WASHINGTON — The black mold creeping into the spines of hundreds of people who got tainted shots for back pain marks uncharted medical territory.
Never before has this particular fungus been found to cause meningitis. It's incredibly hard to diagnose, and to kill, requiring at least three months of a treatment that can cause hallucinations. There's no good way to predict survival, or when it's safe to stop treating, or exactly how to monitor those who fear the fungus may be festering silently in their bodies.
"I don't think there is a precedent for this kind of thing," said Dr. Arjun Srinivasan of the Centers for Disease Control and Prevention. "This is definitely new territory for us."
Health officials and doctors have tracked down most of the 14,000 people potentially at risk for fungal meningitis, blamed for the deaths of 24 people and sickening more than 300.
The fungus' brown-black color signals an armor that, along with being injected near the spine, helped this mold sneak past the immune defenses of otherwise healthy people, said Dr. Arturo Casadevall, a fungal disease specialist at New York's Albert Einstein College of Medicine.
"What we're dealing with here is fundamentally different" from a typical fungal infection, he said. "This is a bug that most of us don't know much about."
But they're learning fast, piecing together clues that promise some hope.
Doctors are beginning to detail in medical journals the first deaths in this outbreak, and the grim autopsy findings make clear that treating early is crucial, before the fungus becomes entrenched. In one case, a woman died in Maryland after the fungus pierced blood vessels in her brain, leading to severe damage.
People getting treated earlier "seem to be doing okay," with fewer of the strokes that characterized the outbreak's beginning, said Dr. Carol Kauffman of the University of Michigan. She has advised the CDC and co-authored advice in the New England Journal of Medicine on how to handle the complex medication used in treatment.