By Tim Ghianni
NASHVILLE, Tenn., Oct 24 (Reuters) - A Tennessee doctor who ordered "extra tests" on the spinal fluid of a patient is credited by colleagues with unlocking the mystery of a devastating fungal meningitis outbreak and prompting a national alert that may have saved lives.
Dr. April Pettit, an infectious diseases specialist at Vanderbilt University, could not figure out last month why a patient in his 50s was not responding to standard antibiotic treatments for meningitis, her colleagues at the school told Reuters.
During her research and discussions with the man's family, she discovered that he had received an epidural steroid injection at St. Thomas Outpatient Neurosurgical Center in Nashville.
She then asked the Vanderbilt laboratory to check the man's spinal fluid for a rare form of meningitis, caused by a fungus rather than bacteria or a virus, which cannot be fought with conventional medications.
A spinal tap showed the presence of Aspergillus fumigatus. The patient, who was started on the anti-fungal drug voriconazole, became the first documented case of a fungal meningitis outbreak linked to potentially tainted steroids.
More than 300 people since then have been confirmed as stricken with meningitis after receiving the injections, and 24 have died, including Pettit's patient, in what is one of the nation's worst health scares in recent history.
Pettit's discovery led to the emergency recall of the medication from New England Compounding Center and other steps to stop the outbreak. St. Thomas was later confirmed to have received more of the steroids from NECC than any other facility.
Other doctors involved in the meningitis cases have documented how quickly an infected patient can deteriorate, and even die, making early diagnosis and treatment vital for up to 14,000 people believed to have received the steroid injections.
"In my mind she's a hero," Dr. Carol Rauch, associate medical director of clinical laboratories at Vanderbilt, said of Pettit, who declined to be interviewed for this story. "Credit her with saving many lives ... She persevered and ordered the extra tests and we happened upon this fungus."
A Reuters reporter was given a tour of the Vanderbilt laboratory last Friday. Other details of the first diagnosed patient also were reported in the New England Journal of Medicine on Friday.
The samples from that patient were sent to Rauch's lab, where inside the biological safety cabinet, a technologist spread the spinal fluid on Petri dishes and also put it in vials. From there it went to the incubator in an adjacent room. After several days under optimal growth conditions, the fungus was harvested and mycology specialist Tonya Snyder, 59, a medical technologist, made the ultimate discovery.
"It was amazing," says Snyder, recalling her first thoughts when looking into the microscope at the ferocious foreign invader. "It was 'Oh, there's something there that shouldn't be going in spinal fluid.'"
"This set off the bells," she says. "And everyone became involved."
The discovery was first reported to the Tennessee Department of Health and after that to the U.S. Centers for Disease Control and Prevention, which launched a national alert. The company which supplied the steroid, NECC, now faces multiple investigations, and health authorities are trying to trace every product it shipped across the country in recent months.
While Rauch displays a Petri dish that has become a garden of the fuzzy offspring of that original fungus, Snyder puts a slide in the microscope, showing a tiny sample of what she saw in what was supposed to be sterile spinal fluid.
Then the slide is projected on a large screen for group viewing.
"You look at the surface of the stalk," Rauch said, pointing to the projected slide displaying the Aspergillus fungus.
"You look at the shapes, the attachments, the color," she said, pointing to the deep blue image on the screen. She also said experts must look at where the flowery parts are on the crown of the stalk and whether they are breaking free to grow more fungus.
"It's kind of like a dandelion stem. You know, when all those little pieces begin flying off? We inhale them all the time. It's not a problem until you get them in the wrong place."
The fungus she was talking about as well as two others so far believed to be linked to the outbreak - Exserohilum and Cladosporium - are commonly found in the environment. Rauch said there may be more fungi linked to the infections.
While a fungus can be a threat to people with compromised immune systems such as transplant patients, and people with HIV/AIDS, these microscopic pieces of fungal fuzz are not harmful to the healthy unless they end up in places such as spinal fluid.
Snyder said the discovery of the fungus in the spinal fluid was a proud moment for her profession.
"We so often are behind-the-scenes people. I hate that this has happened. It is a tragic situation. But it does show how important we are in the health care puzzle," she said. (Additional reporting by Sharon Begley; Editing by Greg McCune, Michele Gershberg and Paul Simao)