The national total has reached 323 cases of fungal meningitis since the outbreak, linked to steroid injections, began and doctors are struggling to figure out how to handle the crisis. 11 new cases have been reported in the past 24 hours alone and outbreaks are being reported in 18 states nationwide. Most of the infections occurred when contaminated steroids were injected directly into the patients’ spinal fluid but lately reports of infections from joint injections have also been confirmed. According to the CDC this particular type of fungus has never before been known to cause meningitis and health officials are uncertain as to how best to treat infected patients. This particular type of meningitis is very hard to diagnose and even harder to kill. Most patients require at least 3 months of treatment and can suffer hallucinations as a side effect. Doctors are unable to predict what a patient’s chance of survival is or when it is safe to stop treatments. What doctors have learned so far is that early treatment is essential to a patient’s recovery and since most people get sick within 42 days of receiving an injection they are hopeful that the worst of the outbreak is coming to an end. It is unusual for a fungal infection of this type to sicken or kill an otherwise healthy person but it seems that the location of the injection site and the particular strain of fungus are making this an exceptional killer. Because the fungus is injected near the spine doctors believe that it reduces inflammation, bypassing one of the body’s key defenses against infection. It also grows quietly enough that it is able to create an abscess in the spinal canal and then travel directly to the brain via the spinal fluid before a patient exhibits any symptoms. The good news is that there is a treatment called voriconazole, that is now replacing earlier attempts at treatment that is proving to be more successful, with less side effects than its predecessor.