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3 Ocala clinics linked to outbreak

7 patients under review

Ocala, FL - October 5, 2012

Published in the Ocala Star-Banner on Friday, October 5, 2012 at 6:33 p.m.


Three medical facilities in Ocala received contaminated lots of the steroid medication that has been blamed for 47 meningitis cases — five of them fatal — in seven states.

The local facilities, as identified by the Florida Department of Health, are:

  • Florida Pain Clinic
  • Surgery Center of Ocala
  • Marion Pain Management Center

The number of suspected cases of the rare fungal meningitis in Marion County also has potentially grown since Thursday, when only two people were being treated at Munroe Regional Medical Center.

The federal Centers for Disease Control and Prevention still reports only two confirmed cases in Florida. But Ocala Health Systems said it is testing five patients for the disease linked to the contaminated medicine, which typically is injected to relieve back pain.

OHS Chief Medical Officer Dr. Art Osberg said although none of the five patients has yet tested positive — the test can take 7-10 days — they are being kept in the hospital based on their risk level.

Again, as with the cases that emerged Thursday, no patients received the tainted medicine at any Ocala hospital. The patients are just being treated and tested at hospitals.

Osberg declined to discuss the cases in more detail, citing federal health privacy laws. He did say the patients were being evaluated by infectious disease specialists.

In general, Osberg said, when there is a "high index of suspicion" in such cases, patients typically would be hospitalized, monitored and treated as appropriate.

With this rare form of the disease, the treatment is intravenous anti-fungal medications.

Some of the patients being treated by Ocala Health Systems received their contaminated steroid injections at Florida Pain Clinic, according to the clinic's owner, Dr. Stephen Pyles.

Pyles said about 65 of his patients had received injections with one of the three tainted lots that his clinic received. He said those patients were notified by his office, by telephone when possible, or by mail, about the contamination.

He said he sent 95 of the suspect vials back after the Massachusetts manufacturer recalled the medications.

Pyles said he learned Friday that some of the patients hospitalized by OHS, whose corporate family includes Ocala Regional Medical Center and West Marion Community Hospital, are his patients.

The other five Florida medical facilities that received the tainted drugs were:

  • Surgical Park Center, Miami
  • North County Surgicenter, Palm Beach
  • Interventional Rehab Center, Pensacola
  • Pain Consultants of West Florida, Pensacola
  • Orlando Center for Outpatient Surgery, Orlando


Payles said he has received telephone calls from patients asking for advice upon learning of the contamination, but none have been angry or accusatory toward him or his clinic.

Michael Guarino, administrator at Surgery Center of Ocala, said his clinic injected just more than 20 patients with a suspected lot of the steroid. He said his office has contacted all of the affected patients, letting them know about the recall.

"Of our patients, none have been hospitalized to our knowledge," Guarino said.

He said members of the U.S. Food and Drug Administration visited his clinic Friday and retrieved any suspect vials of the medicine.

The third Ocala clinic that received at least one of the three contaminated lots, Marion Pain Management Center, did not return telephone calls from the Star-Banner for this story.

Both Florida Pain Clinic and Surgery Center of Ocala now get the steroid from a different manufacturer.

The Massachusetts compounding pharmacy that manufactured the suspected contaminated steroid medication — called methylprednisolone acetate — recalled three lots of the medicine last week and has shut down operations. The recalled steroid was shipped to 75 facilities in 23 states since July, according to officials with the FDA and the CDC, who spoke during a joint telephone conference Thursday.

The seven states that reported cases are Tennessee, with 29 cases; Michigan, with four cases; Indiana with three, Virginia with six, North Carolina with one, Maryland with two and Florida with two. There were 35 cases Thursday.

Three deaths occurred in Tennessee, one in Maryland and one in Virginia.

"All patients who may have received these medications need to be tracked down immediately. Patients can find the names of the clinics that used these medications on the CDC website," said Dr. Benjamin Park, a medical officer with the Mycotic Diseases branch of the CDC. "It is possible that if patients with infection are identified soon and put on appropriate anti-fungal therapy, lives may be saved."

The type of fungal meningitis involved in this outbreak is not contagious, like other, more common forms of the disease. This kind is caused by a fungus often found in leaf mold.

Symptoms included worsening, severe headache, nausea, dizziness, fever, sensitivity to light, new weakness or numbness in any part of the body. The same health officials also said some people were experiencing stroke-like symptoms, including slurred speech.

They also warned that some of the symptoms could be mild, making it more difficult for patients with the disease to suspect what is wrong.

The symptoms appear one to four weeks after infection.


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