Fungal Meningitis: What to Know About the Recent Outbreak Linked to Mexican Clinics
Getty Images / thianchai sitthikongsak
Fact checked by Nick Blackmer
An outbreak of fungal meningitis linked to two clinics in Matamoros, Mexico may have impacted as many as 200 Americans.
Fungal meningitis is not contagious; individuals are infected by inhaling fungal spores from their environment.
Experts agree that knowing your healthcare provider and environment is crucial for avoiding outbreaks like this.
An outbreak of fungal meningitis is being closely monitored by the Centers for Disease Control and Prevention (CDC).
Fungal meningitis is a potentially fatal infection and inflammation in the brain and spinal cord. It does not spread from person to person but is caught by inhaling fungal spores in one’s environment.
The CDC estimates that the outbreak has impacted nearly 200 Americans who may have been exposed to the virus after receiving epidural anesthesia before undergoing cosmetic procedures at two clinics in Matamoros, Tamaulipas, Mexico, a city just across the border from Brownsville, Texas.
The agency is advising that anyone who was seen at either River Side Surgical Center or Clinica K-3, both in Matamoros, between January 1 and May 13, 2023, should be evaluated for meningitis at their nearest emergency room, even if they don’t currently have symptoms, and should tell their health care team that they had visited one of the clinics and are at risk.
“That is really important because that is how they are going to intercept any cases that are brewing,” Peter Pappas, MD, an infectious disease specialist at UAB Medicine in Alabama told Health.
Early symptoms of fungal meningitis related to this outbreak include redness and pain at the injection site, which, if caught early, can be treated before the infection seriously impacts the brain.
“The more concerning thing is what is happening is these symptoms of more invasive disease are occurring weeks after the exposure. These include headache, stiff neck and low-grade fever on the mild side, and stroke and altered brain function on the extreme side,” Dr. Pappas said, noting that the mortality rate for this specific outbreak is about 40%.
Although the infections are serious and must be treated as soon as possible, experts say fungal meningitis is not contagious, and people who have not been to these clinics during that time frame are not at risk and do not have to protect themselves against infection.
“It’s not spread from person to person, so for this particular outbreak, as long as you’re not one of the unlucky people who traveled to those clinics in Mexico between January 1 and May 13, there’s no risk to you,” said Stuart Levitz, MD, a professor of medicine at UMass Chan Medical School, whose research is focused on fungal infections.
Getty Images / thianchai sitthikongsak
How Is Fungal Meningitis Treated?
Bacteria, viruses, parasites, and fungi can all cause meningitis, and “any type of meningitis is concerning because any type of meningitis can have long-lasting effects on the brain and on brain function,” said Dr. Levitz.
Fungal meningitis is particularly difficult to treat.
“There aren’t as many antifungal drugs as there are antibacterial drugs and some of the antifungal drugs don’t penetrate as well into the brain,” he said.
It also takes longer for symptoms to form. Whereas bacterial meningitis symptoms typically show up within a week following exposure, fungal meningitis symptoms can take weeks to develop.
According to Dr. Levitz, the organism that caused this outbreak, Fusarium solani, is notoriously difficult to treat. The same fungus caused an outbreak traced back to a hospital in Durango, Mexico back in December, which killed 35 patients, mostly pregnant women who had received an epidural.
“It’s hard. There just are a few options. It becomes more established and invasive and harder to get on top of,” Dr. Pappas said.
Related: These Are the 6 Main Types of Meningitis, According to Neurologists and Infectious Disease Doctors
How Does Fungal Meningitis Form?
According to Dr. Levitz, the most common way a person can get fungal meningitis is when a fungal infection spreads through the bloodstream and then makes its way into the brain, where it can cause meningitis
Most of these cases occur in people who are immunocompromised, including people with HIV/AIDS or those who have received an organ transplant and are on immunosuppressants.
“That’s far and away the most common way of getting fungal meningitis. It spreads through the body and makes it to the brain,” he said.
But that’s not what happened with the most recent outbreak.
In the two clinics associated with the new outbreak, people were given anesthesia via an epidural. And although the exact cause is still unknown, Dr. Levitz said it’s likely that either the needle or the anesthesia drugs themselves were not sterile and were contaminated with fungi that were injected directly into the cerebrospinal fluid—a straight shot to the brain.
“These types of outbreaks have occurred before with contaminated solutions and it’s unfortunate that a sterile technique was not used,” Dr. Levitz said.
Outbreaks caused by contaminated medical equipment have also occurred in the U.S. In 2012, an outbreak was found among people who received steroid injections for pain at the New England Compounding Center in Framingham, Massachusetts.
“It’s not necessarily a specific issue with traveling to Mexico for medical tourism, but it happens sometimes when people are trying to save costs by using medications that are meant for single use and reusing them,” Dr. Levitz said.
Sometimes equipment is contaminated before it even reaches the medical facility, unbeknownst to the medical professionals at that clinic.
According to Dr. Levitz, the recent outbreak may have also been caused by clinic employees mixing vials of anesthesia drugs—anesthesia often does require multiple drugs—in an unsterile environment.
“It sounds like it was a serious break in the use of sterile techniques and that’s what led to this outbreak and what has led to outbreaks in the past,” Dr. Levitz explained.
The good news is, “Like the outbreak that occurred in 2012, the source of this has been identified and we expect the number of new cases has dropped off tremendously,” he said.
An understanding of your healthcare provider and environment is key to avoiding outbreaks like this, Dr. Pappas said. “What it really underscores is: know your physician. Know your healthcare provider. Know the clinic you are visiting to have a procedure where they’re going to do an epidural.”
For more Health news, make sure to sign up for our newsletter!
Read the original article on Health.
