The death toll of the nationwide meningitis outbreak continues to rise with 23 deaths and 297 sickened, according to the U.S. Centers for Disease Control and Prevention.

While Alabama has not received tainted drugs, 19 Alabama residents have been injected with the tainted steroids from other states, and one of the 19 has died, said State Health Officer Don Williams in a press conference.

Confirmed victims of this multi-state outbreak received epidural spinal injections of a compounded steroid, methylprednisolone acetate, manufactured by the New England Compounding Center in Framingham, Mass. Currently, 16 states have confirmed cases, according to the CDC.

The outbreak has also been linked to patients who have received injections in a peripheral joint space, such as a knee, shoulder or ankle, according to the CDC.

“Meningitis is inflammation of the meninges,” said Drew Brooks, pharmacist at Milner Rushing Discount Drugs. “It’s serious because it’s an infection of the central nervous system.”

Meninges are the three membranes surrounding the brain and spinal cord, according to WebMD.com.

Fungal meningitis develops after a fungus spreads through the bloodstream from somewhere else in the body as a result of the fungus being introduced directly into the central nervous system. Fungal meningitis is not contagious, according to the CDC.

“The drug was used to inject into what is called the epidural space, that’s how it was introduced into the spinal fluid,” said Dr. Ralph Aquadro, Jr. at Internal Medicine Clinic.

Experts are learning more about this human-made medical outbreak. Some signs indicate that cases could still be emerging until Thanksgiving or beyond, according to the CDC.

The fungus found in tainted steroid injections matched the fungus linked to the outbreak. The fungus, Exserohilum rostratum, was also found in unopened vials of steroids produced by the compounding pharmacy, according to the Food and Drug Administration.

A compounding pharmacy is a place that both makes and sells prescription medication. A compounding pharmacy can often concoct drug formulas that are specifically tailored to patients, according to MedicineNet.com.

“The medication was delivered to 23 states, not including Alabama,” Aquadro said. “The majority of cases were in Tennessee.”

The CDC and state health departments estimate that 14,000 patients may have received the contaminated steroid injections.

“Alabama was not a state affected by the outbreak, but as a safety precaution we still checked with our pharmaceutical suppliers to make sure that we haven’t received any medication here at the health center from the New England Compounding Center,” said Dr. Kyrel Buchanan, director of University Health Services. “We just wanted to do our diligence on our part to make sure that we kept our students safe and our faculty and our staff who we also see here at University Health Services.”  

Aquadro said this is a bizarre medical event.

“This is a very unusual case,” Aquadro said. “You just don’t see fungal meningitis.”

Although anyone can get fungal meningitis, people with weak immune systems are at higher risk, according to the CDC.

Patients have been told that symptoms can occur up to a month after their spinal injection. Although early symptoms of fungal meningitis are mild, the inflammatory disease could potentially cause permanent neurological damage and death, according to the CDC.

“Symptoms of fungal meningitis are high fever, mental confusion, stiff neck and photophobia (sensitivity to light),” Aquadro said.

Headaches, nausea, vomiting and dizziness may also occur, according to WebMD.com.

Treatment for fungal meningitis depends on the condition of the immune system and the type of fungus that caused the infection. It is typically treated with long courses of high dose antifungal medications, given through an IV line at a hospital. For patients who have weak immune systems because of other conditions, treatment is usually longer, according to WebMD.com.

“Meningitis is very dangerous,” Aquadro said. “It can potentially be lethal.”

The CDC also has confirmed cases of Aspergillus and Cladosporium meningitis, as well as contaminated vials of methylprednisolone acetate, an injectable steroid used to treat back and joint pain.

“We have not received anything from the New England Compounding Center,” Buchanan said.