Warning signs

Fungal meningitis signs and symptoms may include:FeverHeadacheStiff neckNausea and vomitingSensitivity to lightAltered mental statusRisk factorsInclude: A weakened immune system caused by HIV infection, chemotherapy or severe diabetes. Centers for Disease Control and Prevention

The number of people with fungal meningitis soared to 105 on Monday, including eight deaths and cases reported in nine states, the Centers for Disease Control and Prevention reported.

Local officials said the outbreak is precedent-setting.

“It’s unheard of. (Fungal) meningitis is very, very rare,” said Dr. Bruce Frankel, professor of neurosurgery at the Medical University of South Carolina.

Officials are investigating whether a fungus-contaminated steroid injected into the spine for pain relief is the cause of the illnesses. Meningitis is an inflammation of the lining of the brain and spinal cord, and a back injection would put any contaminant in more direct contact with that lining.

Frankel said the situation is troubling because 17,700 single-dose vials of the potentially fungus-tainted product were shipped to 76 medical facilities in 23 states, including two clinics in the Lowcountry.

Inspectors found at least one sealed vial contaminated with fungus, and tests were being done on other vials, The Associated Press reported.

Frankel said the situation has the potential to become much worse.

“Especially with the number of vials of this stuff floating around. It could be catastrophic,” he said.

Infections after a spinal injection are rare, he said.

Fungal meningitis is not contagious. The infection is typically seen in people with poorly functioning immune systems, such as those receiving chemotherapy or people diagnosed with HIV or severe diabetes, he said.

So far, no current cases of fungal meningitis have been reported in South Carolina, although MUSC has received quite a few calls from concerned patients, he said.

The New England Compounding Center has recalled the contaminated steroid. On Saturday, the pharmacy company announced an additional voluntary nationwide recall of all its other products dating to Jan. 1.

However, officials are primarily concerned about the steroid product called methylprednisolone acetate, said Jim Beasley, spokesman for the state Department of Health and Environmental Control.

“The focus of the active surveillance investigation remains on the three lots of MPA (steroid) recalled on Sept. 26,” he said in an email.

Beasley said he checked state records dating back through 2010 and found no cases of meningitis due to a fungal infection.

The expanded recall was happening out of an abundance of caution, and there was no indication that any of the other products were contaminated, NECC said. The recall includes a 71-page list of drugs such as acetaminophen suppositories, the muscle relaxant Baclofen, caffeine citrate used to treat migraines and the pain-management drug Fentanyl.

Intervene MD clinics in North Charleston and Mount Pleasant said Friday they are taking steps to notify 189 patients given spinal steroid injections since July after being informed by the state health department that the facilities had received the suspect steroid. The possibly-contaminated vials of steroid medication have been returned to the manufacturer.

A spokeswoman for Intervene MD did not respond to requests Monday for an update on the situation. A call to the clinic seeking comment was not returned.

The Intervene MD clinics were contacted Sept. 21 and informed that they had received the suspect medicines. The situation became public Friday.

“It was never a threat to the general public. It was a threat to a specific population,” Beasley said.

Intervene MD said Friday it had spoken with almost all 189 people affected, and that it is sending letters that detail signs and symptoms to watch for until the possibility of the illness passes. None of the patients are showing any signs or symptoms of meningitis, the clinics said.

On Monday, fungal meningitis cases were reported in Florida, Indiana, Maryland, Michigan, Minnesota, North Carolina, Ohio, Tennessee and Virginia. Tennessee led the list with 35 cases, followed by Virginia with 23 and Michigan with 21.