PRO/EDR> Meningitis – USA (06): (TX) Mexico (TM, DU) F. solani, epidural anesth, fatal, RFI


A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Fri 26 May 2023
Source: CBS News [edited]

Authorities in the U.S. and Mexico have asked the World Health
Organization to declare a public health emergency of international
concern over a deadly fungal outbreak, a Centers for Disease Control
and Prevention official said Friday [26 May 2023]. The request comes
after recruiters lured hundreds of patients from multiple countries
and 24 U.S. states to 2 facilities in Mexico for cosmetic operations
that may have exposed them to the fungus.

The CDC is currently monitoring the condition of 195 people across the
U.S. who got surgeries involving epidural anesthesia at the
now-shuttered River Side Surgical Center and Clinica K-3 in Mexico. A
total of 14 are “suspected” and 11 are “probable” cases of fungal
meningitis — infections of the brain or spinal cord — based on their
symptoms or test results. Two of these patients have died. Six
potential cases have been ruled out since the CDC’s last update on
Wednesday [24 May 2023].

Most reported headaches before their infections worsened, progressing
to symptoms like fever, vomiting, neck pain, and blurred vision.
Meningitis can quickly become life-threatening once symptoms begin,
the CDC warns.

Recent test results from authorities in Mexico have sparked concern of
a repeat from another deadly outbreak that was linked to surgeries
elsewhere [Durango] in Mexico earlier this year [2023]. In that
outbreak, nearly half of all patients diagnosed with meningitis died
[39 of 80 cases died].

A WHO committee would have to be convened first before an
international emergency is declared by the agency’s director-general.
While countries must notify WHO of all potential emergencies, not all
end up reaching that stage. “[We] are notified of hundreds of events
every day and assess each one,” WHO spokesperson Margaret Ann Haris
said in an email. She declined to confirm whether such a notification
had occurred from the U.S., saying communications with member states
are confidential. A spokesperson for the U.S. Department of Health and
Human Services did not provide an answer to a request for comment.

Authorities have urged Americans who had surgeries involving epidural
anesthesia at either of these clinics since January [2023] to go
immediately to the emergency room or an urgent care facility, even if
they do not currently think they have symptoms. People from 24 states
as far north as Alaska were potentially exposed during surgeries at
one of the 2 clinics, according to a list provided by Mexican
authorities to the CDC. The vast majority — 178 — are residents of

Most patients with symptoms have been female so far, although one
probable male case has also been identified with symptoms of
meningitis. One of the 2 patients who died was also an organ donor,
with 5 different recipients around the country earlier this year
[2023] who could be at risk.

“All have been notified, and are under evaluation, and we were working
with transplant centers and other partners to properly manage these
patients who had these organs transplanted into their bodies,” the
CDC’s Dallas Smith told a webinar Friday [26 May 2023] hosted by the
Mycoses Study Group. The consortium has been working with the CDC on
guidance for doctors treating patients who may have been infected by
the procedures.

“Because patients in Mexico, the United States, Canada, and Colombia
were on the exposed list, we wanted to make sure these countries were
aware, and provide such situational awareness, through a public health
emergency of international concern,” said Smith.

Investigators now believe that the 2 facilities, located near Mexico’s
border with Texas, had drawn patients from across the Americas for
surgical procedures. “There’s these agents that act as recruiters in
the U.S. for patients, they link U.S. patients to these clinics to
receive certain care, and certain procedures like cosmetic
procedures,” Smith said. From in-depth interviews with a handful of
patients, officials believe many had sought operations like
liposuction, breast augmentation or Brazilian butt lifts.

Authorities have not yet confirmed the cause of the outbreak. Results
from U.S. patients so far have been inconclusive for tracking down the
fungus. However, testing in Mexico has yielded positive results for a
fungus known as Fusarium solani in samples of spinal cord fluid.
This same kind of fungus was seen in a deadly outbreak that started
late last year [2022] in the Mexican state of Durango which was also
linked to surgeries. “We are not sure if these 2 outbreaks are linked,
but the fact that the same organism is most likely causing this fungal
meningitis makes us worried about a high mortality rate. So that’s why
it’s so important to get patients in early, even if they’re
asymptomatic,” said Smith.

Medications used during anesthesia in the current outbreak may have
been contaminated, Smith said, either in the epidural itself or in
other medications that are added in conjunction during the surgeries
like morphine. “There’s a shortage currently in Mexico, and there
could be potential for a black market that could have contaminated
medicine,” said Smith. Another theory is that there were lapses in
infection control practices to prevent contamination during surgery,
which is currently blamed for the other outbreak. “The outbreak that
we’re experiencing now is pretty similar, and it has the capacity to
have this high mortality rate, and just devastate families and
communities,” Smith said.

[Byline: Alexander Tin]

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