Has anyone come across any patients who were infected with fungal mengitis from the tainted steroids? I just got a referral for a cervical ESI on a patient who was treated for the mengitis and was cleared by ID to undergo ESI. Patient wants another ESI due to relief from the original injection and wants to avoid surgery. Would like to hear your thoughts on reasons to / not to inject...
ESI after meningitis
- Thread starter nwbgn
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Cleared by ID is the big thing. Also, how long can a pt go and still have a recurrence of the fungal meningitis? I don't know, but you definitely want to be out of that window, whatever it is.
Any recurrence would not be due to your injection, but they could still attempt to blame you and the company making your steroids.
Probably okay if cleared by ID, but:
CYA
Any recurrence would not be due to your injection, but they could still attempt to blame you and the company making your steroids.
Probably okay if cleared by ID, but:
CYA
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Treating fungal meningitis pain from prior injection is not an indication.
What was the complaint and concordance with imaging prior to the fungal injection?
I'd pass on the face of it. Not a hero.
What was the complaint and concordance with imaging prior to the fungal injection?
I'd pass on the face of it. Not a hero.
The ESI referral is to treat the original radicular pain from 2 discs the patient was having before the 1st injection. She is not complaining of new pain from meningitis. Apparently she had good relief for several months after her first injection and wants to have another as 2 level fusion is the alternative (which she doesn't want) and she is having a lot of pain and nothing else has helped her.
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I wouldn't touch this with a 10 foot pole. So she had relief for a few months, this is temporary relief, which a lawyer would ask you in court why you risked this patients life for a few months relief, after she develops a complication with the 4th injection.
If they have truly failed all neuropathic medications, (at least 4 of them), I would send them for a second surgical consult, (maybe they don't actually require a fusion)
I am unfortunate enough to be caught up in this. Accordingly, I have participated in EVERY CDC conference call including the one last week. This was specifically discussed. The CDC's position is that they dont have enough experience with this pathogen at this time to say when it is safe to go ahead. There are many cases of those who had meningitis treated "successfully"and now have developed local infections, osteo, abscess, phlegmon at the innoculation site. They anticipate seeing these infections probably for ONE YEAR from innoculation date. Therefore my advice is DO NOT PROCEED. There are a handful of ID guys who have a clue about this. If your ID guy gave the blessing he is clueless. If you feel compelled to go ahead AT LEAST dont do so without a contarst enhanced MRI at the innoculation site and make sure your radiologist knows what he is looking at. I had one patient who had two MRIs read as NORMAL. I didnt believe it so I sent the MRI to St. Joe's in Ann Arbor, MI (>200 cases) and they confirmed a likely phlegmon at the innoculation site on both scans.
Very informative post.
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On second thought, I can't argue with this response.
I greatly appreciate everyone's input on this. I had heard of negative CSF cultures and late cases of meningitis in these patients and you have all confirmed my reasons for hesitating on this case and I agree - no need to be a hero.
Wise decision. You don't need to get caught up in this nightmare.
On the most recent conference call with the CDC a worker's comp case nurse from Michigan on the call reported that they had several patients who had meningitis and now were receiving additional epidural injections performed by other practitioners. The head of the myocotic diseases division at the CDC was virtually speechless. Unfortunately, given all that is unknown about the involved mold species, I don't know that they will ever be able to tell us that it is safe to do additional intraspinal injections on these folks. As it is the antifungal treatment duration has gradually gone from 3 months to now "a year or more".
On the most recent conference call with the CDC a worker's comp case nurse from Michigan on the call reported that they had several patients who had meningitis and now were receiving additional epidural injections performed by other practitioners. The head of the myocotic diseases division at the CDC was virtually speechless. Unfortunately, given all that is unknown about the involved mold species, I don't know that they will ever be able to tell us that it is safe to do additional intraspinal injections on these folks. As it is the antifungal treatment duration has gradually gone from 3 months to now "a year or more".
