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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Seven dead in Mexico flooding.

Seven people have died in flooding in Mexico this week. On Friday 15 June 2018 a fourteen-year-old boy was swept into a storm drain in Mexico City and drowned, On Tuesday 19 June a woman and a teenage girl died of carbon monoxide poisoning while trapped in a car caught in floodwaters in Aguascalientes, while a landslide killed a man in Guanajuato. Landslides are a common problem after severe weather events, as excess pore water pressure can overcome cohesion in soil and sediments, allowing them to flow like liquids. Approximately 90% of all landslides are caused by heavy rainfall.On Wednesday 20 June a forty-year-old man drowned in Mexico City, and two people were electrocuted when they touched power cables after climbing onto buildings to escape floodwaters, one in Mexico City and another in the city of Matamoros in Tamaulipas State. Flooding has also been reported in Texas as far north as Houston.

Cars caught in floodwater in Aguascalientes on Tuesday 19 June 2018. Mexico Daily News.

Rainfall in eastern Mexico an southern Texas is driven principally by evaporation of water from the Caribbean, an area which has been suffering exceptionally high temperatures this year. However the flooding has also been linked to rapid urban expansion in many area, which has led to building on areas of historic wetlands, reducing the ability of the ground to absorb water and leading to surface flooding.

Flooding in Weslaco, Texas, on 20 June 2018. Joel Martinez/The Monitor/AP.

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A new species of Bromeliad from Tamaulipas State, Mexico.

Bromeliads are herbaceous Monocotyledons native to the Americas (with a single species known from West Africa) and related to the Sedges and Grasses. They have a distinctive rosette shape, with blade-like leaves spiraling out from a central point. In some cases the centre of this rosette forms a water reservoir held in place by tightly overlapping leaf-bases, which can contain entire miniature ecosystems. Many Bromeliads are epiphytes, living on the branches of trees, particularly in rainforests, but others live on the ground and many are found in deserts.

In a paper published in the journal Phytotaxa on 19 June 2013, Ivón Ramírez Morillo and Carlos Jiménez Nah of the Centro de Investigación Científica de Yucatán and Jacinto Treviño Carreón of the Facultad de Ingeniería y Ciencias at the Universidad Autónoma de Tamaulipas describe a new species of Bromeliad from Tamaulipas State in northeast Mexico.

The new species is placed in the genus Hechtia, and given the specific name hernandez-sandovalii, in honour of Luis Hernández Sandoval, who collected the specimens from which the species is described. Hechtia hernandez-sandovalii is a 1-1.8 m high Bromeliad with rosettes up to 35 cm in diameter. New rosettes bud off at the bottom of established plants, forming large colonies. The plant produces 1.15-1.53 m inflorescences with whitish flowers. The plant was found living in a restricted area of the southwest of Tamaulipas State, living both in the open on limestone hills and rocky areas, and as an understory plant in Pine and Yucca forests. Hechtia hernandez-sandovalii was found living at altitudes if between 1800 and 2200 m, in areas where the temperature could range from -4℃ to 41℃.

Individual rosette of Hechtia hernandez-sandovalii. Ramírez Morillo et al. (2013).

Colony of Hechtia hernandez-sandovalii. Ramírez Morillo et al. (2013).

Flowers of Hechtia hernandez-sandovalii. Ramírez Morillo et al. (2013).

See also New species of Onion from Kyrgyzstan, New species of Pipewort from Brazil, A new species of Orchid from Bahia State, Brazil and New species of Bromiliad from Brazil.

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