CDC - Outbreak of Fungal Meningitis - Case Definitions

[Catbird]

Updated Oct. 12th.

Case Definitions for Meningitis and Septic Arthritis


October 12, 2012 3:30 PM EDT

Probable Case:
A person who received an injection with methylprednisolone acetate produced by the New England Compounding Center who developed any of the following:

• Meningitis (*1) of unknown etiology following epidural injection after May 21, 2012.
• Stroke following epidural injection after May 21, 2012 (*2), who has not received a diagnostic lumbar puncture.
• Spinal osteomyelitis or epidural abscess of unknown etiology at the site of injection following epidural or sacroiliac injection after May 21, 2012.
• Osteomyelitis or worsening inflammatory arthritis of a peripheral joint (e.g., knee) of unknown etiology diagnosed following joint injection after May 21, 2012.

*1 Clinically diagnosed meningitis meaning 1 or more of the following symptoms: headache, fever, stiff neck, or photophobia, in addition to a cerebrospinal fluid (CSF) profile showing pleocytosis (>5 white blood cells, adjusting for presence of red blood cells by subtracting 1 white blood cell for every 500 red blood cells present) regardless of glucose or protein levels.

*2 These people, if possible, should have a lumbar puncture.


Confirmed Case:

• A probable case with evidence of a fungal pathogen (by culture, histopathology, molecular, or antigen-based assay) associated with the clinical syndrome.

Patients under investigation:

• A person who developed an infection of a normally sterile site (e.g., blood, CSF, pleural fluid, peritoneal fluid, pericardial fluid, surgical aspirate, bone, joint fluid, or internal body site (e.g., lymph node, brain)) following use of a product labeled as sterile prepared by the New England Compounding Center.

 

[Catbird]

Re: CDC - Outbreak of Fungal Meningitis - Case Definitions

Updated case definitions.

Case Definitions for Meningitis and Septic Arthritis

October 16, 2012 8:00 PM EDT


Probable Case

A person who received a methylprednisolone acetate (MPA) injection, with MPA that was definitely or likely produced by the New England Compounding Center (NECC), and subsequently developed any of the following

• Meningitis(*1) of unknown etiology following epidural or para-spinal injection(*2) after May 21, 2012;
  
• Posterior circulation stroke without a cardioembolic source and without documentation of a normal cerebrospinal fluid (CSF) profile, following epidural or para-spinal injection2 after May 21, 2012;(*3)
  
• Osteomyelitis or abscess of unknown etiology in the spinal or para-spinal structures at the site of injection following epidural or para-spinal injection2 after May 21, 2012; or
  
• Osteomyelitis or worsening inflammatory arthritis of a peripheral joint (e.g., knee, shoulder, or ankle) of unknown etiology diagnosed following joint injection after May 21, 2012.

*1 Clinically diagnosed meningitis with one or more of the following symptoms: headache, fever, stiff neck, or photophobia, in addition to a CSF profile showing pleocytosis (>5 white blood cells, adjusting for presence of red blood cells by subtracting 1 white blood cell for every 500 red blood cells present) regardless of glucose or protein levels.

*2 Para-spinal injections include, but are not limited to, spinal facet joint injection, sacroiliac joint injection, spinal or para-spinal nerve root/ganglion block, or blood patch.

*3 Patients in this category who do not have any documented CSF results should have a lumbar puncture performed if possible.


Confirmed Case

A probable case with evidence (by culture, histopathology, or molecular assay) of a fungal pathogen associated with the clinical syndrome.


Post-ProceduralIinfection in Patients Exposed to Non-MPA NECC Products

A patient who developed an infection in a normally sterile site(*4) following use of one or more products labeled as sterile and prepared by NECC, excluding MPA.

*4 Normally sterile sites include blood, CSF, pleural fluid, peritoneal fluid, pericardial fluid, surgical aspirate, bone, joint fluid, or internal body site (e.g., lymph node or brain).

 

[Catbird]

Re: CDC - Outbreak of Fungal Meningitis - Case Definitions

Multistate Fungal Meningitis Outbreak Investigation​

Case Definitions for Meningitis and Septic Arthritis​

October 24, 2012 6:30 PM EDT


Probable Case

A person who received a methylprednisolone acetate (MPA) injection, with MPA that definitely or likely came from one of the following 3 lots produced by the New England Compounding Center (NECC) [05212012@68, 06292012@26, 08102012@51], and subsequently developed any of the following:

• Meningitis (*1) of unknown etiology following epidural or paraspinal injection (*2) after May 21, 2012;
• Posterior circulation stroke without a cardioembolic source and without documentation of a normal cerebrospinal fluid (CSF) profile, following epidural or paraspinal injection2 after May 21, 2012 (*3);
• Osteomyelitis, abscess or other infection (e.g., soft tissue infection) of unknown etiology, in the spinal or paraspinal structures at or near the site of injection following epidural or paraspinal injection2 after May 21, 2012; or
• Osteomyelitis or worsening inflammatory arthritis of a peripheral joint (e.g., knee, shoulder, or ankle) of unknown etiology diagnosed following joint injection after May 21, 2012.

*1 Clinically diagnosed meningitis with one or more of the following symptoms: headache, fever, stiff neck, or photophobia, in addition to a CSF profile showing pleocytosis (>5 white blood cells, adjusting for presence of red blood cells by subtracting 1 white blood cell for every 500 red blood cells present) regardless of glucose or protein levels.

*2 Paraspinal injections include, but are not limited to, spinal facet joint injection, sacroiliac joint injection, or spinal or paraspinal nerve root/ganglion block.

*3 Patients in this category who do not have any documented CSF results should have a lumbar puncture performed if possible, using a different site than was used for the epidural injection when possible.


Confirmed Case

A probable case with evidence (by culture, histopathology, or molecular assay) of a fungal pathogen associated with the clinical syndrome.