The e-mail Dr. Marion A. Kainer received on Sept. 18
suggested an investigation of a case of fungal meningitis
and stroke
in a man whose immune system was normal and whose only risk for the infection
was a spinal injection of a steroid.
“Alarm bells went off” because of its rarity, Dr.
Kainer, an epidemiologist at the Tennessee health department, said in an
interview.
She immediately began what became a national
investigation that has now identified 409 cases, including 30 deaths, from a
fungus so unusual that it is not in medical textbooks. The fungus was
transmitted through injections of a contaminated steroid drug prepared by the
New England Compounding Center in Framingham, Mass.
Dr. Kainer’s investigation led Tennessee to take
extraordinary measures to track down 1,009 people at risk of the fungal
infection. The state is credited as the driving force in discovering one of
the most shocking outbreaks in the annals of American medicine.
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