Fatal fungal meningitis cases nearly double as CDC rushes to find exposed people

Enlarge / One of the medical clinics suspended by Mexican health authorities, in Matamoros, Tamaulipas, Mexico, May 19, 2023. Getty | AFP

Cases nearly doubled in a deadly outbreak of fungal meningitis linked to contaminated cosmetic surgeries in Matamoros, Mexico, the Centers for Disease Control and Prevention reported this week.

To date, 34 cases have been identified in the outbreak: 18 suspected, 10 probable and 6 confirmed. That's up from just 18 cases - nine suspected, nine probable, zero confirmed - at the end of last month. The number of deaths from the cases has risen from two to four since then. The CDC is investigating 172 other people who may have been exposed.

Health officials in the United States and Mexico suspect the infections stemmed from cosmetic procedures, including liposuction, that involved epidural anesthesia, a component of which may have been contaminated with the fungus Fusarium solani . The US cases relate to procedures performed from Jan. 1, 2023, to May 13 at two specific clinics in Matamoros, which is across the border from Brownsville, Texas. Both clinics - River Side Surgical Center and Clinica K-3 - have since been closed by Mexican health authorities, who also closed other clinics in the area during the investigation.

Even with all the links so far, health officials are still struggling to identify the source and those infected. The outbreak highlights both the dangers of cheap surgeries in poorly monitored facilities and the deadly vagaries of what happens when fungi enter people's spinal cords and brains.

The source

Despite knowing the clinics, procedures and medications used in the cases, health officials are skeptical that the source of the fungus can be confirmed. "It's not like you can go to the clinic and find the drugs on the shelf and go and test them," Dr. Tom Chiller, chief of the CDC's Mycotic Diseases Branch, told Ars.

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In Mexico, anesthesiologists source their own medications and bring them to clinics, Chiller explained. To screen for a contamination problem, "you have to find the anesthetist and find out where they bought [the drugs] and more than likely they left, because they've already used them," he said. p >

Chiller stressed that Mexican officials, who have jurisdiction over the outbreak investigation, not the CDC, are doing their best and being open with the CDC. But he highlighted the significant challenges they face. The city of Matamoros is in the state of Tamaulipas, which is heavily influenced by cartels.

So far, Chiller said, local authorities are skeptical that the source of the infection is the anesthetic drug itself. It's "a fairly common anesthetic that's widely distributed across Mexico," he said. If it was contaminated during manufacturing, "they think they would see signals elsewhere." But the numbing drug is mixed with morphine before being injected into people's spines, he noted. And morphine can be the source. It's rare and hard to get in Mexico right now, he said. One speculation by Mexican officials is that the morphine could come from the black or gray market while being sold as legitimate.

In addition to bad morphine, another hypothesis concerns bad practices. “If anesthesiologists bring in their medications and they access those vials multiple times, or they just do bad practice, they could contaminate one vial, and then that vial could be reused multiple times,” he said. noted.

This was thought to be the cause of an outbreak of fungal meningitis last year in Durango, Mexico. This epidemic mainly affected women who underwent an epidural during cesarean deliveries in private hospitals. The cases were also Fusarium solani infections. The epidemic has claimed 80 cases and 39 deaths as of