CDC Again Warns of Unrecognized Infections in Patients Linked to NECC

The Dec. 20 Health Alert Network notice re-emphasized guidance from a month earlier recommending “assertive clinical evaluation” of patients.

A Dec. 20 Health Alert Network notice from CDC re-emphasized its guidance from a month earlier that recommended "assertive clinical evaluation" of patients who received contaminated methylprednisolone acetate from the New England Compounding Center (NECC) in Framingham, Mass., even if they're showing no symptoms of infection.

"New information from diagnostic imaging of patients ... demonstrates the need for assertive clinical evaluation of these patients for the possibility of an unrecognized, localized spinal or paraspinal infection," the notice states. It was CDC and state partners "have analyzed new preliminary data based on recent Magnetic Resonance Imaging (MRI) studies among patients who had spinal or paraspinal injection with contaminated MPA from NECC. These findings demonstrate that among patients with no previous evidence of infection, and with new or worsening symptoms at or near the site of their injection, more than 50% had findings suggestive of a localized spinal or paraspinal infection, including epidural abscess, phlegmon, arachnoiditis, discitis, or vertebral osteomyelitis.

"This new information suggests that some patients who received spinal or paraspinal injections with implicated MPA from NECC may currently have an unrecognized, localized spinal or paraspinal infection. CDC is therefore re-emphasizing the guidance from the November 20 HAN advisory that recommended clinicians remain vigilant for evidence of fungal infection in these patients and use an assertive approach for clinical management and follow-up of these patients. CDC continues to recommend MRI with contrast of the symptomatic area(s) in patients with new or worsening symptoms at or near their injection site following spinal or paraspinal injection of implicated MPA. In addition, CDC is recommending that clinicians should consider obtaining an MRI with contrast of the injection site in patients with persistent but baseline symptoms because the presentation of these spinal or paraspinal infections can be subtle and difficult to distinguish from a patient's baseline chronic pain.

In this outbreak of fungal meningitis and other infections among patients exposed to contaminated medications from three lots distributed by NECC, as of Dec. 18, 2012, a total of 620 cases and 39 deaths had been reported in 19 states. Visit http://www.cdc.gov/hai/outbreaks/meningitis.html for additional guidance and information.

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