The number of cases nearly doubled in a deadly outbreak of fungal meningitis linked to compromised cosmetic surgeries in Matamoros, Mexico, the Centers for Disease Control and Prevention reported this week.
To date, 34 cases have been identified in the outbreak: 18 suspected, 10 probable and six confirmed. That’s up from just 18 cases — nine suspected, nine probable, zero confirmed — at the end of last month. The death toll from the cases has since risen from two to four. The CDC is investigating 172 other people believed to have been exposed.
Health officials in the US and Mexico suspect the infections are the result of cosmetic procedures, including liposuction, which involved epidural anesthesia, part of which may have been contaminated with the fungus Fusarium solani. The US cases are related to procedures performed from January 1, 2023 to May 13 at two specific clinics in Matamoros, across the border from Brownsville, Texas. Both clinics – River Side Surgical Center and Clinica K-3 – have since been closed by Mexican health officials, who also closed other clinics in the area during the investigation.
Even with all the links so far, health officials are still struggling to pinpoint the source and those infected. The outbreak highlights both the dangers of cheap surgical procedures in under-supervised facilities and the deadly vagaries of what happens when fungi invade people’s spines and brains.
The source
Despite knowing the clinics, the procedures and the drugs used, health officials are skeptical that they will ever be able to confirm the source of the fungus. “It’s not like you can go to the clinic and find the drugs on the shelf and test them,” Dr. Tom Chiller, chief of the CDC’s Mycotic Diseases Branch, told Ars.
In Mexico, anesthesiologists buy their own drugs and take them to clinics, Chiller explains. To detect a contamination problem, “you need to find the anesthetist and find out where they bought [the drugs] of and more than likely they’re gone, because they’ve already used them,” he said.
Chiller emphasized that Mexican authorities — which have jurisdiction over the outbreak investigation, not the CDC — are doing their best and being open with the CDC. But he stressed the major challenges they face. The city of Matamoros is located in the state of Tamaulipas, which is heavily influenced by cartels.
So far, Chiller said, authorities there are skeptical that the source of the infection is the anesthetic itself. It is “a fairly common anesthetic that is widespread throughout Mexico,” he said. If it were contaminated during production, “they think they would see signals in other places.” But the anesthetic is mixed with morphine before being injected into people’s spines, he noted. And the morphine could be the source. It’s scarce and hard to get in Mexico right now, he said. One hypothesis Mexican officials have is that the morphine may have come from black or gray markets while being sold as legitimate.
Besides bad morphine, another hypothesis is bad practice. “If the anesthesiologists bring in their medications and they have access to these vials multiple times, or they just do bad practices, they can contaminate a vial and then that vial can be reused multiple times,” he noted.
This was thought to be the cause of an outbreak of fungal meningitis in Durango, Mexico, last year. That outbreak mainly affected women with epidural during caesarean deliveries in private hospitals. The cases were too Fusarium solani infections. The outbreak resulted in 80 cases and 39 deaths as of the last outbreak update on June 6. Whether the outbreak in Durango is related to that of Matamoros is an open question, Chiller said.
