As public health officials continue to plead with people who may have been exposed to fungal meningitis at two cosmetic clinics in Mexico to get tested, doctors in a small Texas county are noticing a peculiar complication: Some patients who appear to be recovering with treatment suddenly get sicker.
Seven people have died from the fungal meningitis outbreak associated with the two surgery clinics in Mexico, according to the Centers for Disease Control and Prevention.
The fungal meningitis outbreak associated with surgical procedures using epidural anesthesia has infected almost three dozen people and killed seven so far, according to the latest numbers from the CDC. It is not clear how many patients are hospitalized across the country. Most of the patients are young women from 23 states in the United States who went to the clinics for cosmetic surgery procedures between Jan. 1 and May 1.
A majority of those exposed, however, are from Texas.
“We’re still having people trickle in that have not been tested but the vast majority have been notified,” said Dr. Ivan Melendez, the public health authority for Hidalgo County in Texas. “Less than half have actually done the test,” a spinal tap to look for signs of meningitis.
Melendez and other health officials are concerned that people who have been exposed aren’t taking the risk seriously.
Symptoms of fungal meningitis, unlike bacterial or viral meningitis, typically take weeks or longer to appear. Some fungal infections can take up to a year to show symptoms. The CDC declined to give a specific date when people could be confident they’re no longer at risk.
In Cameron County in southern Texas, where three of the seven fatalities have been reported, only half of the 54 patients identified have gotten the spinal tap, said Dr. James Castillo, the health authority for the county.
The current outbreak is thought to be caused by a relatively rare organism, Fusarium solani, that has been isolated from a few patients so far. This is the same fungus responsible for an outbreak of fungal meningitis in Durango, Mexico, last November that killed almost half of those infected.
Surprising complication from fungal meningitis
Dr. Jose Campo Maldonado, an infectious disease specialist at Valley Baptist Medical Center in Harlingen, Texas, noticed that infected patients have problems with blood vessels in the brain.
“Practically all the patients that we have seen in the hospital have some sort of neurovascular complications,” he said. These include issues such as spasms of the arteries in the brain or an infection of the walls of the blood vessels themselves, known as a mycotic aneurysm, he added.
All patients at Valley Baptist Medical Center were tested recently after some patients appeared to be doing well on treatment but then suddenly took a turn for the worse, Castillo said.
“It looks like a stroke where they suddenly can go unconscious,” said Castillo, who was surprised by how many patients are having this problem. “For some reason, the aneurysms and the spasms are all happening around the brainstem but nobody knows why it’s happening.”
Blood vessel problems are not unique to fungal meningitis and can also occur with the more common bacterial meningitis.
A possible explanation, Campo Maldonado said, is that the Fusarium solani organism has a special liking for the blood vessels in the brain. More testing would be required to say for sure, however.
This situation, unfortunately, is familiar to CDC scientists who, in a call last week with Campo Maldonado, described similar findings in a fungal meningitis outbreak in Durango, Mexico, that killed almost half of those infected.
“This makes the situation of some of the patients who are hospitalized right now very complex because we are seeing a high prevalence of those same problems,” he said.
As a result, some patients have been left with permanent vision loss and hydrocephalus, a condition where there is too much fluid in the brain.
Since treatment involves three to six months of antifungal therapy, it’s too early to know the full prognosis of patients who come in for treatment, Campo Maldonado said.
Making recovery more challenging, he said, is the host of side effects associated with drugs used for treatment, including hallucinations and kidney and liver problems.
Almost 40% of the confirmed cases in Cameron County have died and none of the almost dozen confirmed cases in hospitals there have been discharged because of complications, Campo Maldonado said.
The three confirmed cases in Hidalgo County are recovering at home and will continue to be on treatment for some time to come, Melendez said.