Update on Outbreak of Fungal Meningitis Among US Residents Who Received Epidural Anesthesia at Two Clinics in Matamoros, Mexico

Dallas J Smith¹, Jeremy A W Gold¹, Tom Chiller¹, Nirma D Bustamante², Maria Julia Marinissen^{3

4}, Gabriel Garcia Rodriquez⁵, Vladimir Brian Gonzalez Cortes⁵, Celida Duque Molina⁶, Samantha Williams¹, Axel A Vazquez Deida^{7

8}, Katrina Byrd^{2

7}, Peter G Pappas⁹, Thomas F Patterson¹⁰, Nathan P Wiederhold¹¹, George R Thompson 3rd^{12

13}, Luis Ostrosky-Zeichner¹⁴; Fungal Meningitis Response Team

Collaborators, Affiliations

Collaborators

Affiliations

¹ Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
² Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
³ Health Attache, U.S. Embassy, Mexico City, Mexico.
⁴ U.S. Section, U.S.-Mexico Border Health Commission, U.S. Department of Health and Human Services, Washington D.C., USA.
⁵ General Director of Epidemiology, Ministry of Health Mexico, México City, México.
⁶ Director of Medical Services, Mexican Social Security Institute, México City, México.
⁷ Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁸ Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁹ Division of Infectious Diseases, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁰ Division of Infectious Diseases, Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas, USA.
¹¹ Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center, San Antonio, Texas, USA.
¹² Division of Infectious Diseases, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, California, USA.
¹³ Department of Medical Microbiology and Immunology, University of California, Davis, Davis, California, USA.
¹⁴ Division of Infectious Diseases, McGovern Medical School, Houston, Texas, USA.

PMID: 37739479
PMCID: PMC10957502
DOI: 10.1093/cid/ciad570

Update on Outbreak of Fungal Meningitis Among US Residents Who Received Epidural Anesthesia at Two Clinics in Matamoros, Mexico

Dallas J Smith et al. Clin Infect Dis. 2024.

. 2024 Jun 14;78(6):1554-1558.

doi: 10.1093/cid/ciad570.

Authors

Collaborators

Affiliations

¹ Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
² Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
³ Health Attache, U.S. Embassy, Mexico City, Mexico.
⁴ U.S. Section, U.S.-Mexico Border Health Commission, U.S. Department of Health and Human Services, Washington D.C., USA.
⁵ General Director of Epidemiology, Ministry of Health Mexico, México City, México.
⁶ Director of Medical Services, Mexican Social Security Institute, México City, México.
⁷ Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁸ Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
⁹ Division of Infectious Diseases, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁰ Division of Infectious Diseases, Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas, USA.
¹¹ Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center, San Antonio, Texas, USA.
¹² Division of Infectious Diseases, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, California, USA.
¹³ Department of Medical Microbiology and Immunology, University of California, Davis, Davis, California, USA.
¹⁴ Division of Infectious Diseases, McGovern Medical School, Houston, Texas, USA.

PMID: 37739479
PMCID: PMC10957502
DOI: 10.1093/cid/ciad570

Abstract

Background: Public health officials are responding to an outbreak of fungal meningitis among patients who received procedures under epidural anesthesia at 2 clinics (River Side Surgical Center and Clinica K-3) in Matamoros, Mexico, during 1 January to 13 May 2023. This report describes outbreak epidemiology and outlines interim diagnostic and treatment recommendations.

Methods: Interim recommendations for diagnosis and management were developed by the Mycoses Study Group Research Education and Consortium (MSGERC) based on the clinical experience of clinicians caring for patients during the current outbreak or during previous outbreaks of healthcare-associated fungal meningitis in Durango, Mexico, and the United States.

Results: As of 7 July 2023, the situation has evolved into a multistate and multinational fungal meningitis outbreak. A total of 185 residents in 22 US states and jurisdictions have been identified who might be at risk of fungal meningitis because they received epidural anesthesia at the clinics of interest in 2023. Among these patients, 11 suspected, 10 probable, and 10 confirmed US cases have been diagnosed, with severe vascular complications and 8 deaths occurring. Fusarium solani species complex has been identified as the causative agent, with antifungal susceptibility testing of a single isolate demonstrating poor in vitro activity for most available antifungals. Currently, triple therapy with intravenous voriconazole, liposomal amphotericin B, and fosmanogepix is recommended.

Conclusions: Efforts to understand the source of this outbreak and optimal treatment approaches are ongoing, but infectious diseases physicians should be aware of available treatment recommendations. New information will be available on the Centers for Disease Control and Prevention's (CDC's) website.

Keywords: Fusarium; epidural; fungal meningitis; healthcare-associated infection; medical tourism.

Published by Oxford University Press on behalf of Infectious Diseases Society of America 2023.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. L. O.-Z. is the president of the MSG-ERC, Vice-President of ICHS, and has received research funding, consulting and/or speaking honoraria from the following entities: Scynexis, Pulmocide, Gilead, Astellas, NIH, Pfizer, T2 biosystems, F2G, GSK, Melinta, Viracor, and Cidara. P. G. P. has received research funding from F2G, Cidara, CDC, Astellas, Melinta, Gilead, Mayne, Scynexis, participated on Data Safety Monitoring or Advisory Board for Melinta, Matinas, Cidara, and Scynexis; and serves as a consultant for Melinta, F2G, Matinas, and Scynexis. T. F. P. has served as a consultant, on data safety monitoring/data review committees, on a Scientific Advisory Board, or received research support from: Cidara, F2G, Gilead, Scynexis, and Sfunga, outside of the submitted work and royalties from Wolters Klower. A. N. M. serves as a consultant to the Michigan Department of Health & Human Services and is a shareholder of Pfizer pharmaceuticals. N. P. W. has received research support from bioMerieux, Bruker, F2G, Maxwell Biosciences, Mycovia, Scynexis, and Sfunga; payment or honoraria for speaking or educational events and travel support from American Society for Microbiology; a leadership or fiduciary role at Clinical and Laboratory Standards Institute; receipt of antifungal powders from F2G, Pfizer, and Scynexis; and has served as a consultant for F2G. G. R. T. reports grants or contracts and consulting fees from Astellas, Cidara, F2G, Mayne, Mundipharma, and Melinta; and participation on a Data Safety Monitoring or Advisory Board for Pfizer. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

References

1. CDC Health Alert Network. Outbreak of suspected fungal meningitis in U.S. patients who underwent surgical procedures under epidural anesthesia in Matamoros, Mexico. 17 May 2023. Available at: https://emergency.cdc.gov/han/2023/han00491.asp. Accessed 10 July 2023.
1. Mexico Ministry of Health. Comunicado técnico semanal. Meningitis, Durango. Available at: https://www.gob.mx/salud/documentos/comunicado-tecnico-semanal-meningitis. Accessed 10 July 2023.
1. Fungus Education Hub. Interim recommendations for diagnosis and management of cases of fungal meningitis associated with epidural anesthesia administered in Matamoros, Mexico. Available at: https://funguseducationhub.org/interim-guidance-matamoros-fm-outbreak-5_.... Accessed 27 June 2023.
1. Chiller TM, Roy M, Nguyen D, et al. Clinical findings for fungal infections caused by methylprednisolone injections. N Engl J Med 2013; 369:1610–9. - PubMed
1. Al-Hatmi AMS, Meis JF, de Hoog GS. Fusarium: molecular diversity and intrinsic drug resistance. PLoS Pathog 2016; 12:e1005464. - PMC - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Update on Outbreak of Fungal Meningitis Among US Residents Who Received Epidural Anesthesia at Two Clinics in Matamoros, Mexico

Collaborators

Affiliations

Update on Outbreak of Fungal Meningitis Among US Residents Who Received Epidural Anesthesia at Two Clinics in Matamoros, Mexico

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources