Staff at a Roanoke hospital outlined how they are treating the outbreak of fungal meningitis using intravenous voriconazole 6 mg/kg every 12 hours, or switching to IV amphotericin-B if symptoms or side-effects warranted, a journal article reported.
Patients remained hospitalized until oral voriconazole was available, and weekly follow-ups are done at an outpatient clinic. The article's authors reported not knowing how long patients will have to be followed, and noted that there were long-term sequelae such as neurological consequences.
The Carilion Clinic in Roanoke saw half the fungal meningitis cases reported from Virginia of patients presenting with suspected fungal meningitis related to contaminated epidural spinal injections. This created a surge of patients with a rare infection seeking help from physicians who had little data to guide treatment.
Outcomes were reported online Nov. 9 in Annals of Internal Medicine.
Of 172 patients who'd had epidural steroid injections potentially with contaminated methylprednisolone, 131 underwent lumbar puncture because of symptoms or signs consistent with central nervous system disease. Twenty-five (19%) had neutrophilic meningitis. All were started on voriconazole therapy alone.
Of those 25 patients, 10 patients had arachnoiditis, another had an epidural abscess and nine experienced urinary retention. Fifteen remain on voriconazole; ten were switched to amphotericin B. MRIs uncovered ventriculitis, leptomeningeal enhancement, infarct, hemorrhage and arachnoiditis. Three patients being followed had strokes during treatment.
Two other patients had strokes and died quickly, leading authors to suggest that Exserohilum rostratum cultured from the outbreak is angio-invasive.
Also, 72% of patients reported complaints of difficulty finding words, and the authors said neurological histories, examinations and brain imaging will have to be done to determine the extent of this adverse event.