One more person has died from fungal meningitis linked to tainted steroid injections, raising the death toll for the outbreak to 15.
The U.S. Centers for Disease Control and Prevention reported Saturday that 198 people in 13 states have contracted fungal meningitis after receiving spinal injections of methylprednisolone acetate for back pain. One person has contracted a joint infection after receiving an injection for ankle pain.
As many as 14,000 people may have been exposed to the suspect steroid, made by the New England Compounding Center in Framingham, Mass. Fifty sealed vials of the drug, obtained by the Food and Drug Administration, were found to contain fungus. The firm has recalled all of its products and shut down operations.
Seventy-six clinics in 23 states that received methylprednisolone acetate from the recalled lots have been instructed to notify all affected patients. The "potentially contaminated injections were given starting May 21, 2012," according to the CDC.
Fifty-two of the fungal meningitis cases — six of them lethal — have been reported in Tennessee. Cases have also been reported in Florida, Michigan, Virginia, Indiana, Maryland, Minnesota, North Carolina, Ohio, New Jersey, Idaho, Texas and, most recently, Illlinois.
Meningitis affects the membranous lining of the brain and spinal cord. Early symptoms of fungal meningitis, such as headache, fever, dizziness, nausea, sensitivity to light, stiff neck, weakness or numbness, slurred speech and pain, redness or swelling at the injection site can take more than a month to appear.
The longest duration from the time of injection to the onset of symptoms in the current outbreak is 42 days, according to the CDC's Dr. Benjamin Park.
"But we want to emphasize that we don't know what the longest will be," he said, adding that patients who received injections of the recalled drug should be wary of the subtle symptoms "for months."
Fungal meningitis is diagnosed through a lumbar puncture, which draws cerebrospinal fluid from the spine that can be inspected for signs of the disease. Once detected, it can be treated with high doses of intravenous antifungal medications.
People affected by the current outbreak are being treated with two different types of antifungal medications until the type of fungus causing the infection — aspergillus or exserohilum — can be identified.
"These drugs are very strong and can be very difficult for patients to tolerate over time," said Dr. J. Todd Weber, incident manager of the Multistate Meningitis Outbreak at the CDC, adding that the agency is working with experts on the dose and duration of the treatments.
Unlike bacterial meningitis, fungal meningitis is not transmitted from person to person and only people who received the steroid injections are thought to be at risk.
The Associated Press, New York Times and Washington Post contributed to this report.