Three more people in the US have died from fungal meningitis in an outbreak linked to contaminated operations in Mexico, bringing the total number of deaths to seven, the Centers for Disease Control and Prevention reported Thursday.
The total number of cases remains unchanged from an update earlier this month, with 34 cases in the US: nine confirmed, 10 probable and 15 suspected. Health officials are investigating 161 others who may have been exposed.
The outbreak is related to cosmetic surgeries with epidural anesthesia at two clinics in Matamoros, Mexico, just across the border from Brownsville, Texas. Mexican and US officials suspect that some component of the anesthetic was contaminated, resulting in the disease-causing fungus Fusarium solani injected directly into the spinal cord of humans. The tainted operations are said to have taken place between January 1, 2023 and May 13, 2023, around the time the clinics were closed by local health officials.
In an interview earlier this month, Dr. Tom Chiller, chief of the CDC’s Mycotic Diseases Branch, told Ars that Mexican officials suspect morphine used in the epidural may be the culprit. The painkiller is mixed with a commonly used anesthetic, but morphine is currently in short supply in Mexico, which may have led to the use of gray or black market drugs.
Another possibility is simply poor hygiene practices by anesthesiologists. In Mexico, anesthesiologists do not use clinic or hospital stores for medicines; they buy their own medicines and take them to the facilities where they practice. This makes it difficult to track down the specific drugs used in the outbreak cases.
Fungal meningitis is also difficult to test for and treat, Chiller noted. Tests looking for genetic traces of the fungus in the spinal fluid often miss it if it is present, he said. “The fungus itself doesn’t hang in that fluid, it gets into the tissues,” Chiller said. “It clamps down in the meninges and in the brain.” There it can remain indolent and still for weeks to months, “but then it can boom, then it can go fast,” Chiller said. In the current outbreak, officials have seen cases with symptoms starting 102 days after an infected operation.
The CDC is urging anyone who has undergone procedures at either of its two clinics — River Side Surgical Center or Clinica K-3 — from January 1 to May 13, 2023, to receive immediate medical care, even if there are no symptoms of infection are. Health care providers are advised to give anyone exposed a lumbar puncture to look for signs of infection.
If symptoms have developed, they may include fever, headache, stiff neck, nausea, vomiting, sensitivity to light, and confusion.