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更新时间:2020-4-15 6:48:52 来源:本站原创 作者:佚名 浏览:

‘Worried Sick’: Meningitis Risk Haunts 14,000

Cathy Literski could tell something was wrong just from her mother’s voice on the telephone.

仅仅是从母亲在电话里的声音,凯西·利特斯基(Cathy Literski)就能听出,有些事情不对劲。

Her mother had learned that a steroid drug injected into her spine for back pain might have been contaminated with a fungus that could cause meningitis. Mrs. Literski had recently had the same type of injections herself, at the same pain clinic in Brighton, Mich. For a moment, neither woman could speak.


“I think we’re both terrified that the other one is going to come down with it,” Mrs. Literski, 57, said. “She’s worried sick about me, and I’m worried sick about her. She’s 80 years old, and if she were to come down with it, she would have very little chance of survival.”


It will be weeks, maybe even months, before the two women know if they are in the clear, past the incubation period for this type of meningitis, which can cause strokes.


About 14,000 people in the United States are in the same nerve-racking situation: knowing they might have been infected, waiting to see if they get sick. So far, 282 have contracted meningitis, and 23 have died, in a national outbreak linked to a contaminated drug made by the New England Compounding Center in Framingham, Mass. A few other patients have developed joint infections from having the drug, methylprednisolone, injected into knees, hips, shoulders or elbows.

在美国,大约有1.4万人处于这种忐忑焦虑的境地。他们知道自己可能已被感染,但还须等待观察,看自己会不会发病。到目前为止,已经有282人染上脑膜炎,并有23人死亡。这次全国疫情与一种由马萨诸塞州弗莱明汉的新英格兰复方药物中心(New England Compounding Center)制造的受到污染的药物有关。还有其他一些患者因为接受膝关节、髋关节、肩关节或肘关节注射这种名为甲基强的松龙 (methylprednisolone)的药物,患上了关节感染。

Three lots of the drug, more than 17,000 vials, were shipped to 23 states. The meningitis and other infections are not contagious.


As the case count rises day by day, experts are racing to see if they can determine which patients among all those exposed are most likely to contract meningitis. If they can identify the high-risk patients, doctors can follow them intensively with spinal taps and other tests in hopes of detecting the disease and treating it early enough to prevent its dreadful complications.


As early as Monday, health officials may be able to offer doctors a method to estimate a patient’s risk and help decide how aggressive the follow-up should be, Dr. Marion Kainer of the Tennessee Health Department said on Friday during a telephone conference.

田纳西卫生署(Tennessee Health Department)的马里昂·凯纳博士(Marion Kainer)在周五的一次电话会议中称,最早在本周一,卫生官员们将能够提供给医生们一种方法,来预测病人的风险,并帮助确定后续是否采取积极的跟踪诊疗。

So far, most of the meningitis cases have been caused by a fungus called Exserohilum, a type of black mold. People with severe symptoms have been hospitalized and given high intravenous doses of a powerful antifungal drug, voriconazole, that can cause liver and kidney problems, hallucinations and abnormal heart rhythms.

到目前为止,大部分脑膜炎病例都是由一种叫突脐蠕孢属(Exserohilum)的真菌引起的,这是黑曲霉(black mold)的一种。症状严重的患者已经入院治疗,并被静脉注射了高剂量的强力抗真菌药物,伏立康唑(voriconazole),这种药会引发肝脏与肾脏的副作用,还可能引发幻觉和心律失常。

But when the symptoms are mild and a spinal tap finds evidence of early infection, some patients can be treated at home with pills, said Dr. Carol Kauffman, an expert on fungal diseases at the University of Michigan. It is not clear how long the treatment will have to continue.

密歇根大学(University of Michigan)的真菌疾病专家卡罗尔·考夫曼(Carol Kauffman)博士说,在症状轻微,并且通过脊椎抽液发现了早期感染的证据时,一些患者可以在家中服用药物进行治疗。目前尚不清楚这类治疗将会持续多久。

The medical profession has no experience in treating Exserohilum infections of the nervous system, said Dr. Thomas F. Patterson, chief of infectious diseases at the University of Texas Health Science Center in San Antonio. However, he said that in a meningitis outbreak in North Carolina in 2002, also caused by a black mold, voriconazole cured four of five patients (the fifth died). That outbreak was also caused by a contaminated steroid injected for back pain, also made by a compounding pharmacy (not the New England one).

德克萨斯大学圣安东尼奥分校健康科学中心(University of Texas Health Science Center in San Antonio)传染病科主任托马斯·F·帕特森(Thomas F. Patterson)博士说,目前医学界对于治疗神经系统的突脐蠕孢属感染尚无经验。不过他说,在2002年北卡罗来纳州一场由黑曲霉引起的脑膜炎疫情中,伏立康唑治愈了五名患者中的四位 (第五名患者死亡)。那次疫情也是由为治疗背痛而注射的受到污染的类固醇药物引起的,这些药物同样是由一家复方药物制药厂制造(并非这次的新英格兰药厂)。

Mrs. Literski said she felt “terribly guilty” because her mother, who previously had the injections and thought they helped, had planned to get them at a different clinic, until Mrs. Literski talked her into switching.


“I was the one who encouraged her to come to the Brighton facility so I could be with her,” Mrs. Literski said.


She added: “I’m concerned that my mother isn’t sharing symptoms because she’s terrified to have a spinal tap.”


For herself, Mrs. Literski said, the only option seems to be to wait and see.


She said, “It’s like an ominous cloud following me around every day, sapping the joy out of life because you’re waiting to find out if you have a deadly disease festering in your body.”