Fungal Meningitis infections reported at two Mexican hospitals.

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. 

Hyphae of Fusarium solani stained with Prussian blue. Josef Reischig/Wikimedia Commons.

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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Sinomonas gamaensis: A new species of Actinobacteria from Chad.

Actinobacteria are Gram-positive, typically filamentous, aerobic Bacteria found in soils and aquatic ecosystems, where they play a significant role in the decomposition of Plant material and other organic matter, making them highly important in the formation and maintenance of soils. Some species of Actinobacteria are capable of 'fixing' nitrogen from the atmosphere (i.e. taking atmospheric nitrogen and using it to form nitrogen compounds that can be utilised by Plants). The genus Sinomonas are soil- or rock-dwelling Bacteria noted for a life-cycle in which they alternate between rod-shaped forms that form long filaments and coccoid (spherical) forms which form clusters. They are noted for the production of anti-fungal compounds, with some species being capable of fixing silver to form nanoparticles (which also have antimicrobial properties).

In a paper published in the journal Microorganisms on 8 June 2019, Yansong Fu, Rui Yan, Dongli Liu, Junwei Zhao, Jia Song, Xiangjing Wang, Lin Cui, and Ji Zhang of the Heilongjiang Provincial Key Laboratory of Agricultural Microbiology at the Northeast Agricultural University, and Wensheng Xiang, also of the Heilongjiang Provincial Key Laboratory of Agricultural Microbiology at the Northeast Agricultural University, and of the State Key Laboratory for Biology of Plant Diseases and Insect Pests at the Institute of Plant Protection of the  Chinese Academy of Agricultural Sciences, describe a new species of Sinomonas  from the Hadjer Lamis Region of Chad.

The new species is named Sinomonas gamaensis, meaning 'from Gama', in reference to the district of Gama; the new species was cultured from a soil sample collected from a cotton field in this area. The species was found to have formed rods after 12 hours of cultivation and cocci after 24 hours. The species was able to grow at temperatures of between 10°C and 45°C, with optimum growth at about 30°C, and at pH values of between 5 and 10, with an optimum of about 8.

Transmission electron micrograph of negatively staining cells of Sinomonas gamaensis after incubation for 12 hours (C) and 24 hours (D). Fu et al. (2019).

Sinomonas gamaensis was found to produce antifungal compounds which inhibited the growth of Exserohilum turcicum, the cause of Northern Corn Leaf Blight, a serious agricultural pest in cold temperate and highland regions.

The antagonistic activity of Sinomonas gamaensis (labelled as NEAU-HV1) against Exserohilum turcicum (a) and the antifungal activity of the supernatant and cell pellet of Sinomonas gamaensis against Exserohilum turcicum (b) Fu et al. (2019).

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Clostridium niameyense: A new species of Firmicute Bacterium from a malnourished Nigerian patient.

Firmicutes are a group of Bacteria which are not typically pathogenic, but which includes a few species such as Staphylococcus aureus and Listeria monocytogenes which can cause food poisoning or skin infections, as well as more dangerous species such as Clostridium perfringens (Gas Gangrene) and Bacillus anthracis (Anthrax) which are normally soil-dwelling Bacteria, but which can cause lethal infections due to the toxins which they produce. Members of the genus Clostridium are particularly prone to causing infections, with several species, although usually found living in soil, having a range of specialist adaptions for surviving in Human and animal hosts when the oportunity arises. In adition to Clostridium perfringens, this genus also includes Clostridium botulinum (Botulism), Clostridium tetani (Tetanus), and Clostridium difficile (Pseudomembranous Colitis).

In a paper published in the journal New Microbes and New Infections in July 2018, Selma Chabou, Maryam Tidjani Alou, Saber Khelaifia, Jean-Christophe Lagier, Noémie Labas, Teresa Cimmino, Seydina Diene, Didier Raoult and Jean-Marc Rolain, off Aix-Marseille Université and IHU Méditerranée Infection, describe a new species of Firmicute Bacterium from a Nigerian patient suffering from both anorexia (a mental health disorder in which patients suffer an acute fear of gaining weight, resulting in extreme fasting and other forms of self harm) and marasmus (a condition in which malnutrition causes a child to be severely underweight for their age).

The new bacterium is named Clostridium niameyense, though no explanation for this name is given. The description is based up samples of the Bacterium recovered from the patient in Nigeria and flown to Marseille for identification. Clostridium niameyense thrived at 37°C in the absence of oxygen and was capable of processing a range of sugars. It was resiliant to penicillin, amoxicillin, trimethoprim/sulfamethoxazole, colistin, and metronidazole, but susceptible to other antibiotics. It was unclear whether the presence of the Bacterium was having any effect on the patient, not whether it is regularly found in the gut of some people, able to infect some or most people, or only present due to the weakened nature of the patient.

Transmission electron microscopy of Clostridium niameyense using a TechnaiG2 Cryo device (FEI Company, Limeil-Brévannes, France) at operating voltage of 200 keV. Chabou et al. (2018).

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Beauveria majiangensis: A new species of entomopathogenic Fungus from Guizhou Province, China.

Fungi of the genus Beauveria are entomopathogenic (Insect pathogens) Ascomycetes closely related to the behavior-modifying Cordyceps, but asexual in nature. These Fungi infect a wide range of Insects and Spiders, with some species considered to be economically significant due to their impact on agricultural pests.

In a paper published in the journal Phytotaxa on 9 January 2018, Wan-Hao Chen of the Department of Microbiology at the Guiyang College of Traditional Chinese Medicine and the Institute of Fungus Resources at Guizhou University, Man Liu, Zhen-Xing Huang, and Guang-Ming Yang of the Guizhou Institute of Biology, Yan-Feng Han, also of the Institute of Fungus Resources at Guizhou University, Jian-Dong Liang, also of the Department of Microbiology at the Guiyang College of Traditional Chinese Medicin, and Zong-Qi Liang, again of the Institute of Fungus Resources at Guizhou University, describe a new species of Beauveria from Guizhou Province, China.

The new species is named Beauveria majiangensis, where 'majiangensis' means 'from Majiang', the species having been discovered on a Blueberry farm in Majiang County in Guizhou Province, where it was infecting the grubs of an unidentified Scarab Beetle.

Beauveria majiangensis infected grub. Chen et al. (2018).

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Peptoniphilus lacydonensis: A new specis of pathogenic Firmicute Bacterium isolated from an elderly patient in France.

Firmicute are a group of Bacteria which are not typically pathogenic, but which includes a few species such as Staphylococcus aureus and Listeria monocytogenes which can cause food poisoning or skin infections, as well as more dangerous species such as Clostridium perfringens (Gangrene) and Bacillus anthracis (Anthrax) which are normally soil-dwelling Bacteria, but which can cause lethal infections due to the toxins which they produce. Members of the genus Peptoniphilus are thought to be exclusively pathogenic, with fifteen described species, twelve of which are known only from infections in Humans and three from infections of Animals.

In a paper published in the journal New Microbes and New Infections on 27 February 2018,  Mamadou Beye, Sofiane Bakour, Erwan Le Dault and Jaishriram Rathored, of the Service de Santé des Armées at Aix-Marseille Université, Caroline Michelle and Frédéric Cadoret of the Institut Hospitalo-Universitaire Méditerranée-Infection at Aix-Marseille Université, Didier Raoult, also of the Institut Hospitalo-Universitaire Méditerranée-Infection at Aix-Marseille Université, and of the Special Infectious Agents Unit at King Abdul Aziz University, and Pierre-Edouard Fournier, also of the Service de Santé des Armées at Aix-Marseille Université, describe a new species of Peptoniphilus isolated from an 85-year old patient with chronic refractory sinusitis (persistant blockage of the sinus caused by Bacterial infection) from Marseille, France,

The new species is named Peptoniphilus lacydonensis, where 'lacydonensis' means 'from Marseille' (Lacydon is the ancient name for the city). The Bacteria Gram-positive, non–spore-forming and nonmotile cocci (spherical Bacteria), which grew in culture best at 37°C and a pH of 6.5 to 8.0. The Bacteria thrived in anaerobic (without oxygen) and microaerophilic (with very low levels of oxygen) conditions, but not under normal aerobic conditions.

Transmission electron microscopy of Peptoniphilus lacydonensis strain made using Tecnai G20 electron microscope (FEI Company). Beye et al. (2018).

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Beauveria araneola: An araneogenous Fungus from Guizhou Province, China.

Pathogenic Fungi can infect a wide variety of organisms, including Plants, Animals and other Fungi. In Animals species that infect Vertebrates are well studied, but less attention has been paid to Invertebrate-infecting species, and most studies on such species have concentrated on Insects, particularly economically significant ones. Spiders have softer, more permeable integuments than Insects, and are potentially more vulnerable to Fungal infections, but far fewer species of Spider-infecting Fungi have been described than Insect-infecting species. The Spider-infecting, or araneogenous, species that have been described are generally Ascomycote Fungi closely related to Insect-infecting, or entomogenous, species, though, as with Insect-infecting Fungi, each species typically has a single host species.

In a paper published in the journal Phytotaxa on 28 March 2017, Wan-Hao Chen, of the Institute of Entomology and Institute of Fungus Resources at Guizhou University and the Provincial Special Key Laboratory for Development and Utilization of Insect Resources, Yan-Feng Han and Zong-Qi Liang, also of the Institute of Fungus Resources at Guizhou University, and Dao-Chao Jin, also of the Institute of Entomology at Guizhou University and the Provincial Special Key Laboratory for Development and Utilization of Insect Resources, describe a new species of araneogenous Fungus from Guizhou Province, China.

The new species is placed in the genus Beauveria, which also contains several Insect-infecting species, though other members of the genus are soil-living Fungi which break down dead plant and animal material, and is given the specific name araneola, referring to its host-Spider. The species is described from a single infected Spider collected from a vegetable field at the Experimental Farm of Guizhou University, and determined to be a new species by genetic analysis. 

Spider infected with Beauveria araneola. Chen et al. (2017).

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Lecanicillium araneogenum: A new species of araneopathogenic Fungus from Guizhou Province, China.

Araneopathogenic Fungi, i.e. Fungi that infect Spiders, have been documented since at least the early nineteenth century. Since the opisthosoma (abdomen) of Spiders lacks the toughened exoskeleton seen in Insects, Spiders are more vulnerable to pathogenic infection by Fungi, and arenopathogenic Fungi tend to be less specialised than entomopathogenic Fungi, often being closely related to species which attack completely different organisms. Members of the genus Lecanicillium, are Ascomycote Fungi which parasitize a variety of organisms, including Plants, Arthropods, Nematodes and other Fungi.

In a paper published in the journal Phytotaxa on 21 April 2017, Wan-Hao Chen of the Institute of Entomology and the Institute of Fungus Resources at Guizhou University, and The Provincial Special Key Laboratory for Development and Utilization of Insect Resources in Guizhou Province, Yan-Feng Han and Zong-Qi Liang, also of the Institute of Fungus Resources at Guizhou University, and Dao-Chao Jin, also of the Institute of Entomology at Guizhou University, and The Provincial Special Key Laboratory for Development and Utilization of Insect Resources, describe a new, araneopathogenic, member of the genus Lecanicillium from Pine forests around Guiyang City in Guizhou Province, China.

The new species is named Lecanicillium araneogenum, where 'araneogenum' means 'growing on Araneus', in reference to the genus of the Spiders it was found growing on. The Fungus forms irregular cottony colonies, fatal to the Spider. This is the fourth species in the genus found growing on Spiders, and was confirmed as a new, separate, species by DNA extraction, PCR amplification and nucleotide sequencing.

Spider infected with Lecanicillium araneogenum. Scale bar is 10 mm.

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