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CDC fights fungal meningitis outbreak

11:24 AM, Oct 15, 2012   |    comments
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ATLANTA - Scattered across the carefully landscaped main campus of the Centers for Disease Control and Prevention are the staff on the front lines fighting a rare outbreak of fungal meningitis.

A scientist in a white lab coat peers through a microscope at fungi on a glass slide. In another room, another researcher uses what looks like a long, pointed eye dropper to suck up DNA samples that will be tested for the suspect fungus.

Not far away in another building is the emergency operations center, which is essentially the war room.

There's a low hum of voices as employees work the phones, talking to health officials, doctors and patients who received potentially contaminated pain injections believed to be at the root of the outbreak.

Workers sit at rows of computers, gathering data, advising doctors and reaching out to thousands of people who may have been exposed.

Overall, dozens of people are working day and night to bring the outbreak under control. More than 200 people in 14 states have been sickened, including 15 who have died.

This is not a race against a fast-spreading illness like avian flu or SARS. Unlike those outbreaks, this strain of meningitis isn't contagious and doesn't spread between people. It is likely isolated to the suspect steroid, produced by the New England Compounding Center in Framingham, Mass.

"This is a very unusual infection," said Dr. John Jernigan, a CDC medical epidemiologist who is leading the clinical investigation team for the outbreak response. "So, treatment recommendations, diagnostic recommendations are all going to be new, and we're learning as we go on this one."
Local case

Meningitis, an inflammation of the membranes surrounding the brain and spinal cord, is not uncommon. But it is usually caused by bacteria, and it is very unusual to see it in patients with normal immune systems, Jernigan said.

This strain is caused by a fungus that is common in dirt and grasses - people routinely come into contact with it without getting sick - but it has never before been identified as the cause of meningitis.

Florida Case

The Florida Department of Health on Saturday reported the first Escambia Couty case of fungal meningitis resulting from spinal injections of contaminated medicine.

The 47-year-old Pensacola area man is one of about 600 patients treated with the steroid at Pain Consultants of West Florida on North Davis Highway.

At the CDC, a meeting is held each morning to review overnight developments and plot a course of action for the day. Another meeting at the end of the day summarizes the day's developments and looks ahead to the next day.

Maps on big screens in the front of the emergency operations center track the states where the tainted medications were sent and the tally of cases reported in affected states.

A few steps away in the joint information center, another team works to keep the information about the outbreak on the CDC's website up to date and disseminate information via the media and other outlets.
Testing samples

In another building on the campus in the northeast corner of Atlanta, in a part of the CDC that specializes in fungal infections, about 15 scientists in the reference and research labs log 12 hours or more a day and work through weekends to test samples coming in from around the country.

Because the lab scientists had never worked with this particular fungus in cerebrospinal fluid before, they had to quickly develop new tests to detect it before they could start analyzing the hundreds of samples - cerebrospinal fluid samples, cultures and bits of tissue - sent in from around the country, research lab team leader Ana Litvintseva said.

Friday, Shawn Lockhart, the fungal reference lab team leader, peered through a microscope as images of what looked like red pea pods appeared on a computer screen next to him. Many other closely related fungi look similar, but a tiny dot at the end of a pod told him he was looking at the fungus believed to be at the root of the outbreak.

"The scale is much, much bigger than we would normally work with," Litvintseva said of the lab's workload. "We are working every weekend and people are here 12 to 13 hours at a time, and we're testing samples nonstop."

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