UPDATE: Two Minnesota women diagnosed with meningitis after receiving tainted medication

Two Minnesota women have been diagnosed with meningitis after being injected with steroids from a Massachusetts specialty pharmacy that issued a recall last week and has since shut down operations.

The Minnesota Department of Health reported Saturday that the women are both in their 40s. In the first case, the woman "was evaluated after experiencing possible symptoms of meningitis, including fever and headache. Evidence of meningitis was subsequently found in her spinal fluid."

Both women have been hospitalized, and are being treated with antibiotic and antifungal drugs.

State officials said Friday that about 25 people in Minnesota who were injected with the steroid are being evaluated for fungal meningitis as part of a widening national outbreak. The CDC said the number of cases reached nearly 50 nationwide on Friday. The number of deaths in the outbreak remained at five.

About 950 Minnesota patients are believed to have been treated with the steroids linked to the outbreak, officials said Saturday. The only Minnesota health care facilities known to have used the now-recalled drugs are Medical Advanced Pain Specialists (MAPS), with locations in Edina, Fridley, Shakopee and Maple Grove, and the Minnesota Surgery Center (MSC) in Edina and Maple Grove, state officials said. MAPS owns the Minnesota Surgery Center clinics.

About 350 of those patients had been contacted by state or clinic officials as of Saturday morning, with those efforts to continue through the weekend.

State epidemiologist Ruth Lynfield said it's difficult to know how many could be affected because the form of meningitis is rare and the outbreak is still developing.

“We're having a very low threshold to have people evaluated,” Lynfield said.

“There's a massive effort to contact all the patients,” said Marsha Thiel, MAPS’ chief executive officer. “If there's any question at all, they're being directed to go to their physician.”

Thiel said the Minnesota clinics received the steroid from the New England Compounding Center on July 3, and stopped using it Sept. 26.

“This just happened to be our supplier and we happened to get the lots that are in question,” Thiel said.

The meningitis in question cannot be spread from person to person. The Minnesota Health Department said symptoms of infection typically show up within one to four weeks of an injection, but could start sooner or develop later.

Lynfield said symptoms can include a worsening headache, stiff neck, fever, numbness or difficulty speaking. She said the patients who received the steroid already have chronic pain that can include headaches, which makes it more difficult to identify meningitis symptoms.

A spinal tap is needed to test for this kind of meningitis, and the treatment is antifungal medicine that typically would be given in a hospital.

“There's a lot about this we don't know, but what seems to be happening in the cases we have information on is that sometimes they can have mild symptoms for a period of time and then they get sicker,” Lynfield said.

State health officials are also contacting patients who got the steroid injected into joints or other body parts instead of their spines.

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