2012 fungal meningitis outbreak associated with contaminated steroid injections dr. joan duwve chief...
TRANSCRIPT
![Page 1: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/1.jpg)
2012 Fungal Meningitis 2012 Fungal Meningitis OutbreakOutbreakAssociated WithAssociated WithContaminated Steroid Contaminated Steroid InjectionsInjections
Dr. Joan DuwveChief Medical Officer
Indiana State Department of HealthApril 12, 2013
![Page 2: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/2.jpg)
![Page 3: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/3.jpg)
![Page 4: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/4.jpg)
• Clinic notification/assessment• Case investigation/reporting• Advising clinicians• Messaging and media • Laboratory testing• Participating in calls• Requesting CDC Epi-Aid team
![Page 5: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/5.jpg)
• Meningitis: mild symptoms• Posterior circulation stroke• Joint infections• Localized injection site infections
– Epidural abscess– Osteomyelitis– Arachnoiditis/discitis
![Page 6: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/6.jpg)
Illustrations of location and approaches of epidural injection (1a) and location of CNS and parameningeal infections in the spine (1b)
CDC
![Page 7: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/7.jpg)
Operative FindingsOperative Findings
7
Thecal Sac with phlegmonThecal Sac with phlegmon
Photo credit: St. Joseph Mercy Health Systems CDCPhoto credit: St. Joseph Mercy Health Systems CDC
![Page 8: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/8.jpg)
![Page 9: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/9.jpg)
![Page 10: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/10.jpg)
![Page 11: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/11.jpg)
![Page 12: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/12.jpg)
• 11 Total
• 4 Out of State
• Date range from October 2012 to January 2013
![Page 13: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/13.jpg)
• Main outbreak organism
• Found in soil and plants• Warm, humid climates• Rarely causes infection
– Sinusitis– Skin– Eye– Endocarditis– OsteomyelitisPhoto courtesy of CDC
![Page 14: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/14.jpg)
• Rapidly evolving situation• CDC case definition evolved with Outbreak• Unique, little known clinical course• Clinical guidelines were unknown • Harsh treatment regimens• Uncertain disease progression
![Page 15: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/15.jpg)
National Total - 730 cases with 51 deaths
As of 3/28/13
![Page 16: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/16.jpg)
National Data As 3/4/13
![Page 17: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/17.jpg)
![Page 18: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/18.jpg)
![Page 19: 2012 Fungal Meningitis Outbreak Associated With Contaminated Steroid Injections Dr. Joan Duwve Chief Medical Officer Indiana State Department of Health](https://reader030.vdocument.in/reader030/viewer/2022032802/56649dff5503460f94ae8559/html5/thumbnails/19.jpg)
Joan Duwve, MD MPHChief Medical Officer, ISDH
Tina Feaster, MSInvasive Disease Epidemiologist, ISDH
Jean Svendsen, RN BSChief Nurse Consultant, ISDH