On 11 May 2023, the United States of America Centers for Disease Control and Prevention notified the Mexico General Directorate of Epidemiology of five cases with central nervous system infection in the United States of America, according to a press release issued by the World Health Organization on 1 June 2023.. All five cases were females with a history of undergoing surgical procedures performed under spinal anaesthesia in Mexico. The surgeries were performed in two private clinics, located in the city of Matamoros in Tamaulipas State, on the border with the USA. Laboratory test results from samples collected from patients in the USA and Mexico were consistent with Meningitis caused by pathogenic Fungi. Fungal Meningitis is rare but can be fatal and requires immediate medical care.
As of 26 May 2023, the health authorities from Mexico and the USA have reported a total of 20 cases presenting with signs and symptoms compatible with central nervous system infection, including two deaths reported by the United States of America Centers for Disease Control and Prevention. Patients presented to the hospital with symptoms including headache, fever, nausea, vomiting, sensitivity to light, and fainting after receiving surgical procedures in two private clinics in Mexico, between January and April 2023.
The Mexico Epidemiological Diagnosis and Reference Institute has received five samples of cerebrospinal fluid that tested positive for a Fungus, Fusarium solani by real-time polymerase chain reaction. Additionally, according to the health authorities from the USA, the laboratory results from nine suspected cases were consistent with Meningitis, of which two cerebrospinal fluid and two blood samples showed elevated levels of (1,3)-beta-D-glucan, a biomarker for Fungal infection. Two pan-fungal polymerase chain reaction tests were negative.
Fusarium solani is a common, filamentous Acomycote Fungi, found in soil systems worldwide, but known to occasionally cause opportunistic infections, typically of the eyes. Although distinct from other members of the genus Fusarium, Fusarium solani is now recognised to be a species complex, i.e. a group of closely related and morphologically similar species, which are nonetheless genetically isolated from each other.
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According to the investigation performed, a total of 547 people had these procedures between January and April 2023 in the concerned two private clinics, of whom 304 (56%) reside in Mexico, 237 (43%) in the United States, and one in Canada.
Several species of Bacteria, Viruses, Fungi, and Parasites can cause Meningitis, an inflammation of the tissues surrounding the brain and spinal cord. Fungal Meningitis can develop after a Fungal infection spread from somewhere else in the body to the central nervous system. It can be fatal and requires immediate medical care. While rare, medical and surgical procedures can lead to Fungal Meningitis if medical devices or medications are contaminated with Fungi, or if proper infection prevention control practices are not taken. This type of healthcare-associated infection can lead to severe illness or death. Healthcare-associated Fungal Meningitis outbreaks have occurred among patients who received spinal anesthesia.
Fungal Meningitis cases following a medical/surgical procedure are very infrequent and unusual. In 2012, the United States of America Centers for Disease Control and Prevention investigated a multistate outbreak of Fungal Meningitis and other infections among patients who received contaminated preservative-free methylprednisolone acetate steroid injections; 753 cases were reported, including 64 deaths in 20 States in the USA.
The source, vehicle, and the transmission route for the current outbreak remains unknown, although the investigations are ongoing. A Fungal infection is suspected based on preliminary information provided by the health authorities from Mexico and the USA.
Each year, more than a million people from the USA participate in medical tourism. In 2017, more than 1.4 million Americans sought health care in a variety of countries around the world. These medical tourists commonly travel to Mexico, Canada, and countries in Central America, South America, and the Caribbean. At present, there is no evidence to suggest any secondary spread from these cases of health care associated Fungal Meningitis The involved healthcare facilities where the procedures were undertaken have been closed since 13 May. However, there is an ongoing investigation and follow up of people who may have been exposed to Fungal infections. This may lead to additional cases being reported until the follow up of people exposed to such procedure is completed.
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