Fungal Meningitis

[NRSKarenRN, BSN, RN]

Meningitis Victims Face Long, Uncertain Recovery

Fungal Meningitis is a rare fungal infection spread by the bloodstream to the spinal cord.

Persons most susceptible are diabetics, those treated with Cancer and HIV medications, along with rare contaminated injectable solutions. It is not contageous.

Treatment is high dose Intravenous antifungal Voriconazole and Amphotericin B which have many side effects; course of treatment is 3 months minimum.

When administering amphotericin B, nurses need to ensure adequate hydration and premedication (acetaminophen and/or diphenhydramine for fever, chills, and headache) along with anti-nausea meds to prevent therapy-related side effects.

Dexamethasone (Decadron) and acetazolamide (Diamox) are used to decrease edema.

CDC: Fungal Meningitis

Treatment guidelines

Fungal Meningitis - Care Guide

Critical Care Medicine:

"Current Approaches to the Diagnosis of Bacterial and Fungal Bloodstream Infections in the Intensive Care Unit,"

NH DOH Info:

http://www.dhhs.state.nh.us/dphs/cdcs/fungal-meningitis.htm

[blondy2061h, MSN, RN]

Meningitis Victims Face Long, Uncertain RecoveryFungal Meningitis is a rare fungal infection spread by the bloodstream to the spinal cord. Persons most susceptible are diabetics, those treated with Cancer and HIV medications, along with rare contaminated injectable solutions. It is not contageous.Treatment is high dose Intravenous antifungal Voriconazole and Amphotericin B which have many side effects; course of treatment is 3 months minimum.When administering amphotericin B, nurses need to ensure adequate hydration and premedication (acetaminophen and/or diphenhydramine for fever, chills, and headache) along with anti-nausea meds to prevent therapy-related side effects.Dexamethasone (Decadron) and acetazolamide (Diamox) are used to decrease edema.CDC: Fungal Meningitis

Treatment guidelines

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Fungal Meningitis - Care GuideCritical Care Medicine:"Current Approaches to the Diagnosis of Bacterial and Fungal Bloodstream Infections in the Intensive Care Unit," NH DOH Info:http://www.dhhs.state.nh.us/dphs/cdcs/fungal-meningitis.htm

We stopped premedicating for Amphotericin when the liposomal version, Ambisome, became common. The rate of side effects is much lower.

[mmutk, BSN, RN, EMT-I]

I have taken care of one of these patients who died here in Nashville. It is a tough situation even if you do get the antibiotics started quickly. Expect a prolonged ICU stay with multiple co-morbidities. Also several of the cultures will come back sterile for the first 6-7 days. See this month's New England Journal of Medicine for a detailed case presentation on patient ZERO @ VUMC.

Index Case for the U.S. Fungal Meningitis Outbreak

October 19, 2012 | A.C. Pettit

and Others

In September, a patient in Tennessee died unexpectedly from fungal meningitis. An epidural glucocorticoid injection was identified as a potential source of this infection. A multistate investigation is ongoing; this report describes the index case.

[nurseprnRN, BSN, RN]

When I did transplants a hundred or so years ago we occasionally had recipients get massive Aspergillis infections. We didn't call it Amphoterrible for nothing.

I have seen daily updates on this whole sorry story in the local papers, since it's come out of a compounding pharmacy in my home state. The first story that came out I emailed the reporter and told them to look at joint infections, too...and they did. Obviously not as serious, and less likely, as the injected amounts are smaller, but still-- how'd you like to have a fungal infection in your knee/shoulder/ankle?

There will be hell to pay for years on this one.

[Trekfan]

They now have recalled two other drugs from that same pharmacy that where also used in spinel injections . I got a letter in the mail that I had gotten one of the recalled drugs ! Talk about freking out !