The fungus behind last year's spate of deadly meningitis cases linked to Mexican clinics was found to be actively attacking the base of patients' brains, researchers announced Wednesday. Announced in the report. New England Medical Journal.
Fungal meningitis was reported in as many as 24 patients from the United States who visited two clinics in Matamoros, Mexico. Many came from Texas. 12 people died.
All patients had undergone cosmetic procedures such as breast implants, hip lifts, and liposuction that required epidural anesthesia. It was later determined that the epidural was contaminated with a fungus called Fusarium solani. Experts say the epidural allowed the fungus to invade the patient's cerebrospinal fluid, a fluid that exists in and around the spinal cord and brain, providing nutrition, protection, and removing waste.
For the report, researchers from the University of Texas and the Centers for Disease Control and Prevention reviewed the electronic health records, diagnostic imaging, and pathology reports of 13 patients. They found that this fungus, which tends to attach to blood vessels, was prevalent in the blood-filled brainstem.
“What we ended up seeing is that this fungus was literally eating away at blood vessels and causing clotting,” said UT Health Houston and Memorial Hermann Health System's Infectious Diseases and said Dr. Louis Ostrosky, head of epidemiology and one of the study authors.
As a result, the inflammation blocked the flow of spinal fluid, causing patients to suffer strokes or cerebral hemorrhages, and increase intracerebral pressure.
Dr Celeste Philip said: “Seeing how the brainstem was affected in an unexpected, abnormal and very specific way is an important finding and will help alert clinicians to future cases. “This could potentially lead to better and faster diagnosis and treatment.” Senior Public Health Advisor for Health and Medical Affairs at the American Public Health Association. Philippe was not involved in the new report.
Dr. Katrina Byrd, an infectious disease expert and communicable disease information officer at the CDC, said getting treatment early is important. “If we can catch the infection early, the treatment period will be shorter and the impact of the infection on the body will be reduced,” she says.
Many patients in the Matamoros outbreak were not evaluated or treated for more than a month after symptoms of meningitis developed, including chronic headaches, sensitivity to light and sound, and fever. Some people were turned away from the emergency room and told they might have a post-epidural headache. Some did not have health insurance and others ignored their symptoms.
Dallas Smith, an epidemiologist in the Division of Mycoses at the CDC's National Center for Zoonotic Diseases, said six of the surviving patients died after laboratory tests showed that the fungal strain was resistant to current drugs. He said he was given an experimental antifungal drug late in the outbreak. The Emerging Infectious Diseases Director led the agency's efforts against the outbreak. Seven patients also died after receiving the drug.
He noted that it is difficult to grow fungi from spinal fluid in the lab. The sample that was successfully cultured was taken from the brain of a deceased patient.
Those who died as well as survivors received steroids for inflammation, shunts to divert backed-up spinal fluid, and other advanced treatments to deal with attacks on the brainstem.
Contaminated epidural
Exactly how the fungus got into the epidural solution at the Matamoros clinic remains unclear, but the CDC has a theory. Mr Smith said it was most likely that the morphine mixed with the anesthetic had been contaminated.
Smith, the author of the new report, said the anesthetists, who moved between both clinics, likely bought morphine on the black market because morphine is difficult to obtain in Mexico due to drug shortages. .
A few weeks ago, the CDC was able to grow Fusarium bacteria from the spinal fluid of a patient in Tennessee and compare them to bacteria cultured from a brain autopsy last year. Although the two patients visited different clinics, they were genetically nearly identical. The findings support the theory that the bacteria entered the epidural through contaminated morphine rather than poor hygiene during the surgery, Smith said.
In any case, the fungus was pumped directly into the epidural space of the spine, “and that's why we had this devastating mortality rate,” he said.
This is an unusual spread of infections, but it won't be the last.
Despite the unusual and serious nature of the outbreak, experts warned that more infections are likely in the future.
“This probably won't be the last fungal outbreak,” Ostrosky said. A similar outbreak occurred in Durango, Mexico, at the end of 2022.
Dr. Smith said patients with symptoms of meningitis, which can be caused by bacteria, viruses or fungi, should be asked about their recent medical history.
“Have they ever been exposed to an epidural? Do they have a recent history of medical tourism?” Smith said. If the answer is yes, patients should be tested for fungal meningitis, he said.
Bird offered the following tips for people considering treatment abroad, where it's cheaper than in the United States.
- Speak with your health care provider at least four weeks in advance to discuss your care plan upon your return and to schedule an appointment with a specialist in advance to check for any complications.
- To make sure you have all the necessary vaccines, consult a travel medicine specialist.
- Research medical facilities to see if they are accredited, and research clinicians to see if they are licensed.
- Please purchase travel insurance.
- Bringing back medical records from foreign clinics
- Also, don't hesitate to tell your health care 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 treatment plan is to talk to your health care provider when you return home,” Bird says.
correction (February 8, 2024, 4:05 PM ET): An earlier version of this article incorrectly stated the number of surviving patients who received experimental antifungal drugs. It was 6 instead of 7.
