M-R-I Detects Spinal Infection In Patients Who Received Contaminated Steroid Injections But Reported No New Symptoms

INTRO: Last fall, a multi-state outbreak of fungal meningitis occurred after contaminated steroid injections were given to patients to treat back pain and other neuropathic symptoms. These contaminated injections also produced spinal infections at the injection site. A new study examined whether a screening MRI could detect these infections in patients who did not initially report new symptoms after receiving these contaminated injections. Catherine Dolf has more in this week’s JAMA Report.

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Graphic: U-S Map
Headline: Methylprednisolone Outbreak
Michigan highlighted
New England highlighted
75 Independent Pain Centers, J.R. Mazure talking with Dr. Malani

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THE 23 STATE OUT BREAK OF CONTAMINATED INJECTIONS HIT THE STATE OF MICHIGAN THE HARDEST. THE METHYLPREDNISOLONE (Methal-pred-nis-ah-lone) WAS DISTRIBUTED FROM A COMPOUNDING CENTER IN NEW ENGLAND AND USED IN INJECTIONS FOR PATIENTS AT 75 INDEPENDENT PAIN CLINICS NATIONWIDE. CONSTRUCTION WORKER J.R. MAZURE (May-zuhr) RECEIVED AN INJECTION WITH THE CONTAMINATED DRUG LAST SEPTEMBER AND CAME TO THE FUNGAL CLINIC AT ST. JOSEPH MERCY HOSPITAL. THE CLINIC WAS SET UP TO HELP TREAT PATIENTS LIKE HIM.

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SOT/FULL Super @:23 J.R. Mazure – Patient Runs:07
“I decided it was time to come to the clinic because I couldn’t turn my neck or bend my neck down. I had an excruciating headache.”

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J.R. with Dr. Malani, Dr. Malani looking at MRI

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HE WAS DIAGNOSED WITH FUNGAL MENINGITIS.  HOWEVER, THE CLINIC STARTED NOTICING PATIENTS WHO HAD RECEIVED THE INJECTIONS BUT DIDN’T DEVELOP MENINGITIS.

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SOT/FULL Super @:40 Anurag N. Malani, M.D., – St. Joseph Mercy Hospital Runs:06
“We actually started seeing some patients that only presented with just infection at the injection site.”

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Dr. Malani walking into clinic, woman getting MRI, Graphic:
118-Normal
18-Equivocal
(Neither normal nor clearly showing infection)
36-Abnormal

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DR. ANURAG (Ahn-eh-Rahg) MALANI FROM ST. JOSEPH’S HOSPITAL AND CO-AUTHORS PERFORMED M-R-I’S ON 172 PATIENTS WHO HAD NOT PRESENTED FOR CARE RELATED TO THEIR CONTAMINATED INJECTIONS.  BASED ON THESE M-R-Is, 118 PATIENTS HAD NO EVIDENCE OF INFECTION, 18 HAD EQUIVOCAL RESULTS (NEITHER NORMAL NOR CLEARLY SHOWING INFECTION), AND 36 HAD EVIDENCE OF INFECTION.

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SOT/FULL Super @1:02 Anurag N. Malani, M.D., – St. Joseph Mercy Hospital Runs:16
“Of the patients that had abnormal MRIs 35 of them actually met the Centers for Disease Control and Prevention case definitions for probable or confirmed fungal spinal or paraspinal infection related to this outbreak.”

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JAMA COVER

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THE STUDY APPEARS IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.

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SOT/FULL Super @1:12 Anurag N. Malani, M.D., – St. Joseph Mercy Hospital Runs:08
“24 required surgery and about 70 percent of the patients or 25 of them required two-drug therapy.”

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Patient undergoing testing

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RESEARCHERS SAY EACH CASE IS DIFFERENT AND CAN PRESENT WITH OR WITHOUT INCREASED SYMPTOMS.

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SOT/FULL Super @1:35 Voice of:Anurag N. Malani, M.D., – St. Joseph Mercy Hospital Runs:05
“Over a third of these patients had no change in their chronic pain but yet were found to have infection.”

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Dr. Malani looking at MRI

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ON AVERAGE IT TOOK ABOUT 87 DAYS TO DETECT WHETHER PATIENTS DEVELOPED INFECTIONS. THIS M-R-I ON THE LEFT WAS INITIALLY NORMAL. 19 DAYS LATER ANOTHER M-R-I SHOWED THE SAME PATIENT HAD AN INFECTION.

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SOT/FULL Super @1:51 Anurag N. Malani, M.D., – St. Joseph Mercy Hospital Runs:07
“It’s important to recognize that we don’t fully understand what the incubation period is.”

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J.R. in office with Dr. Malani, walking out of hospital

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J.R. MAY HAVE TO GO BACK INTO THE HOSPITAL BUT SAYS HE HAS A VERY SUPPORTIVE WIFE AND IS TRYING TO STAY POSITIVE.

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“I hope to stay alive and I hope to keep the ability to walk. I am hoping that we can cure this thing.”

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CATHERINE DOLF, THE JAMA REPORT.

TAG: RESEARCHERS SAY PRO-ACTIVE OUTREACH IS NEEDED FOR THESE PATIENTS TO SEE WHETHER THEY HAVE UNDERGONE AN M-R-I OR HAVE EXPERIENCED NEW OR INCREASED PAIN.