The Minnesota Department of Health estimates that as many as 1,000 patients may have received contaminated steroids that have been implicated in a national meningitis outbreak.
Two Twin Cities-based health care groups used steroids from the same product lots that have been linked to the deaths of five patients and 30 illnesses in six states.
So far Minnesota has not identified any cases of fungal meningitis related to the outbreak.
Officials with Medical Advanced Pain Specialists and the Minnesota Surgery Center are scrambling to contact all of their patients who received the potentially contaminated steroid injections. Medical Advanced Pain Specialists has locations in Edina, Fridley, Shakopee and Maple Grove. The Minnesota Surgery Center has locations in Edina and Maple Grove.
The steroids in question were used to treat back pain. The drugs were prepared by a specialty pharmacy in Massachusetts.
That pharmacy, the New England Compounding Center, has closed during the investigation and has voluntarily recalled the steroids it produced. But the U.S. Food and Drug Administration urged hospitals, clinics and doctors in all of the affected states to discontinue use of any products made by NECC.
State Epidemiologist Ruth Lynfield says Minnesota's priority is to make sure that patients who received the steroid injections at Medical Advanced Pain Specialists or the Minnesota Surgery Center are notified quickly.
Potential cases could go back as far as July. But Lynfield says the Health Department is also keeping an eye on the bigger picture. The agency sent an alert to all Minnesota providers urging them to heed the FDA's advice and check their inventories for any products prepared by the Massachusetts pharmacy.
"The active surveillance that we're doing, whereby we're calling patients, is for the patients who got this specific product," Lynfield said. "But clearly, we're on the lookout and we're concerned about expanding. Although at this point there is no evidence that it has expanded beyond this product."
One challenge for health officials in identifying the scope of this outbreak is that some of the meningitis cases have been mild.
Lynfield says when Tennessee health officials first identified the outbreak there, subsequent patient testing revealed that several people had contracted meningitis, but their symptoms were mild enough that they didn't seek medical care. She says those patients needed to be treated, though, because their infections were in their spinal area.
"The cases that have been reported have a fungal infection in their central nervous system," she said. "And some of them have had strokes associated with it, and others went on to develop severe systems and so we are concerned."
If any Minnesota cases are identified, Lynfield says those patients will likely need to be hospitalized so they can receive anti-fungal medication through an IV.
Meningitis is an inflammation of the lining of the brain and spinal cord. Common symptoms of fungal meningitis infection may include headache, fever, sensitivity to light, a stiff neck or pain at the injection site.
Lynfield said that this fungal form of the disease cannot be transmitted person to person.