The ongoing epidemic of fungal infections from contaminated steroid injections is going beyond the brain and spinal cord to include the many joints injected by arthritis specialists. The medicine, methylprednisolone acetate, is a commonly used prescription steroid for the treatment of inflamed joints. Since rheumatologists often inject joints in patients with arthritis, this presents a potential problem.
While infections in the spinal cord and central nervous system present fairly quickly following injection, it is apparent that joints injected with contaminated steroids may take several months to produce symptoms. According to Dr. Kevin McKown of the University of Wisconsin Medical Center, new cases of fungal infections in joints may present for the next six months... or even longer!
Unlike the brain, joint infections can remain indolent which leads to delay in diagnosis.
There have been at least two cases of joint infections from contaminated steroids reported to the FDA as of November 1, 2012.
Symptoms suggestive of infection include, fever, pain, increased redness, warmth, and swelling in the joint that received the injection. Since this is also a sign of a joint flare from arthritis, an infected joint may not be easy to identify.
If the infection is not recognized, the fungus can spread and lead to osteonecrosis (dead bone), a destroyed joint, and also spread to other joints via the blood stream. In its most virulent form, it may cause death.
The compounding pharmacy responsible for this outbreak is the New England Compounding Center located in Framingham, Massachusetts. It was found guilty of selling large amounts of the medication across state lines. The New England Compounding Pharmacy sold lots of their drugs to clinics in more than 23 states before being shut down by the Federal Food and Drug Administration.
So far, the two species of fungus isolated have been Aspergillus and Exserohilum.
The major problem in identifying cases is that fungal infections are slow to develop and symptoms are not always recognizable after such a long period between symptom presentation and joint injection. For example, cases of meningitis often take anywhere from one to four weeks before presentation. Joints that have been injected can take much longer.
Of the many states reported to have received the contaminated steroid preparations, there are California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Maryland, Michigan, Minnesota, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, and West Virginia.
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