Tainted steroid sickens local man

Warren County man ill as outbreak grows nationwide


These facililities received medications of some type from New England Compounding Center in Framingham, Mass. The compounding pharmacy closed earlier this month and has voluntarily recalled all of its products, though only injectable steroids used to treat back and joint pain have been linked to fungal meningitis so far.

  • Bidwell Surgery Center,5950 Innovation Drive,Franklin
  • Christ Hospital Spine Surgery Center, 4020 Smith Road, Cincinnati
  • Cincinnati Eye Institute,3219 Clifton Ave., Cincinnati
  • Cincinnati Eye Institute,1945 CEI Drive, Blue Ash
  • Cincinnati Pain Management,8261 Cornell Road, Cincinnati
  • Dayton Vitreo-Retinal Associates, 301 W. First St., Dayton
  • Eye Laser and Surgery Center, 4235 Indian Ripple Road, Dayton
  • Eye Services LLC, 671 W. Main St., Wilmington
  • Greater Cincinnati Pain Management,4243 Hunt Road, Cincinnati
  • Kunesh Eye Center Inc., 2601 Far Hills Ave., Oakwood
  • Medical Weight Management Center, 9050 Montgomery Road, Cincinnati
  • Physicians Healthsource, Inc. 3328 Westbourne Drive, Cincinnati
  • Professional Radiology, 9825 Kenwood Road, Blue Ash
  • Samaritan North Surgery Center, 9000 N. Main St., Dayton
  • SW Ohio ASC 295 N. Breiel Blvd., Middletown
  • Western Hills Interventional Pain, 6460 Harrison Ave, Cincinnati

A 52-year-old Warren County man is the ninth in Ohio sickened in an outbreak of a rare brain infection that has resulted in the deaths of 19 people nationwide.

The Ohio Department of Health released no additional details Wednesday about the man as the multistate fungal meningitis cases continue to grow. Ohio has reported one case each in Crawford, Hamilton and Morrow counties, and five cases in Marion County. Nationally, the outbreak has also infected 247 people in 15 states.

The Food and Drug Administration and the Centers for Disease Control and Prevention are jointly investigating the outbreak, which is linked to an injectable steroid — methylprednisolone acetate — manufactured by New England Compounding Center in Framingham, Mass. The company has recalled all of its products and ceased operations. As many as 14,000 people received injections from suspect shipments of the steroid treatments produced by NECC. The shots are administered for back and joint pains.

Criminal investigators from the FDA have joined the investigation, and two members of Congress have asked the U.S. Department of Justice to investigate the pharmacy. Civil lawsuits are also being filed by victims and their families, and a law firm in Minnesota is seeking to establish a class action lawsuit connected to the outbreak.

Additional products made by NECC — a second steroid and a medication used to paralyze heart muscle during open heart surgery — are also being investigated for potential risks after two people who received those drugs showed signs of fungal infection.

Test results so far show infections with three kinds of fungus, most of them a form of black mold, the CDC said. Of 42 patients, 40 were infected with Exserohilum fungus. The others were infected with Aspergillus or Cladosporium. All are treated with the same anti-fungal medications.

Three lots of the suspect steroid were recalled last month by NECC. All the illnesses have been traced to one of those lots.

Ohio officials have asked local health care providers to check on patients who received any injectable products prepared by NECC, including those prepared for eye surgeries and other procedures, “out of an abundance of caution,” said Dr. Mary DiOrio, state epidemiologist for the health department. Sixteen facilities in the Dayton and Cincinnati region are among 64 statewide that have received medications compounded or repackaged by NECC since May 21.

Local facilities on alert

Local providers say they are cooperating and fielding questions from patients worried about their safety.

Christa Paul, an administrator at Bidwell Surgery Center in Franklin, said the outbreak “has created a lot of panic among our patients.”

The surgery center purchased a repackaged medication from NECC, she said, not a medication the pharmacy mixed itself, and it was not one of the injectable steroids. Patients who received the medication have been notified, Paul said.

Lucy Helmers, administrator at the Kunesh Eye Center in Oakwood, said the center purchased from NECC repackaged Avastin, a chemotherapy drug sometimes injected to treat certain eye conditions. It has not been implicated in the outbreak, but patients who received it have been notified, and the center has pulled it from their shelves.

“My phone is ringing off the hook,” she said.

In a statement, doctors at Dayton Vitreo-Retinal Associates said they are not aware of any Ohio or national cases “associated with injections in and around the eye.” They are “contacting patients who have had recent ocular injections to insure they are healthy and doing well and what potential warning signs to be alert to. We are taking this very seriously.”

Jeff Nicolai, executive director of the Southwestern Ohio Ambulatory Surgery Center in Middletown, said the center was not using any of the medications linked to the meningitis cases. Still, he said, all medications from the now-closed Massachusetts company were returned to the company as an abundance of caution.

The FDA Tuesday notified medical facilities and told them to warn all patients who were given a similar medication within a certain date. On Wednesday, Nicolai started mailing out letters to about 100 patients, who mostly had eye surgeries, urging them to contact their family doctors if they experienced meningitis symptoms. He said it is important that the center make sure the “right steps are taken.”

Nicolai said there was only “a slim chance” someone could get meningitis from the medication.

DiOrio said the state is “asking physicians who have received these products to contact their patients who may have gotten an injection to make sure that they’re healthy and not having any adverse effects from the medication.”

Physicians are being asked to monitor patients who received the medication for “several months” to make sure they do not develop the infection, she added.

Two broad factors are complicating the outbreak, she said. First, fungal meningitis is rare, and doctors do not know how long it might take someone to become ill after receiving a potentially contaminated medication. CDC officials said this is the first time one of the fungi implicated in the outbreak has been identified as causing meningitis.

“We are learning a lot,” DiOrio said.

Tessie Pollock, a spokeswoman for ODH, said in one case in the national outbreak, the person became ill 42 days after receiving the steroid.

Secondly, steroid medications are administered to reduce inflammation, which is how they help fight pain caused by arthritis and other injuries. But inflammation is a sign of infection, so the steroids are actually helping disguise the infection to which they have been linked, DiOrio said.

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