Hospital Faces Uncertainty as It Copes With Surge of Patients With Fungal Meningitis

Abstract

IN THE FIRST WEEK AFTER NEWS BROKE in early October that contaminated steroid injections from a New England compounding pharmacy were the likely cause of a multistate outbreak of fungal meningitis, dozens of patients who had been exposed to potentially contaminated injections at a private pain management practice began presenting each day in the emergency department of a nearby hospital, St Joseph Mercy Ann Arbor Hospital in Ypsilanti, Mich. “In that first week, there was a day our emergency department did more than 60 spinal taps,” said Anurag Malani, MD, an infectious disease specialist at the hospital. “We had this massive influx of [exposed] patients, probably a couple hundred that first week.” Before the initial reports of the outbreak, however, the hospital had already seen 6 cases of patients with fungal meningitis, although clinicians weren’t quite sure of the cause of this cluster, explained Malani. Although this first group of patients presented with meningitis symptoms such as headache, photophobia, and neck stiffness, the symptoms were less severe than typically seen in patients with bacterial meningitis, and tests for bacterial meningitis came back negative. But patients would return to the emergency department with persistent symptoms. “We started to have an inkling something wasn’t right,” Malani said. “The US Centers for Disease Control and Prevention [CDC] notice really put things together.” The notice (http://tinyurl.com/cnvm83q) alerted physicians to the outbreak and the ongoing investigation. By early December 2012, more than 590 cases had been reported to the CDC; 152 of these patients were treated at the 537-bed hospital in Ypsilanti. Of those 152 patients, 63 remained hospitalized at press time, and 7 had died. For clinicians and the hospital administrators at St Joseph Mercy, the outbreak has created unprecedented challenges. In addition to dealing with a huge influx of patients and developing treatment protocols for an extremely rare condition, they have been preparing for what is likely to be at least several more months of care for many of the patients.