The mold linked to the fungal meningitis outbreak is an unlikely pathogen that has left clinicians scrambling to diagnose and treat affected patients and wondering what to expect next.
Exserohilum rostratum is one of a class of black molds, so-called because they have melanin in their cell walls, that only rarely cause human illness and even more rarely cause invasive disease, experts told MedPage Today.
"They really prefer to infect plants," according to Carol Kauffman, MD, of the University of Michigan in Ann Arbor.
As of Monday, according to the CDC, the outbreak has claimed 30 lives and made 429 people sick in 19 states.
E. rostratum is found pretty much everywhere in soil and decaying matter, but its most common clinical manifestation is allergic sinusitis, with occasional cases of keratitis if the mold gets into a scratch on the cornea, Kauffman said.
In rare cases, a splinter can carry the mold deep into tissue, leading to a localized infection.
That, in a sense, is what has happened in the meningitis outbreak. "Unfortunately," Kauffman said, "it happens to be a localized infection in the central nervous system."
The outbreak has been linked to injections of a steroid, preservative-free methylprednisolone acetate, that was contaminated with E. rostratum.
The majority of cases have involved some sort of central nervous system infection, mainly meningitis, although several patients have presented with classic stroke symptoms thought to be caused by the fungal infection.
The outbreak, which came to light in late September with a single case in Tennessee, is the largest outbreak ever of fungal meningitis, a CDC spokesman told MedPage Today.
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