The fungal meningitis outbreak five years later: what have we learned about Exserohilum rostratum?

Abstract

ABSTRACTIntroduction: On 18 September 2012, United States health officials began to react to a large outbreak of fungal meningitis traceable to methylprednisolone from a compounding pharmacy in Framingham, Massachusetts. Although the index case was attributed to the opportunistic mold Aspergillus fumigatus, all subsequent cases were due to the dematiaceous mold Exserohilum rostratum, which had previously been an uncommon cause of disease in humans.Areas covered: In this paper, the authors examine recent advances in the diagnosis and treatment of Exserohilum infection and provide updates on how the innate and acquire immune responses enable clearance of human fungal pathogens.Expert commentary: The fungal meningitis outbreak of 2012 stretched across 20 states and resulted in 753 cases of central nervous system infection and 64 deaths. In this paper, the authors examine how the outbreak prompted investigators to develop novel diagnostic and therapeutic options that have advanced the study of human fungal pathogens and will benefit patients who are susceptible to invasive mycoses.