Fungal meningitis scare: Ocala woman was horribly ill
After spending three months in the hospital and enduring some harrowing setbacks, Roseann Fusco survived the fungal meningitis she contracted after receiving a contaminated epidural steroid injection. And although she realizes she is more fortunate than those who have succumbed after receiving the tainted medication, she lives in fear of what might possibly lie ahead for her.
Contaminated pain medication from the New England Compounding Center triggered a fungal meningitis scare.
The latest statistics:
• 704 cases nationwide, including 25 in Florida
• 46 deaths nationwide, including three in Florida — all of which were in Marion County.
"I do have concerns if something will come out of this later on because they (doctors) don't know," Fusco said. "I panic right away when I get a headache."
So far 46 people, including three from Marion County, have died nationwide after being injected with the contaminated steroid supplied by the now bankrupt New England Compounding Center in Massachusetts.
Before she ever took the injection at Marion Pain Management Center, Fusco had gone for an MRI that uncovered that she had herniated discs, bone spurs and spinal stenosis, which is a narrowing of the spine and neck. Nerves would send what felt like electrical shocks down her arm.
She consulted with a neurosurgeon, a neurologist and the Marion Pain Management Center. All advised her that she needed surgery to correct the problem, but that the steroid compound usually helps with the pain and delays surgery.
"I really didn't want to get the shot," Fusco said, but all three physicians suggested it. "One practically begged me."
So, on Aug. 24, she agreed to take one injection.
Nine days later, Fusco, who almost never is ill, had a headache, a high fever, was very weak and became sensitive to light. She thought she had a cold and went to the city of Ocala's employee clinic, where she was given a Z-Pack. She lost four days' work but then began feeling better and returned to her job as Ocala's deputy city clerk.
A fellow employee, who had read about the problems being caused by contaminated steroid injections, questioned Fusco about her shot, but Fusco brushed it off saying that the pain center would let her know if there was anything to be concerned about.
When she got home that night, there was a message on her telephone answering machine from Marion Pain Management saying she had received a contaminated injection, that she would receive a letter to that effect and, if she had any symptoms, she should go to the emergency room.
Since she was feeling better she did not go to the emergency room right away, but then decided she would go just to advise them that she had received the injection.
At Munroe Regional Medical Center's emergency room, she was told she would have to have a spinal tap to make certain she was not infected. The results came back positive and she was admitted to the hospital on Oct. 8.
But because not enough fluid had been taken, she was told she would need a second spinal tap.
Before she had the second procedure, a radiologist said she first would have to have an MRI, which she did. The doctors were looking for an epidural abscess. Unfortunately, they found what they were looking for and Fusco was given an emergency laminectomy to remove the infected abscess and part of her spine bone.
She said she was started on the anti-fungal medication Voriconazole, a highly toxic drug that can damage the liver and kidneys, that was recommended by the federal Centers for Disease Control and Prevention. She had a severe allergic reaction "that I later found out I could have died from," Fusco said.
She then was placed on Amphotericin B, another toxic anti-fungal drug, which made her shake. But that seemed to get matters under control.
Just as it appeared the treatment was going well, Fusco had another, severe setback.
"I kept telling them there was pressure at the incision site, that I felt I was humpback and it would not go away," Fusco said.
Doctors attributed that to her muscles, she said. But an MRI showed fluid accumulating and it was decided the area needed to be aspirated so the fluid could be tested to make certain it was not infected.
But before that was done, her husband noticed bloody fluid on the back of her pajamas and he saw a little hole in her back. She was scheduled to go to radiology that morning but before she could go, her wound broke open gushing blood and fluid, leaving a gaping, bloody hole and her neck bones exposed. It took eight weeks for the wound to close.
On Nov. 12, because she no longer met the criteria to remain in Munroe, she was transferred to Promise Hospital of Florida at The Villages, a long-term acute care facility in Oxford that was able to administer her wound care and her toxic medications. Five days later, she awoke with a fever and her wound appeared infected.
"They did a culture and found out I had MRSA in the wound," Fusco said about the staph infection, methicillin-resistant Staphylococcus aureus, which is difficult to treat.
She remained at Promise from Oct. 12 to Jan. 6 and has been seeing doctors weekly since then for blood tests and physical therapy. Her kidney functions were damaged but have recovered, but she is now anemic.
"I get tired," said Fusco, who has returned to work full time. "I am slowly trying to regain and get into everyday activities."
She still has to get plastic surgery on wound site, which is very thin, so it will be thick enough to protect her neck and spine.
But she has retained two attorneys, John Piccin of Ocala and Ervin Gonzales of Coral Gables.
"I am pretty upset because this never should have happened because of their negligence in the compounding company in making the medication," Fusco said.
She said someone needs to be held accountable.
At various times throughout her ordeal Fusco suffered with nausea, swelling, headaches and periods of delirium. Now she is losing her hair.
One of her biggest fears was that she would be paralyzed.
Dr. Ivan Soosaipillai, an infectious disease specialist in Ocala who treated Fusco after she developed problems from the pain shot, did not return calls seeking comment.
Before any of this happened, Fusco, a 52-year-old mother of three grown children, had been an avid tennis player who worked out most days.
Fusco's husband, Paul, tried to be a comfort to his wife. He stayed overnight with her in the hospital. He had to work during the day, but would call her about three times a day.
"It was very scary," Paul said. "This medication is so toxic."
One of the most difficult times for him was when his wife had the allergic reaction to the Voriconazole.
"I thought that night she was not going to make it," Paul said. "She was going in a negative direction very fast and that was a very scary night."
And when the wound opened, he feared she would be susceptible to additional infections.
It was not only his wife's physical condition that concerned him but also her psychological well-being.
"You are in the hospital for a long period of time. It starts to wear on you after a while," he said.
The doctors' uncertainty also created stress for the couple.
"They even told us, ‘We really don't know. We think this is what is going to happen. We are just going by what the Centers for Disease Control recommends,' " Paul said. "The doctors told us, things could change really quick."
He said all this pain and suffering happened because of a company that was trying to make a profit.
Craig Ackerman, public information officer for the Marion County Health department, said 429 Marion County residents were exposed.
"They didn't necessarily become sick," Ackerman said. "There were 18 people who became sick in Marion County. Three of those people died. Their deaths were attributable to the results of being ill from receiving that medication."
He said all 429 people were exposed to three medications from the New England Compounding Center that were administered at one of two facilities: the Marion Pain Management Center or the Florida Pain Clinic. Ackerman said there were other Marion County facilities that received medications from NECC but those were the only two centers where cases emerged.
In the United States, there were 13,534 exposures, and 704 have been labeled as cases by the CDC. Nationwide, there have been 46 deaths. In Florida, there were 1,055 exposures, and 25 have been labeled as cases. All three deaths in Florida were in Marion County.
The CDC defines a case in four different ways: a person develops meningitis with no other source; a person develops a certain type of stroke without another source; if an abscess develops at the site of the injection; or if inflammatory arthritis develops in a joint where a person received an injection.
The last case announced in Marion County was on Dec. 5 and involved a 73-year-old man who received an injection at the Florida Pain Clinic. He was not only the last case named in Marion County but also the last named in Florida, Ackerman said.