(HealthDay News) – Factors such as increased case finding may explain why Michigan had half of the total spinal infections associated with contaminated methylprednisolone acetate in the recent fungal meningitis outbreak, according to research published in the May 17 issue of the U.S. Centers for Disease Control and Prevention’s Morbidity & Mortality Weekly Report.

To examine why Michigan had 52% of the of the 320 localized paraspinal or spinal infections without meningitis and 29% of the deaths associated with the 2012–2013 national fungal meningitis outbreak even though the state received only 13% of potentially contaminated vials, Jennie Finks, DVM, from the Michigan Department of Community Health in Lansing, and colleagues examined the epidemiologic and clinical characteristics of the Michigan patients.

The researchers noted that patients who had received injections but had no symptoms of infection were offered spinal magnetic resonance imaging, and repeat imagings were offered every two to three weeks, suggesting increased case finding as a factor. The vials of methylprednisolone acetate shipped to Michigan had higher fungal contamination, which may have predisposed patients to localized infection or tissue reaction. The authors also note that 80% of patients received their contaminated injections from one source that had received the largest shipment of the lot associated with an increased risk for infection. Clinicians also preferred the transforaminal rather than translaminar injection technique, which may also have been a factor.

“Among patients exposed to contaminated methylprednisolone acetate through injection, early recognition and initiation of therapy might reduce the risk for associated complications, including stroke and death, and remains crucial to management of this outbreak,” Finks and colleagues conclude.

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