People who may have been injected with contaminated steroids can undergo an MRI scan to check for signs of infection, even if they do not have symptoms, according to a new study published in JAMA.

A group of researchers examined 172 people who were injected with methylprednisolone from a New England Compounding Center (NECC) lot that may have been tainted with meningitis and fungi, and identified 36 unusual test results in these subjects – including 13 subjects who had no new or worsening symptoms such as pain or weakness near the injection site.

According to the Centers for Disease Control and Prevention, tainted steroids were responsible for 58 deaths in 2012, as well as many people becoming ill.

Meningitis was the cause of most of the original injection-related illnesses, and later fungal infections that developed weeks and months following the injections of patients.

Dr. Anurag Malani, lead author of the study at St. Joseph Mercy Hospital in Ann Arbor, Michigan, said:

“The clinical symptoms can be subtle, and it can be difficult for patients and providers to distinguish from chronic pain. It’s important to recognize that we continue to see infections, as recently as the end of April. We still need to be vigilant looking for these infections. I suspect there are still cases of infection out there.”

Malani and his team assessed patients without meningitis or symptoms of infection beginning in November 2012. All of these patients had potentially received a contaminated spinal steroid injection, about three months before their MRI, on average.

Of the 172 people who were examined, 36 had an MRI result that revealed fluid build-up or a different sign of infection. Of those 36, thirty-five met the standards set by the CDC for probable spinal infection, while 24 needed surgery, and 17 of those had a laboratory-confirmed infection.

Among people with symptoms, the authors pointed out that it can be hard to identify whether back pain was caused by the injection itself, or what made the injection necessary in the first place.

However, one investigator said that examining everyone who had received an injection around the time of the contamination is not recommended.

Dr. Thomas Patterson, head of infectious diseases at the University of Texas Health Science Center at San Antonio added, “More than 10,000 people got injections, and the absolute number of infections is still very small.”

Additionally, the anti-fungal medicine prescribed to people with suspected infections had side effects including:

  • memory changes
  • liver problems
  • alopecia (hair loss)

The authors concluded:

“Our findings support obtaining contrast-enhanced MRI of the injection site in patients with persistent back pain even when their pain disorder has not worsened,” the researchers write. “A proactive outreach to patients receiving injections from a highly contaminated lot, especially lot No. 06292012@26, is needed. Magnetic resonance imaging may detect infection earlier in some patients, leading to more efficacious medical and surgical treatment and improved outcomes.”

Written by Kelly Fitzgerald