On September 21, 2012, CDC was notified by the Tennessee Department of Health of a patient with the onset of meningitis approximately 19 days following epidural steroid injection at a Tennessee ambulatory surgery center (ASC). Initial cultures of cerebrospinal fluid (CSF) and blood were negative; subsequently, Aspergillus fumigatus was isolated from CSF by fungal culture. On September 28, investigators identified a case outside of Tennessee, possibly indicating contamination of a widely distributed medication. As of October 4, a total of 35 cases* in the following six states have been identified with a clinical picture consistent with fungal infection: Florida (2 cases), Indiana (1 case), Tennessee (25 cases, including 3 deaths), Maryland (2 cases, including 1 death), North Carolina (1 case), and Virginia (4 cases, including 1 death). Fungus has been identified in specimens obtained from five patients, one of whom also had Propionobacterium acnes, of unclear clinical significance, isolated from a post-mortem central nervous system specimen.
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