MMWR Morb Mortal Wkly Rep. 2013 May 17;62(19):377-81.
As of May 6, 2013, Michigan had reported 167 (52%) of the 320 paraspinal or spinal infections without meningitis associated with the 2012-2013 fungal meningitis outbreak nationally. Although the index patient had a laboratory-confirmed Aspergillus fumigatus infection, the fungus most often identified, including in unopened vials of methylprednisolone acetate (MPA), remains Exserohilum rostratum, a common black mold found on plants and in soil. Exposures have occurred through epidural, paraspinal, peripheral nerve, and intra-articular injection with MPA from contaminated lots compounded by the New England Compounding Center in Framingham, Massachusetts. The Michigan Department of Community Health and CDC conducted case ascertainment to describe epidemiologic and clinical characteristics of Michigan patients and to determine factors that might have contributed to the high percentage of spinal and paraspinal infections reported from Michigan. A distinct epidemiologic or clinical difference was not observed between patients with paraspinal or spinal infection with and without meningitis. Lengthy periods (range: 12-121 days) were observed from date of last injection with contaminated MPA to date of first magnetic resonance imaging (MRI) finding indicative of infection. Clinicians should continue to maintain a higher index of suspicion for patients who received injections with contaminated MPA but have not developed infection.
截至 2013 年 5 月 6 日，密歇根州报告了 167 例（52%）与 2012-2013 年全国真菌性脑膜炎爆发相关的无脑膜炎的脊柱旁或脊柱感染，全国共报告了 320 例。尽管索引患者的实验室确认了烟曲霉感染，但最常发现的真菌包括在未开封的醋酸甲基强的松龙（MPA）小瓶中，仍然是喙枝孢菌，这是一种常见的在植物和土壤中发现的黑色霉菌。暴露发生在通过硬膜外、脊柱旁、周围神经和关节内注射受污染的 MPA 部位，这些部位是由马萨诸塞州弗雷明翰的新英格兰复合中心混合而成。密歇根州社区卫生和疾病预防控制中心进行了病例确定，以描述密歇根州患者的流行病学和临床特征，并确定可能导致密歇根州报告的脊柱和脊柱旁感染比例较高的因素。未发现有或无脑膜炎的脊柱旁或脊柱感染患者之间存在明显的流行病学或临床差异。从最后一次注射受污染的 MPA 到首次发现感染的磁共振成像（MRI）结果的时间间隔很长（范围：12-121 天）。对于接受过受污染 MPA 注射但尚未发生感染的患者，临床医生应继续保持更高的怀疑指数。
