A fungal meningitis outbreak linked to cosmetic procedures performed at clinics in Mexico has killed four patients from the U.S. and infected over two dozen others. Nearly 200 in the U.S. may have been exposed to the deadly illness at the medical clinics, as public health officials rush to identify and test those at risk.
Two clinics, River Side Surgical Center and Clinica K-3 in Matamoros, Tamaulipas, are associated with the outbreak, according to the Centers for Disease Control and Prevention. Patients who went to the clinics between Jan. 1 and May 13, 2023 were potentially infected during procedures such as breast implants or liposuction that required epidural anesthesia, according to the CDC. The clinics have since closed.
Dr. Tom Chiller, head of the fungal diseases branch at the CDC, estimates that officials have been able to reach fewer than half of the people from the U.S. who may have been exposed before the clinics were shut down.
Tracking patients from the clinics has been challenging, Chiller said, because some people gave wrong names and contact numbers, or the information was transcribed incorrectly.
“We’re being very aggressive and telling people to go in, yet we’re getting some hesitation on people that are asymptomatic,” said Chiller. “This is a serious illness and it can manifest late so you may not feel anything right now.”
In the current outbreak, symptoms have appeared about 18 days up to a month after undergoing surgery at the clinics. All the patients had epidural anesthesia, which is numbing medication injected into parts of the spine to block pain signals in certain parts of the body.
Dr. Ivan Melendez, Hidalgo County health authority in Texas, has had better luck getting in touch with patients at risk, reaching almost all the 23 patients in Hidalgo County who had a procedure at one of the clinics. His worry: People aren’t taking the disease seriously, including local doctors.
“When patients went to the emergency departments [to get tested], they were turned away because the doctors said you don’t have any symptoms, you can’t have meningitis,” Melendez said in an interview.
Some patients he’s contacted are hesitant to get the necessary testing because they are worried they can’t afford it.
Only seven of the 23 have undergone the necessary testing so far, Melendez said.
Symptoms of meningitis
Meningitis refers to inflammation of the layers of tissue that protect the brain and spinal cord. The inflammation can be caused by viruses, bacteria and even fungi. Regardless of the cause, symptoms can be similar, including:
- Stiff neck.
- Sensitivity to light.
Unlike bacterial meningitis, in which cases symptoms typically develop three to seven days after exposure, fungal meningitis symptoms can take weeks or longer to develop, as the fungus continues to grow in the body. The infection can only be treated with powerful antifungal drugs.
Fungal meningitis is not contagious and does not spread among people, but viral and bacterial meningitis can.
“It’s critical, whether you’re symptomatic or not, if you’ve been exposed to an epidural anesthesia in one of these clinics you get evaluated,” urged Chiller. “We’re going to treat aggressively because we know for a fact that early treatment is what saves lives.”
Who is at risk
Most of the patients are young women who visited the clinics for elective cosmetic procedures, such as breast augmentation, liposuction or Brazilian butt lifts, according to the CDC.
Dr. Luis Z. Ostrosky, an infectious disease doctor in Houston who has treated meningitis cases, says that one reason doctors are so concerned is that the organism isolated in the two clinics appears to be Fusarium Solani, a fungus linked to a previous outbreak of meningitis in Durango, Mexico, late last year.
“From our experience in Durango, we saw an almost 50% mortality with these infections,” Ostrosky said. “That’s why we’re so concerned and so aggressive about the messaging.”
In that outbreak, which was also linked to epidural anesthetic procedures, there were 39 deaths among 80 cases, according to the CDC.
What caused the fungal meningitis outbreak?
The exact cause of the current outbreak is not yet known. Poor hygiene practices may have resulted in reusing medication vials, or morphine shortages may have led doctors to get medication by other means, experts say.
The problem, Chiller said, is that doctors at these clinics don’t have a pharmacy that stocks medications.
Clinic anesthesiologists may bring in their own medicines or reuse vials, which can increase the danger of fungal contamination.
“There could be some bad actors in that space that are essentially operating sort of a black-market type of morphine business,” said Chiller.