The fungus behind an avalanche of fatal cases of meningitis last year Linked to medical clinics in Mexico was found to have aggressively attacked the base of patients’ brains, researchers said Wednesday in a report published in The New England Journal of Medicine.
fungal meningitis was reported in up to 24 patients from the United States who visited two medical clinics in Matamoros, Mexico. Many came from Texas. Twelve died.
All patients had undergone cosmetic procedures – as breast implants, buttock lift or liposuction, which required epidural anesthesia. It was later discovered that the epidural was contaminated with a fungus called Fusarium solani; The epidural, experts said, introduced the fungus into patients’ cerebrospinal fluid, a fluid found in and around the spinal cord and brain that provides nourishment and protection and removes waste.
In the report, researchers from the University of Texas and the Centers for Disease Control and Prevention examined the electronic medical records, images and pathology reports of 13 of the patients. They found that the fungus, which has a predilection for sticking to blood vessels, proliferated in the vessel-rich brainstem.
“What we end up seeing is literally this fungus eating away at blood vessels and also causing clotting,” said Dr. Luis Ostrosky, chief of infectious diseases and epidemiology at UTHealth Houston and Memorial Hermann Health System and one of the authors of the paper. .
As a result, patients suffered strokesbrain hemorrhages and increased pressure inside the brain as inflammation blocked the flow of cerebrospinal fluid.
“Seeing how the brainstem was affected in very specific ways, that were unexpected and unusual, is an important finding and could potentially help alert doctors to future cases” and lead to better, faster diagnosis and treatment, he said. Dr. Celeste Philip, the senior public health advisor for medical and health affairs at the American Public Health Association. Philip was not involved in the new report.
Getting treatment early is critical, said Dr. Katrina Byrd, an infectious disease expert and CDC epidemic intelligence officer. “If we can detect the infection early, the duration of treatment is shorter and the effect of the infection on the body is less severe,” she said.
Many of the patients in the Matamoros outbreak were not evaluated or treated for a month or more after the onset of meningitis symptoms, such as chronic headache, sensitivity to light and sound, and fever. Some were turned away from emergency departments and told they probably had post-epidural headaches. Others, some without health insurance, ignored their symptoms.
Seven of the surviving patients were given an experimental antifungal drug at the end of the outbreak, after the fungal strain was found by laboratory testing to be resistant to current medicationssaid Dallas Smith, an epidemiologist in the Division of Fungal Diseases at CDC’s National Center for Emerging Zoonotic and Infectious Diseases, who led the agency’s efforts in the outbreak.
He noted that it is difficult to grow the fungus in the laboratory from cerebrospinal fluid; The sample that was successfully cultured came from the brain of a patient who had died.
The survivors, as well as some of those who died, also received steroids for inflammation, shunts to divert accumulated cerebrospinal fluid and other advanced treatments to address the attack on the brain stem.
It’s still unclear exactly how the fungus got into the epidural solution at the Matamoros clinics, but the CDC has a theory. The morphine that was mixed with the anesthesia was likely contaminated, Smith said.
Because drug shortageMorphine is difficult to obtain in Mexico, so the anesthesiologist, who moved between both clinics, probably bought it on the black market, said Smith, author of the new report.
Several weeks ago, the CDC was able to grow the Fusarium fungus from the cerebrospinal fluid of a patient in Tennessee and compare it to the fungus grown last year from a brain autopsy. The two patients had each visited a different clinic, but the strains were genetically almost identical. That finding supports the theory that the fungus was introduced into the epidural by contaminated morphine and not by poor hygiene during surgery, Smith said.
Either way, the fungus went directly to the epidural space of the spine, “and that’s why we got this devastating mortality rate,” he said.
An unusual outbreak, but not the last
Despite the unusual and serious nature of the outbreak, experts warned that there are likely to be more in the future.
“This is probably not our last fungal outbreak,” Ostrosky said. A similar outbreak occurred in Durango, Mexico, in late 2022.
Doctors should ask patients with meningitis symptomswhich may be caused by bacteria, viruses or fungi, about your recent medical history, Smith said.
“Do they have exposure to epidurals? Do they have a recent history of medical tourism? Smith said. If the answers are “yes,” then patients should be screened for fungal meningitis, she said.
Byrd offered several tips for people considering traveling abroad for medical treatment, where it may be less expensive than in the U.S. These include:
- See a healthcare provider at least four weeks in advance to discuss your care plan when you return and to consult a specialist in advance in case of any complications.
- Consult a travel medicine specialist to ensure you have all necessary vaccinations.
- Research the medical facility to make sure it is accredited and the doctor to make sure it is licensed.
- Buy travel insurance.
- Bring home your medical records from the foreign clinic,
- and never hesitate to tell your healthcare provider if you feel unwell and be sure to mention that you received medical care abroad.
“Even if you don’t have symptoms, a good care plan is, upon your return, to see a health care provider,” Byrd said.