By mid-October, Adair was in too much discomfort to walk, and her husband, a machine builder, drove her to the emergency room. It was the first of 41 days she would spend in the hospital during three stays, including Thanksgiving and her 50th birthday; they had planned to celebrate with a backyard bonfire and cookout.
Like many patients in the early days of the outbreak, Adair was initially misdiagnosed, with a pinched nerve, because her spinal fluid tested negative for meningitis. It was not until her second stay that doctors performed an MRI scan and found the abscess, she said. They put the mother of two on an antifungal drug called voriconazole and told her she would need a walker.
After Adair’s husband wheeled her into the emergency room Nov. 15, doctors realized the infection was eating away her vertebrae. She teared up when they told her they would have to operate to drain fluid, scrape away infected portions of bone, and remove part of a disc.
“If the fungus is allowed to grow and thrive, it will infect the nerves in the spine, and that has far more ominous implications for patients,’’ said Dr. Douglas Geiger, a neurosurgeon at St. Joseph Mercy.
After the surgery, doctors pumped a stronger and more toxic antifungal drug, amphotericin, into Adair’s body, but had to temporarily stop the lemon-colored intravenous drip because she was showing signs of kidney damage. “I had never been so scared in my life as when I thought it was attacking my kidneys,” she said. “I almost refused this treatment at the very end.’’
Michigan doctors have grown particularly aggressive about screening and treating patients, in part because the state received steroids from a batch they are calling a “hot lot’’ that appears to be more highly contaminated. Like Adair, most patients in the state received contaminated injections at Michigan Pain Specialists in Brighton, which got 400 vials of methylpredisolone acetate from lot 06292012@26, made by New England Compounding pharmacists in June.
Tennessee health officials have found that patients injected with the steroid from this lot were four times as likely to develop fungal disease as those injected with steroids from the other two implicated lots. More fungus could have gotten into this lot during mixing at New England Compounding, or it could have sat on shelves longer, giving the mold more time to grow, doctors said.
This lot might be one reason why a greater percentage of patients in Michigan got sick, or it could be that pain specialists there injected steroids in a way that made it easier for the fungus to take root and spread, Dr. John Jernigan of the CDC said in an interview. As to why the number of spinal infections is growing, specialists theorize that the incubation period could be longer than for meningitis or that it has taken longer for patients and doctors to recognize and report infections.
Adair is now at home, taking antifungal pills and waiting for her incision to heal. She requires morphine to get out of bed in the morning, but doctors have told her the pain should subside as her back heals. She has put breeding dogs and chickens, and tending her flower and vegetable gardens, on hold. Her husband, who depends on overtime to help make ends meet, did not get any extra pay last month while he helped care for her. They missed a mortgage payment and are working with the bank.
“We are just lucky I didn’t die,’’ Adair said. “I just don’t want to lose my house over this.”
Many of the patients stricken with meningitis early on are still dealing with the physical and emotional fallout from their disease.
Virginia Milne, 65, developed meningitis while traveling with her family in Europe, and after 31 days in the hospital, she is now home coping with the side effects of treatment. Milne got a steroid injection in her lower back Sept. 5 because she did not want her chronic back pain to ruin the trip. By the time she arrived in London two weeks later, she had developed a terrible headache.
Her husband wanted to return home to Virginia, but Milne insisted they go on to Ireland to meet a cousin. There she ended up in a small rural hospital, but they had not heard about the fungal meningitis outbreak in the United States, so she was not diagnosed until she got back. At one point, amphotericin caused such serious side effects — acute kidney failure and fluid in her lungs — that doctors pulled her off the medication.
“Late at night when there was no one there to talk to I would think, maybe this is how multiple organ failure occurs,” she said. Continued...