Fungal meningitis cases associated with contaminated steroids have grown to 137, killing 12 and affecting patients in 10 states, the CDC reports one week after the agency announced the outbreak originated from medications produced in a New England compounding pharmacy.

Tennessee continues to bear the greatest burden of disease, reporting 44 cases thus far — more than any other state. Tennessee health officials estimate that about 1,000 patients in the state were exposed to the contaminated steroid, preservative-free methylprednisolone acetate, which is used to control back pain.

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Approximately 5% of Tennessee patients who received injections from the three affected medication lots have developed symptoms consistent with fungal meningitis, health officials estimate. These include fever, new or worsening headache, nausea and new neurological deficit consistent with deep brain stroke.

No new exposures are likely, the CDC said, since the medication has been recalled, along with all other products produced by the New England Compounding Center in Framingham, Mass.

However, the agency is urging clinicians to be on the look out for new cases in the coming weeks, as the incubation period is unknown.

A total of 17,676 vials of the steroid were shipped to pain clinics in 23 states:  California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Texas and West Virginia.

Should the FDA enforce more strict quality controls and sterility testing for compounded prescriptions?

Thus far, two cases have been identified in New Jersey, six in Florida, eight in Maryland, 15 in Indiana, 27 in Virginia and 28 in Michigan, in addition to the 44 reported in Tennessee.

Clinicians should inform their State health department of any patients undergoing evaluation for suspected fungal meningitis. The CDC case definition for suspected fungal meningitis is as follows:

  • A person with meningitis of sub-acute onset (1-4 weeks) following epidural injection after May 21, 2012.
  • A person, who has not received a lumbar puncture, with basilar stroke 1-4 weeks following epidural injection after May 21, 20122.
  • A person with evidence of spinal osteomyelitis or epidural abscess at the site of an epidural injection diagnosed 1-4 weeks after epidural injection after May 21, 20.

In order for patient to meet diagnosis criteria, they must have one or more of the following symptoms: headache, fever, stiff neck, or photophobia and a cerebrospinal fluid profile consistent with meningitis (elevated protein/low glucose/pleocytosis). Lumbar puncture should be performed, if possible to confirm the diagnosis. 

Furthermore, clinicians should report any suspected adverse events following the use of the recalled products to the FDA’s MedWatch program at 1-800-332-1088 or