Hat tip Catbird
Laboratory Testing and Results from the Outbreak
October 31, 2012 6:00 PM EDT
CDC laboratory-confirmed results found on this page are from three New England Compounding Center (NECC) preservative-free methylprednisolone acetate (MPA) lots recalled on September 26, 2012.(1)
CDC scientist examines microscopic slides showing Exserohilum rostratum (on screen) during the multistate meningitis outbreak.
CDC's Fungus Reference Laboratory has the capacity and technology to examine fungal isolates under the microscope and to confirm their identification using DNA sequencing methods.
As of October 22, 2012, Exserohilum rostratum has been found in clinical specimens for all but two of the 54 patients with CDC laboratory-confirmed fungal meningitis who meet the confirmed case definition.(2)
Tests at CDC and FDA laboratories on the preservative-free MPA vials have confirmed the presence of the same fungus, Exserohilum rostratum, in unopened vials from two of the three recalled lots.(1) Testing on the third lot of preservative-free MPA is ongoing. These laboratory test results strengthen the link between preservative-free MPA vials and the outbreak.
The fungi found in both patients and in recalled vials are common in the environment but were not recognized as a cause of meningitis before this outbreak.
Exserohilum rostratum
Aspergillus fumigatus
<!--
Cladosporium</div></div></div><div align="center"><div align="center"><div align="center">-->
Cladosporium
Human Tissue and Fluid Samples
Date updated: October 22, 2012
<TABLE style="WIDTH: 460px" summary="This table displays CDC Laboratory-Confirmed Cases of Human Infection*2 Associated with Recalled Lots of Preservative-Free MPA."><CAPTION align=left>Table 1. CDC Laboratory-Confirmed Cases of Human Infection(4) </CAPTION><THEAD><TR><TH style="BACKGROUND-COLOR: rgb(153,204,153)" colSpan=3>CDC Laboratory-Confirmed Cases of Human Infection
Associated with Recalled Lots of Preservative-Free MPA
</TH></TR><TR><TH style="BACKGROUND-COLOR: rgb(255,255,255)" width=131 scope=col>Exserohilum
rostratum
</TH><TH style="BACKGROUND-COLOR: rgb(255,255,255)" width=157 scope=col>Aspergillus fumigatus (3)</TH><TH style="BACKGROUND-COLOR: rgb(255,255,255)" width=146 scope=col>Cladosporium</TH></TR></THEAD><TBODY><TR style="HEIGHT: 1.5em"><TD width=131 align=center>52</TD><TD width=157 align=center>1</TD><TD width=146 align=center>1</TD></TR></TBODY></TABLE>
These numbers do not reflect all cases of fungal meningitis or joint infections because laboratory methods used to detect fungus are not highly sensitive. Many patients with potential fungal infections will have a negative laboratory result (2, 4).
Product Samples: Three Lots of Preservative-Free MPA
Date updated: October 22, 2012
CDC and FDA laboratories are in close communication about identifying the organisms in unopened preservative-free MPA vials.
Associated with Recalled Lots of Preservative-Free MPA
</TH></TR><TR><TH style="BACKGROUND-COLOR: rgb(255,255,255)" scope=col>Product(s)</TH><TH style="BACKGROUND-COLOR: rgb(255,255,255)" scope=col>Fungi Isolated</TH><TH style="BACKGROUND-COLOR: rgb(255,255,255)" scope=col>Description</TH></TR></THEAD><TBODY><TR><TD align=left>MPA (PF) Lot #06292012@26
Beyond Use Date 12/26/2012
MPA (PF) Lot #08102012@51
Beyond Use Date 2/6/2013
</TD><TD align=center>Exserohilum rostratum</TD><TD align=center>Known to cause human disease</TD></TR><TR><TD align=left>MPA (PF) Lot #06292012@26
Beyond Use Date 12/26/2012
MPA (PF) Lot #08102012@51
Beyond Use Date 2/6/2013
</TD><TD align=center>Rhodotorula laryngis</TD><TD align=center>Not known to cause human disease</TD></TR><TR><TD align=left>MPA (PF) Lot #08102012@51
Beyond Use Date 2/6/2013
</TD><TD align=center>Rhizopus stolonifer</TD><TD align=center>Not known to cause human disease</TD></TR></TBODY></TABLE>
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Laboratory Testing and Results from the Outbreak
October 31, 2012 6:00 PM EDT
CDC laboratory-confirmed results found on this page are from three New England Compounding Center (NECC) preservative-free methylprednisolone acetate (MPA) lots recalled on September 26, 2012.(1)
CDC scientist examines microscopic slides showing Exserohilum rostratum (on screen) during the multistate meningitis outbreak.
CDC's Fungus Reference Laboratory has the capacity and technology to examine fungal isolates under the microscope and to confirm their identification using DNA sequencing methods.
- For the multistate outbreak, the fungus laboratory is working with the Clinical and Environmental Microbiology Branch, Division of Healthcare Quality Promotion, to detect and identify other microbial pathogens. In addition, the Infectious Diseases Pathology Branch, Division of High-Consequence Pathogens and Pathology, is examining tissues from biopsies and autopsy materials.
- CDC and the states are testing tissue and fluid samples from patients with probable or confirmed fungal infection. CDC scientists are looking to see if the samples contain fungi and other microbial pathogens, and if so, what type.
- In addition, FDA and CDC are testing vials of NECC preservative-free MPA to see if they contain fungi and other microbial pathogens and if so, what type.
As of October 22, 2012, Exserohilum rostratum has been found in clinical specimens for all but two of the 54 patients with CDC laboratory-confirmed fungal meningitis who meet the confirmed case definition.(2)
Tests at CDC and FDA laboratories on the preservative-free MPA vials have confirmed the presence of the same fungus, Exserohilum rostratum, in unopened vials from two of the three recalled lots.(1) Testing on the third lot of preservative-free MPA is ongoing. These laboratory test results strengthen the link between preservative-free MPA vials and the outbreak.
The fungi found in both patients and in recalled vials are common in the environment but were not recognized as a cause of meningitis before this outbreak.
Exserohilum rostratum
Aspergillus fumigatus
<!--
Cladosporium</div></div></div><div align="center"><div align="center"><div align="center">-->
Cladosporium
Human Tissue and Fluid Samples
Date updated: October 22, 2012
<TABLE style="WIDTH: 460px" summary="This table displays CDC Laboratory-Confirmed Cases of Human Infection*2 Associated with Recalled Lots of Preservative-Free MPA."><CAPTION align=left>Table 1. CDC Laboratory-Confirmed Cases of Human Infection(4) </CAPTION><THEAD><TR><TH style="BACKGROUND-COLOR: rgb(153,204,153)" colSpan=3>CDC Laboratory-Confirmed Cases of Human Infection
Associated with Recalled Lots of Preservative-Free MPA
</TH></TR><TR><TH style="BACKGROUND-COLOR: rgb(255,255,255)" width=131 scope=col>Exserohilum
rostratum
</TH><TH style="BACKGROUND-COLOR: rgb(255,255,255)" width=157 scope=col>Aspergillus fumigatus (3)</TH><TH style="BACKGROUND-COLOR: rgb(255,255,255)" width=146 scope=col>Cladosporium</TH></TR></THEAD><TBODY><TR style="HEIGHT: 1.5em"><TD width=131 align=center>52</TD><TD width=157 align=center>1</TD><TD width=146 align=center>1</TD></TR></TBODY></TABLE>
These numbers do not reflect all cases of fungal meningitis or joint infections because laboratory methods used to detect fungus are not highly sensitive. Many patients with potential fungal infections will have a negative laboratory result (2, 4).
Product Samples: Three Lots of Preservative-Free MPA
Date updated: October 22, 2012
CDC and FDA laboratories are in close communication about identifying the organisms in unopened preservative-free MPA vials.
- As of October 22, CDC laboratories have confirmed the presence of Exserohilum rostratum in lots #08102012@51 BUD 2/6/2013 and #06292012@26 BUD 12/26/2012. This fungus is the same genus and species as the one found in laboratory-confirmed cases of human infection.
- CDC also identified non-human pathogens Rhodotorula laryngis and Rhizopus stolonifer in lot #08102012@51, BUD 2/6/2013; and Rhodotorula laryngis in lot #06292012@26, BUD 12/26/2012.
- The fungi Rhodotorula laryngis and Rhizopus stolonifer are not known to cause disease in humans; they cannot grow at human body temperature.
Associated with Recalled Lots of Preservative-Free MPA
</TH></TR><TR><TH style="BACKGROUND-COLOR: rgb(255,255,255)" scope=col>Product(s)</TH><TH style="BACKGROUND-COLOR: rgb(255,255,255)" scope=col>Fungi Isolated</TH><TH style="BACKGROUND-COLOR: rgb(255,255,255)" scope=col>Description</TH></TR></THEAD><TBODY><TR><TD align=left>MPA (PF) Lot #06292012@26
Beyond Use Date 12/26/2012
MPA (PF) Lot #08102012@51
Beyond Use Date 2/6/2013
</TD><TD align=center>Exserohilum rostratum</TD><TD align=center>Known to cause human disease</TD></TR><TR><TD align=left>MPA (PF) Lot #06292012@26
Beyond Use Date 12/26/2012
MPA (PF) Lot #08102012@51
Beyond Use Date 2/6/2013
</TD><TD align=center>Rhodotorula laryngis</TD><TD align=center>Not known to cause human disease</TD></TR><TR><TD align=left>MPA (PF) Lot #08102012@51
Beyond Use Date 2/6/2013
</TD><TD align=center>Rhizopus stolonifer</TD><TD align=center>Not known to cause human disease</TD></TR></TBODY></TABLE>
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