The black mould, Exserohilum rostratum (ex-sir-oh-HY-lum ross-TRAH-tum), which has caused meningitis in people who were treated with tainted shots for back pain is proving to be difficult to treat.
Exserohilum rostratum an emerging causal agent for meningitis, is a common mould that can be found in soil and thrives in warm, humid climates. Although it has been associated with sinusitis and skin infections and, in some cases, it can cause inflammation of the eyes, bones, and heart, it has never before been observed as a cause of meningitis.
Meningitis, an inflammation of the membranes surrounding the brain and spinal cord is usually caused by bacteria and it is very unusual to see it in patients with normal immune systems. Fungal meningitis caused by Exserohilum rostratum is uncommon.
The fungus is common in dirt and grasses — people routinely come into contact with it without getting sick — but it has never before been identified as the cause of meningitis. The fungus-related meningitis presents differently than typical disease. Patients with the usual form of meningitis (bacterial or viral) get very ill quickly and usually develop fever, headache, and neck stiffness.
Meningitis caused by Exserohilum rostratum develops slowly, and patients may not develop all the classic signs and symptoms of meningitis. If a patient exposed to the fungus-containing steroids develops a headache, fever, or stiff neck, then a lumbar puncture (taking some fluid out of the spinal canal) should be performed to establish the diagnosis of fungal meningitis.
Unlike bacterial or viral meningitis, fungal meningitis is not contagious, which means it is not transmitted from person to person. Fungal meningitis can develop after a fungus spreads through the bloodstream from somewhere else in the body, as a result of the fungus being introduced directly into the central nervous system, or from an infected body site infection next to the central nervous system.
Fungal meningitis is treated with long courses of high dose antifungal medications, usually given through an IV line in the hospital. The length of treatment depends on the status of the immune system and the type of fungus that caused the infection. For people with immune systems that do not function well because of other conditions, like AIDS, diabetes, or cancer, treatment is often longer.
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Article expanded and edited by Dr. Jackson Kung’u, PhD.
