A Nashville outpatient center has voluntarily closed after a cluster of meningitis cases involving two deaths.
Saint Thomas Outpatient Neurosurgery Center shut down indefinitely on September 20 after 11 patients tested positive for meningitis.
The patients, who range in age from 40 to 80, all had lumbar epidural steroid injections between July 31 and September 20. Seven hundred and thirty seven other patients who also received the same procedure during that time have been alerted.
"There's no risk to anybody that did not have a lumbar epidural steroid injection," said Dr. John Dreyzehner, Commissioner of the Tennessee Department of Health.
Aspergillus meningitis is a fungal infection that typically affects patients who have weakened immune systems.
The type of meningitis is neither bacterial nor viral and is not spread by person to person contact.
"This is a very, very unusual event and let me stress a very unusual event," said Dr. Dreyzehner.
Health officials said it is also rare for patients with good immune systems to test positive for the type of meningitis.
Symptoms, in these cases, took seven to 28 days to begin to show. They can be subtle and difficult to diagnose.
Those symptoms include a fever, stiff neck, headache, drowsiness and in some cases slurred speech.
Dr. William Schaffner is Chairman of Vanderbilt University Medical Center's Department of Preventative Medicine. He is not associated with Saint Thomas Outpatient Neurosurgery Center.
"This is obviously by injection and a super unusual way of acquiring it," he said. "Normally when this rare infection occurs it occurs in someone who is very, very ill with other underlying illnesses."
The Tennessee Department of Health and Centers for Disease Control are investigating to try to pinpoint the source of the problem. The equipment used in the procedure was produced outside of the state and at least a dozen other states could be involved.
Other Middle Tennessee patients could be affected, but there are no other known cases and no other Tennessee medical facilities have been identified.
One other state is involved in the investigation but health officials would not say which state.
"When these otherwise harmless organisms get a foot hold they can set up a little pneumonia get into the blood stream get into the brain ad cause meningitis that way," Dr. Schaffner said. "I assure you that is an infection so rare that most doctors have never seen it."
He also said the patients being treated at the clinic were more than likely not as sick as the people who typically develop fungal meningitis.
"Their health generally is more robust than these other people so their prognosis is better," he said.
Saint Thomas Hospital is not involved.
Anyone with concerns should call the state hotline at 1-800-222-1222.
The meningitis deaths are unrelated to two deaths linked to bacterial meningitis in the last month.
Friday, nine-year-old Sam McLeod, a student at West Elementary School in Mt. Juliet, died from a non-contagious form of bacterial meningitis and on September 10, 18-year-old Jacob Nunley, a freshman at Middle Tennessee State University in Murfreesboro, died from the illness.