Deadly Meningitis Cases Worry Gay Community

By Randy Dotinga
HealthDay Reporter

TUESDAY, April 23 (HealthDay News) -- A series of bacterial meningitis cases in Southern California and New York City, resulting in the deaths of several gay men, have set the gay community on edge. However, preliminary tests suggest the cases on each coast aren't connected.

Health activists became concerned in Los Angeles after a 33-year-old gay attorney from West Hollywood suddenly became ill from meningitis and died on April 13. The AIDS Healthcare Foundation, which advocates for health for gay men, initially criticized local health officials for not pushing for vaccinations. However, "we don't think it's part of an outbreak or due to him being a gay man," said Dr. Wayne Chen, the organization's acting chief of medicine.

Still, the Los Angeles County's public health department is offering meningitis vaccinations for free for those who are poor or uninsured.

In New York City, health officials are recommending that certain groups of gay and bisexual men, along with certain visitors to the city, get vaccinated against meningitis.

According to Los Angeles County health officials, four cases of meningitis in gay or bisexual men have been confirmed in the region since December, including one 30-year-old who died of meningitis in Los Angeles, and another man of the same age who died in the San Diego area, both in December, according to news reports.

The officials say the four Los Angeles cases in gay and bisexual men don't appear to be "highly related" to those elsewhere in Southern California or in New York City.

In New York City, officials have noted more than 20 meningitis cases since 2010 in gay or bisexual men; seven of the men died. The city recommends vaccinations for any HIV-infected gay or bisexual men and those who have had close or intimate contact with men they met via websites, apps or at bars or parties. Visitors who have been to the city since Sept. 1 and engaged in these types of activities should get vaccinated too, city officials added.

Meningitis is transmitted through close contact with an infected person and kills, often quickly, by causing the lining around the brain to swell. It commonly spreads through places where people live closely together, such as dorms and military housing.

Meningitis hasn't previously been connected to gay men in particular, Chen said.

Many people have the bacteria that cause meningitis in their nasal passages, but the germs often don't cause problems, said infectious disease specialist Dr. William Schaffner, chair of the department of preventive medicine at Vanderbilt University Medical Center. "They can carry these bacteria for long periods of time and transmit them to other people without being aware of the process."

The germs can create a mild illness at first that can quickly turn deadly, especially if the bacteria gets into the bloodstream, he said.

"You feel kind of punky, and you maybe have a sore throat," Schaffner said. "You lose your appetite, you get drowsy. Then you can slip into a coma."

Antibiotics effectively treat bacterial meningitis, he said, but they must be given quickly. That's why people should seek medical care if they suffer from symptoms like stiff neck, high fever (beyond 100.1 degrees Fahrenheit) or severe headache, he said.

Meningitis vaccines cost about $100, Chen said, and can cause side effects that are similar to those possible in people who get flu vaccines. The vaccines work against most strains of meningitis, Schaffner said, and take 10 to 14 days to become effective.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: William Schaffner, M.D., professor and chair, department of preventive medicine, Vanderbilt University Medical Center, Nashville, Tenn.; Wayne Chen, M.D., acting chief, medicine, AIDS Healthcare Foundation, Los Angeles

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Childhood Meningitis Tied to Reduced Education, Employment Prospects

TUESDAY, April 23 (HealthDay News) -- Some young adults who had bacterial meningitis during childhood have less education and are less financially self-sufficient than those in the general population, a new study from Denmark found.

Survivors of childhood bacterial meningitis are at risk for hearing loss, seizure disorders, and physical and mental impairments. Learning disabilities are a common problem among survivors.

Several types of germs can cause bacterial meningitis. This study looked at nearly 3,000 Danish adults who had meningococcal, pneumococcal or H. influenzae meningitis as children between 1977 and 2007. They were compared to control groups of adults the same age who had never had meningitis.

Among those who had meningococcal meningitis during childhood, 11 percent fewer had completed high school and about 8 percent fewer had received higher education by age 35, compared to those without meningitis.

Among those who had pneumococcal meningitis during childhood, about 10 percent fewer had completed high school and about 9 percent fewer had higher education, compared to those who never had the condition.

Among those who had H. influenzae meningitis during childhood, 5.5 percent fewer had completed high school and 6.5 percent fewer had higher education, compared to people who had never had meningitis, found the study, which was published in the April 24 issue of the Journal of the American Medical Association.

Compared to adults in the control group, nearly 4 percent fewer meningococcal patients, nearly 11 percent fewer pneumococcal patients and more than 4 percent fewer H. influenzae meningitis patients went on to become economically self-sufficient as adults, according to a journal news release.

As for receiving disability pensions, 1.5 percent more of those who had meningococcal meningitis, nearly 9 percent more of those with pneumococcal meningitis and nearly 4 percent of those with H. influenzae meningitis were likely to do so than adults who had never had the condition.

The findings suggest that follow-up into adulthood and possible psychological support may be important for children who have bacterial meningitis, said Dr. Casper Roed, at Copenhagen University Hospital, and colleagues.

Although the study tied childhood meningitis to reduced job and educational prospects, it did not establish a cause-and-effect relationship.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Journal of the American Medical Association, news release, April 23, 2013

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Combo Therapy Helps Knock Out Fungal Meningitis

Study found 2-drug treatment reduced death risk from cryptococcal meningitis by 40 percent

By Serena Gordon

HealthDay Reporter

WEDNESDAY, April 3 (HealthDay News) -- A drug regimen containing two powerful antifungal medicines -- amphotericin B and flucytosine -- reduced the risk of dying from cryptococcal meningitis by 40 percent compared to treatment with amphotericin B alone, according to new research.

The study also found that those who survived the illness were less likely to be disabled if they received treatment that included flucytosine.

"Combination antifungal therapy with amphotericin and flucytosine for HIV-associated cryptococcal meningitis significantly reduces the risk of dying from this disease," said the study's lead author, Dr. Jeremy Day, head of the CNS-HIV Infections Group for the Wellcome Trust Major Overseas Program in Vietnam.

"This combination could save 250,000 deaths across Africa and Asia each year. The key to achieving this will be improving access to the antifungal agent flucytosine," said Day, also a research lecturer at the University of Oxford.

Flucytosine is more than 50 years old and off patent, according to Day. The drug has few manufacturers, and it isn't licensed for use in many of the countries where the burden from this disease is highest, he said. Where it is available, the limited supply often drives the cost higher, Day noted.

"We hope the results of this study will help drive increased and affordable access to both amphotericin and flucytosine," he said.

Infectious disease specialist Dr. Bruce Hirsch, an attending physician at North Shore University Hospital in Manhasset, N.Y., said that in the United States, "the use of these medicines, amphotericin and flucytosine, is the usual standard of care for this dangerous infection, and is followed by long-term treatment with fluconazole [another antifungal]."

But, Hirsch noted that this infection is unusual to see in the United States.

That's definitely not the case in the rest of the world. There are about 1 million cases of cryptococcal meningitis worldwide each year, and 625,000 deaths associated with those infections, according to study background information.

Meningitis is an infection of the meninges, the protective membranes that cover the brain and the spinal cord. Meningitis can be caused by bacteria, viruses and fungi, according to the U.S. Centers for Disease Control and Prevention. Cryptococcal meningitis is caused by the fungus Cryptococcus. There are 30 strains of Cryptococcus, and one that often causes disease is Cryptococcus neoformans.

"Most of us have been exposed to Cryptococcus neoformans. It is ubiquitous in the environment, associated with trees, bird guano and soil. Infection is thought to occur from the inhalation of spores," Day said.

People can be infected for years without knowing it, according to Day. But, if someone who's infected has weakened immunity, the infection can then start to wreak havoc. Common ways people become immune-suppressed are through an HIV infection, taking immune-suppressing medications for organ transplantation, or taking immune-system altering medications for chronic inflammatory diseases, Day explained.

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Fungal Meningitis Patients: A Long Road to Recovery

Dec. 26, 2012 -- Johnnie McKee thought she was out of the woods.

McKee, a 72-year-old grandmother of four from Bethpage, Tenn., was one of nearly 14,000 people who found out this fall that they'd been exposed to tainted medications made by the now shuttered New England Compounding Center.

In her case, the threat came from a steroid shot that she'd had on Sept. 7 to relieve some nagging back pain.

"We got a letter. We were told that if we could make it 28 days, that we'd be clear," says Fred McKee, her husband of 51 years. "We watched it and worried about it," says Fred, his voice filling with emotion.

But Johnnie felt fine. She didn't have any of the symptoms they were told to look for -- headaches, nausea, fever.

The waiting period passed, and she felt good enough to get back to her yard, which she had always tended with great care. "She mowed the lawn," says Fred.

Then, on Oct. 8, the pain hit like a bolt of lightning at the base of her spine. "It was just excruciating pain," says Fred. Their surgeon told them to drive to the emergency room at St. Thomas Hospital in Nashville, where doctors had started to treat a wave of patients who were battling a rare type of fungal meningitis, an infection of the brain and spinal cord.

"There were three criteria they looked for to determine if you have fungal meningitis, and she met all three," Fred says.

Still, he says, they didn't worry. But that may have been because they didn't understand what was coming.

"I don't think we really realized that we were really getting into a two- to three-month hospitalization period and a six-month-to-a-year complete recovery," he says.

Since the outbreak began, 620 people have been infected and 39 have died in 19 states. No one has been cured.

"As far as we know, no one has been taken off medicines, and we wouldn't recommend that now; it's still too early," says Tom M. Chiller, MD, MPH, deputy chief of the Mycotic Diseases Branch at the CDC in Atlanta.

Many hope they are on the road to recovery, but no one can tell them when it will end.

Experts say they've never seen these kind of fungal infections, much less this many cases.

"It's very difficult for the doctors and the patients because we can't say, 'Well, just two more weeks of this and it will be over.' What we're saying is that we're going to keep treating you. We're going to keep caring for you, and when the experts tell us we can stop, we're going to do that," says William Schaffner, MD, an infectious disease specialist at Vanderbilt University in Nashville.

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