergillus meningitis in Tennessee. At this point there have been 14 cases, two of whom have died. All patients received steroid injections into their lumbar spines. From time to time we see sporadic cases of infections due to injections of steroids, most commonly into joints, but the vast majority of those cases are due to Staph. aureus. In the current outbreak, it is postulated that the contamination occurred in a compounding pharmacy prior to shipment to the facility where the injections were performed. Because Aspergillus is an extremely rare cause of meningitis, it is unlikely that clinicians would suspect this infection and it's also unlikely that the organism would be seen on initial microscopic view of the spinal fluid. Thus, delays in diagnosis would not be surprising.

Photo:  CDC.