Pharmacy Fungus Plunges Doctors Into 'Gray Zone'

In another paper in the same issue of the Annals, infectious disease specialist Thomas Kerkering, MD, andclinicians at the Carilion Clinic in Roanoke, VA., describe their outcomes in treating half of the state's 50 infected, symptomatic patients, and the process they've used with all 131 patients who were exposed to contaminated epidural steroid injections, including some who have not become symptomatic to date.

Most worrisome, the researchers say, is that some of the patients who originally underwent lumbar punctures with no evidence of infection have later returned with meningitis caused by the steroid fungus.

This suggests "that patients will need to be followed for an undetermined duration of time."  Additionally, they say, a "high number" of patients have complained of "word searching," suggesting that long-term neurological consequences and central nervous system disease are important concerns for long-term follow-up, the researchers said in a statement.

This national outbreak of fungus or black mold from infected steroids injected into the spine is such a new issue, there still are no clear recommendations for the proper course of care, either for patients who are suspected of being infected or actually have symptoms, the researchers said.

Nevertheless, the hospital has established a hotline, and is treating patients with intravenous voriconazole, or in some cases intravenous amphotericin B if they developed voriconazole symptoms or side-effects.