Meningitis is an infection of the membranes covering the brain and spinal cord. It is one of the few infectious diseases that can be a true medical emergency. Viral meningitis, the most common type of meningitis, is only rarely dangerous, but bacterial meningitis and fungal meningitis can be lethal. Fortunately, the dangerous forms of meningitis are so uncommon that we don’t need to think about them very much. During our school years, we get our meningitis vaccines and merrily go on our way. But harrowing stories of meningitis have been breaking news this past week, so here’s what you need to know.
Outbreak of Unusual Fungal Meningitis
First, there’s been an outbreak of an unusual fungal meningitis caused by contamination of vials of methylprednisolone, a steroid used for epidural injections given to treat back pain. To date, over 65 cases and several deaths have been reported. The contaminating organism is Aspergillus, known more for causing respiratory and sinus infections, although that is uncommon. But when Aspergillus is mechanically introduced in close proximity to the spinal canal during an epidural procedure, disaster can occur. The contamination has been traced to New England Compounding Center in Framingham, Massachusetts (since closed down), which processed the drug and shipped the contaminated vials across the country. Patients who received injections from the contaminated lots are being notified and are being instructed to seek medical attention immediately if–within days to several weeks of the injections–they develop any signs or symptoms of meningitis. These symptoms may include headache, rash, stiff neck, and/or fever. Some of those affected have also presented with stroke-like symptoms, such as slurred speech or weakness in one extremity.
Two points deserve special mention:
- The warnings do not apply to women who received epidurals during delivery–methylprednisolone acetate is not used in those procedures
- Aspergillus meningitis isn’t contagious and does not spread from person to person
Outbreak of Deadly Bacterial Meningitis
The second story comes out of New York, where the Department of Health issued an alert recommending meningococcal vaccination for HIV-positive men who have sex with men and who have had “intimate contact with another man in New York City, met either through an online website, digital app, bar or party since September 1, 2012.” This alert applies to both residents and nonresidents of New York City who meet these criteria.
The reason for the alert: 14 recent cases of bacterial meningitis caused by Neisseria meningitidis, a very aggressive and dangerous organism. Eight of the cases occurred in men who were HIV-positive, and four men have died.
Again, two points should be stressed:
- HIV-positive men who have sex with men should recognize the signs of meningitis and seek medical attention immediately, since early treatment with intravenous antibiotics affords the best hope for cure; if you meet these criteria, call your primary care provider or go to an emergency room immediately
- People whose immune system is compromised by an illness or drug therapy (e.g., chemotherapy for cancer) can still safely get the vaccination
As concerning as these two reports may be, keep in mind that only two very specific populations are at risk, and that the risk of contracting bacterial or fungal meningitis is low for most people. The purpose of publicizing these recent outbreaks is to protect anyone who may fall into one of the two susceptible groups.
Editor’s Note: Be sure to read our latest coverage on the fungal meningitis outbreak.