Pharmacy Fungus Plunges Doctors Into 'Gray Zone'

Physicians trying to treat the hundreds of patients infected by black mold that that contaminated steroids distributed by a Massachusetts compounding pharmacy last month are finding a lack of evidence for what they should do first.

"We're basically in a gray zone," says Shmuel Shoham, MD, an internist and infectious disease specialist at Johns Hopkins University. "What makes this process difficult is that we're just now learning about the natural history of this infection."

Almost nothing is known about Exserohilum rostratum, the black mold or fungus implicated in the current outbreak in which an estimated 14,000 people have been exposed, with 438 patients infected so far in 19 states.

"Up until two months ago, when the first case was diagnosed, nobody had ever seen, in this location of the body, this particular type of infection in these types of patients," Shoham says. "And so what we've had to do is extrapolate data from other similar infections, organisms causing infections at another site, see how it behaves in the laboratory... and try to sort through to make a reasonable treatment plan."

Shoham and colleague, Kieren Marr, MD, director of transplant and oncology infections diseases at Johns Hopkins, published an article in the current online edition of the Annals of Internal Medicine.Itdetails what they've seen in several dozen infected patients treated at their hospital.