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The recent fungal meningitis outbreak caused by contaminated vials of methylprednisolone has been identified to contain black mold. Medical teams are struggling to combat the durable strain of fungus that has seemingly never caused meningitis in the past. Doctors are uncertain when to terminate treatment or how to monitor infected patients.

The fungus contains an armor that some people’s immune defenses cannot fight, according to the Associated Press. "What we're dealing with here is fundamentally different" from a typical fungal infection, said Dr. Arturo Casadevall, a fungal disease specialist at New York's Albert Einstein College of Medicine. "This is a bug that most of us don't know much about."

Autopsy reports confirm that early treatment is crucial to prevent the fungus from infiltrating the brain to cause death or permanent damage. Patients who received a shot from one of the contaminated lots are urged to be on the lookout for symptoms for months, as signs of fungal meningitis tend to show up slowly. The highest risk for becoming ill seems to be within 42 days of receiving a contaminated injection, the CDC said Wednesday. At-risk people can also receive a weekly spinal tap.

Doctors are treating the black mold with voriconazole injections and pills, which can cause hallucinations, nausea, confusion and liver damage. The drug can also lead to an adverse reaction with a number of common medications, and patients’ bodies can process the drug too quickly to combat the fungus. At least three months of treatment is required.

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