ArticleThe American journal of pathology2013
Exserohilum infections associated with contaminated steroid injections: a clinicopathologic review of 40 cases.
Article in The American journal of pathology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
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28 citing papers in PubMed, 55 citations in OpenAlex.
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- Dematiaceous Fungal Infections in Hematopoietic Stem Cell Transplantation and Predisposing Hematological Conditions: A Systematic Review.Journal of fungi (Basel, Switzerland) · 2026Review
- The dual role of azoles: lifesaving antifungals and drivers of resistance - a One Health perspective.Nature communications · 2026Review
- Fungal diagnostic stewardship in immunocompromised populations: a focus on molds and dimorphic fungi.Clinical microbiology reviews · 2026Review
- Microbiological Contamination of Medicinal Products -Is It a Significant Problem?Pharmaceuticals (Basel, Switzerland) · 2025Review
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- Post-Discectomy Infection: A Critical Review and Suggestion of a Management Algorithm.Journal of clinical medicine · 2024Review
- Neurovascular Complications of IatrogenicThe New England journal of medicine · 2024Article
- Granulomatous dermatitis caused byJournal of veterinary diagnostic investigation : official publication of the American Association of Veterinary Laboratory Diagnosticians, Inc · 2024Article
- Outbreaks of Fungal Infections in Hospitals: Epidemiology, Detection, and Management.Journal of fungi (Basel, Switzerland) · 2023Review
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- Molecular Techniques for Genus and Species Determination of Fungi From Fresh and Paraffin-Embedded Formalin-Fixed Tissue in the Revised EORTC/MSGERC Definitions of Invasive Fungal Infection.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Long-term Outcomes of Patients With Fungal Infections Associated With Contaminated Methylprednisolone Injections.Open forum infectious diseases · 2020Article
- Lumbar tinea versicolor and spinal anaesthesia.IDCases · 2019Article
- Multiplexed analysis of fixed tissue RNA using Ligation in situ Hybridization.Nucleic acids research · 2017Article
- The Carbohydrate Lectin Receptor Dectin-1 Mediates the Immune Response to Exserohilum rostratum.Infection and immunity · 2017Article
- Risk factors and the clinical and surgical features of fungal prosthetic joint infections: A retrospective analysis of eight cases.Experimental and therapeutic medicine · 2016Article
- Bone and Joint Infections due to Haemophilus parainfluenzae: Case Report and Review of the Literature.The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale · 2016Article
- In Vitro Activities of Eight Antifungal Drugs against a Global Collection of Genotyped Exserohilum Isolates.Antimicrobial agents and chemotherapy · 2015Article
- Extensive Exserohilum infection in a burn patient.JAAD case reports · 2015Article
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Authors and funding
24 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
September 2012 marked the beginning of the largest reported outbreak of infections associated with epidural and intra-articular injections. Contamination of methylprednisolone acetate with the black mold, Exserohilum rostratum, was the primary cause of the outbreak, with >13,000 persons exposed to the potentially contaminated drug, 741 confirmed drug-related infections, and 55 deaths. Fatal meningitis and localized epidural, paraspinal, and peripheral joint infections occurred. Tissues from 40 laboratory-confirmed cases representing these various clinical entities were evaluated by histopathological analysis, special stains, and IHC to characterize the pathological features and investigate the pathogenesis of infection, and to evaluate methods for detection of Exserohilum in formalin-fixed, paraffin-embedded (FFPE) tissues. Fatal cases had necrosuppurative to granulomatous meningitis and vasculitis, with thrombi and abundant angioinvasive fungi, with extensive involvement of the basilar arterial circulation of the brain. IHC was a highly sensitive method for detection of fungus in FFPE tissues, demonstrating both hyphal forms and granular fungal antigens, and PCR identified Exserohilum in FFPE and fresh tissues. Our findings suggest a pathogenesis for meningitis involving fungal penetration into the cerebrospinal fluid at the injection site, with transport through cerebrospinal fluid to the basal cisterns and subsequent invasion of the basilar arteries. Further studies are needed to characterize Exserohilum and investigate the potential effects of underlying host factors and steroid administration on the pathogenesis of infection.
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