Case Definitions for Meningitis and Septic Arthritis

Multistate Outbreak of Meningitis Associated with Injection of Potentially Contaminated Steroid Products

Case Definitions for Meningitis and Septic Arthritis

October 10, 2012 12:00 PM EDT

A person who received an injection with methylprednisolone acetate produced by the New England Compounding Center (NECC) who has developed any of the following:

1. Fungal meningitis or non-bacterial and non-viral meningitis^a of sub-acute onset, following epidural injection on and after May 21, 2012.
2. Basilar stroke following epidural injection after May 21, 2012^b, who has not received a diagnostic lumbar puncture.
3. Evidence of spinal osteomyelitis or epidural abscess at the site of injection following epidural or sacroiliac injection after May 21, 2012.
4. Septic arthritis^c or osteomyelitis of a peripheral joint (e.g., knee) diagnosed following joint injection after May 21, 2012.

a Clinically diagnosed meningitis meaning one or more of the following symptoms: headache, fever, stiff neck, or photophobia and a cerebrospinal fluid (CSF) profile showing pleocytosis (>5 white blood cells, adjusting for presence of red blood cells) regardless of glucose or protein levels.

b These people, if possible, should have a lumbar puncture.

c Clinically diagnosed septic arthritis meaning new or worsening pain with presence of effusion or new or worsening effusion.

Suspect Case:

A person who has developed an infection of a normally sterile site (e.g., blood, CSF, pleural fluid, peritoneal fluid, pericardial fluid, surgical aspirate, bone, joint fluid, or internal body site [e.g., lymph node, brain]) following use of a product labeled as sterile prepared by the New England Compounding Center (NECC).  http://www.cdc.gov/hai/outbreaks/clinicians/casedef_multistate_outbreak.html