First up, the growing fungal meningitis outbreak in the USA. With 344 cases and 25 deaths spread over 18 states, the outbreak is a result of patients receiving contaminated steroid injections. So far the CDC and U.S. Food and Drug Administration (FDA) have confirmed the presence of the fungus Exserohilum rostratum* in unopened vials of preservative-free methylprednisolone acetate from two different lots made by the New England Compounding Center (NECC). The company has since recalled all of its products currently in circulation that were compounded at and distributed from its facility in Framingham, Massachusetts.
These compounding pharmacies are an interesting bunch. According to the FDA they are authorised to combine, mix or alter ingredients to create specific drugs to meet the specific needs of individual patients. But it seems they are providing a cheap alternative to drugs manufacturers with some doctors and clinics breaking the rules and ordering in bulk. As they are regulated as pharmacies, not drug manufacturers, they are not as tightly regulated. Hopefully this outbreak will change that. It certainly sounds like NECC they have been cutting corners by not testing vials for sterility, or at the very least, holding off distributing them for a short period of time to watch for contamination.
And finally, faecal transplants. Yep. Transplanted poo. Apparently it can be done though a tube up the nose and into the stomach, or through the rectum. A number of doctors have trumpeted the process of transplanting faecal bacteria from healthy individuals into patients suffering from Clostridium difficile infection, a nasty bug which causes horrendous diarrhoea and other intestinal disease when the normal gut flora have been wiped out by antibiotics. A paper by Johan Bakken in the journal Anaerobe put success rates at 90% (alas, it’s not open access so you’ll have to pay Elsevier $31.50 if you want to read it….).
In a paper by Trevor Lawley and colleagues just out in PLOS Pathogens (open access so you can read this one if you really want to!), the authors treated C. difficile infected mice with faeces from healthy mice and found that this rapidly resolved C. difficile disease. So that backs up the human stuff. But what is exciting is that the authors have identified a simple mixture of just six bacteria, three of which have never been described before, which was able to re-establish a healthy gut microbiome and clear the mice of C. difficile infection. Now that is pretty cool. The question now of course is, will those 6 bugs work in people? If they do, we can say goodbye to transplanting poo and hello to a much more palatable ‘probiotic’ drink type treatment.
*There is bugger all on this fungus in wikipedia – other than it being listed as a plant pathogen.