Fungal Meningitis Case Study

(Smith) This led to the recall of lot 08 as well as any unused lots from the New England Compounding Center. Although this recall protected more Americans from the exposure of E. rostratum, it came too late for many others.

In September 2012, a now defunct Massachusetts compounding pharmacy, the New England Compounding Center (NECC) synthesized over 17,000 contaminated steroid pain injections that were shipped to 23 states.2 Up to this point, the methylprednisolone acetate (MPA) injections compounded by the NECC have caused the death of 64 people and resulted in 751 cases of fungal meningitis in 11 states. With over 750 cases and still counting, the NECC outbreak is one the largest of healthcare-associated infections ever reported in the United States.3

Fungal diseases can be detrimental to the health of many organisms in the ecosystem and extremely hard to control the spread. Three once commom tree species in North America have been devastatingly impacted by the spread of Dutch Elm disease, Chestnut blight, and Butternut canker.

N. meningitides bacterium responsible for outbreaks in densely populated areas such as childcare centers, boarding schools, or college living areas (Smeltzer, Bare, Hinkle, & Cheever, 2010). These outbreaks are most common in winter and spring months when risk factors like upper respiratory infections are more likely (Smeltzer, Bare, Hinkle, & Cheever, 2010). Immunosuppression must be present for this pathogen to invade. Other risk factors for meningitis are otitis media (middle ear infection), mastoiditis (mastoid bone infection) (Smeltzer, Bare, Hinkle, & Cheever, 2010), systemic sepsis, sinusitis (sinus infection), basilar skull fractures, and the very young and the very old (Porth & Matfin, 2009).

Cancer causes many deaths across the globe, in the US alone about twenty-five percent of all people who die, die from cancer. Mutations of DNA, can lead to cancer in healthy cells. Once one cell mutates, if it does not die it will replicate itself causing spread of cancer cells (“Cancer”). Harris explains, “Meningitis, is a disease that affects the membranes covering the brain and spinal cord.” Meninges are known as the tissues that surround the brain and spin (“Carcinomatous Meningitis”). As the article “Carcinomatous Meningitis” defines so well, “Carcinomatous meningitis means there is inflammation of the covering of the brain, caused by cancer. It is an uncommon condition caused by cancer cells getting into the thin layers of body

Neutropenic cancer patients are at high risk of developing invasive fungal infections (IFI), especially those who have extended periods of profound neutropenia (a). In particular, patients who have hematologic malignancies and receiving remission induction chemotherapy for acute myeloid leukaemia (AML) are at higher risk of having these invasive fungal infections (b). This risk of fungal infection increase in patients with prolonged duration of neutropenia, increased number of chemotherapy cycles and prolonged duration of using antibiotic (h). Unfortunately, IFI can results in inability of taking the consecutive chemotherapy cycle and substantial morbidity and mortality, with a high mortality rate reaching up to 90% (c,d). The Infectious Diseases

The first recorded Meningitis epidemic occurred in Geneva in 1805, and shortly afterward several other outbreaks in Europe and the United States were recorded as well. Then, thirty-five years later, the first outbreak in Africa was recorded. The African Meningitis outbreaks became much more common in the 20th century. News Medical stated that “The first major epidemic was reported in Nigeria and Ghana from 1905-1908.” In the earliest reports, large numbers of people died from this disease. The first evidence found that linked Meningitis with a bacterial infection was written by Anton Vaykeslbaum, an Austrian bacteriologist, in 1887. This discovery led to many other people conducting research of their own, and “organisms causing Meningitis were identified in the later 19th century including: Streptococcus, Neisseria Meningitidis, and Haemophilus Influenzae” (History).

Variety of agents can cause bacterial meningitis. Since the introduction of new vaccine (Hib and PCV7), the pathogens responsible have changed. Presently, S. pneumaniae and Neisseria meningitidis are the leading cause of bacterial meningitis in children between 3 months and 19 years of age and Neisseria meningitidis is the leading cause in children between 10 and 19 years. The causative pathogen differs in children between 1 and 3 months. The leading cause of neonatal meningitis is group B streptococci about 39% and gram negative bacilli 32% (Nigrovic, Kupperman, and Malley, 2008)

Meningitis is an inflammation of the meninges, membranes that surround the brain. This can extend as far as infecting the cerebral spinal fluid on top of causing the tissue to swell. Meningitis comes in two major forms; bacterially and virally. However, having bacterial meningitis is much more severe than viral meningitis. There is a lot more danger in having a bacterial infection within the brain than a viral infection within the brain. What makes bacterial meningitis so lethal is that “even when the disease is diagnosed early and adequate treatment is started, 5% to 10% of patients die, typically within 24 to 48 hours after the onset of symptoms. Left untreated, up to 50% of cases may die, (6) or there

Candida auris is becoming responsible for the cause of fungal infection in healthcare facilities. Fungus likes to grow in warm moist areas. Research has shown that hospital sinks are positive for Candida auris due to patient nurse contact. On these surfaces certain Candida can live 14-28 days outside of their host. With this occurrence, it is more likely for this Candida auris to be transferred to different hosts daily. With patients already weakened immune system, makes them a susceptible host for this infection possibly making their stay at the hospital longer. (Welsha, Bentz, Lyons, 2017,

Additionally, the proportion of cases among adolescents and young adults has increased in recent years; during the year from 1992 to 1996, twenty eight (28) percent are affected were between the age of 12 and 29, this changes of rates has important implications for preventive strategies. Furthermore, meningococcal meningitis can refer to any illness or compare to any illness that is caused by the type of bacteria that is called Neisseria meningitides that is also known as meningococcus, this illness/ disease are commonly severe and includes infections of the lining of the brain and spinal cord that can cause meningitis and bloodstream infections that can cause either bacteremia or septicimea. Additionally, spreading through the exchange of respiratory and throat secretions like spits are commonly cause meningococcus bacteria, for example are by living in close quarters, squatters, kissing, sharing of

Because aspergillosis is not a reportable infection in the United States, the exact number of cases is difficult to determine. Milder, allergic forms of aspergillosis are more common than the invasive form of the infection. (CDC, 2013)

Cryptococcus neoformans is a basidiomycetous yeast fungus that is enclosed with a polysaccharide capsule. C. neoformans can undergo sexual reproduction that is due to crossing α- and a-mating types, resulting in the formation of sexual spores or basidiospores (Buchanan and Murphy, 1998). It is an intracellular pathogen that affects more than one million individuals, resulting in over 700,000 deaths per year (Centers for Disease Control and Prevention, 2014). Individuals become infected with this pathogen when they inhale fungal particles from the various sources that C. neoformans is found in: bird guano, decaying vegetables and soil (Upadhya et al. 2013). These particles then enter the alveoli within the lungs. In individuals with a healthy immune system, the infection is cleared or stays dormant until an imbalance of the immune system occurs. However, in individuals with compromised immune systems such as those with HIV, cancer or those taking corticosteroid medications; the fungus can disseminate and enter the central nervous system. Symptoms include coughing, chest pain, fever, weight loss, pneumonia and respiratory distress syndrome as well as meningoencephalitis that is fatal if left untreated (Bose et al. 2003; Upadhya et al. 2013).

Fungal contamination of food usually occurs accidentally, but it could occur purposefully as an act of bioterror or biological warfare. The potent acute toxicity and chemical stability of mycotoxins aflatoxin B1 (AFB1), and T-2 toxin make them apt to be weaponized for bioterrorism [3]. Cereals represent one of the most important dietary items around the world. Cereals are very susceptible to fungal attacks while in the field and during storage [4]. T-2 toxin is a member of the fungal metabolites known as trichothecene mycotoxin. The major attribute of T-2 toxin is that it inhibit protein synthesis which is followed by a secondary disruption of DNA and RNA synthesis. T-2 toxin affects the actively dividing cells such as those lining the gastrointestinal

ABPA is a disease of the lung resulting from hypersensitivity to A.spergillus fumigatus and mostly seen in susceptible patients with asthma or cystic fibrosis.