CDC Shows Brain Destruction Caused by Fungus

By Walter F. Roche Jr.

BOSTON Mass. -A physician from the U.S. Centers for Disease Control and Prevention vividly described today the extensive damage to the brains and spinal columns of some of the victims of the 2012 fungal meningitis outbreak.
Testifying here in U.S. District Court, Dr. Sherif Zaki showed four slides for each of 17 victims describing how the fungus climbed the spinal columns of the victims and then attacked the brains invading tissue and blood vessels literally in some cases killing brain cells.
Zaki, head of CDC's infectious disease branch, was a prosecution witness in the second degree murder trial of Barry J. Cadden. Prosecutors have charged that drugs produced by the company Cadden headed were laden with the deadly fungus. The outbreak sickened 778 patients, killing 76 of them.
Zaki and Mary Brandt Ph.D also told the fifteen jurors that as the agency rushed to find out what was killing more patients by the day, they came up with new tests that enabled them to double the percentage of cases being diagnosed with fungal meningitis and to do so much more quickly.
"We really had to know what fungus we had," Brandt said.
She said the effort was further complicated by the fact that some of the victims had been treated with antifungal medications in the weeks before their deaths. The drugs would kill the very DNA they were searching for.
She said a new test, known as Real Time PCR uses fluorescent light and a laser to hunt for the fungus and its DNA. She said once the DNA was found, it was processed and duplicated so the sequence could be determined.
Brandt, head of the mycotic diseases branch, said that they first learned of the outbreak from officials of the Tennessee Health Department which had received the first case report.
Both she and Zaki stressed that one of the first challenges was trying to figure out what they were dealing with because fungal meningitis was not at all common.
"It's a very  rare condition. Not much was known about it,"Brandt said. "That was part of the problem. There was very little expertise."
In addition, she said, at least at first the volume of specimens being sent to the CDC from state health departments was sometimes inadequate.
In his presentation Zaki described how the fungus flows to the base of the brain and "moves around and gets into the vessels. You get inflammation, a stroke, thrombi.
Under questioning by Assistant U.S. Attorney George Varghese, Zaki said the first case reported in Tennessee had a fungus called aspergillus fumigatus, but all the other cases he described had a fungus called exserohilum rostratum.
The slides and case files Zaki presented included victims from Michigan, Tennessee, Indiana, Maryland, Florida and Virginia.
He said one of the CDC's first task was to set a case definition.
"You have to make sure you're covering everything," he said.
In the case of Lyn Laperrier, a Michigan victim, Zaki described how the fungus hung on to the wall of a blood vessel, works its way inside and then attacks.
"You can actually see the fungus.
In the case of another Michigan victim, Gayle Gipson, Zaki said it was "a little different with inflammation at the base of the spine.
In the case of Mary Plattl, also from Michigan he described "intense inflammation around the spinal chord and necrosis of the brain.
He said the analysis of the case of Sally Roe showed the fungus obliterated blood vessels.
Diana Reed, a Tennessee victim, had evidence of meningitis in the spine and the base of the brain, while Thomas Rybinski had ballooning of the arteries. It was Rybinski who had the different fungus, aspergillus fumigatus.
Carol Wetton, also a Tennessee victim, had undergone lengthy treatment with antifungal medication but the fungus remained, killing her, Zaki said. Godwin Mitchell, a Florida victim, also had undergone four months of anti-fungal treatment yet the fungus attacked his blood vessels causing inflammation.
Brandt said analysis showed other NECC drugs were found to be contaminated including triamcinolone, cardioplegia and betamethasone.
Under cross examination, Brandt said she was not aware of any patients being sickened by those additional drugs