under the microscope
under the microscope
By Rodney E . Rohde , PhD , MS , SM ( ASCP ) CM , SVCM , MBCM , FACSc
Fungal Meningitis
Meningitis is a dangerous , and sometimes deadly , inflammation of the tissues surrounding the brain and spinal cord . This infection can be caused by species of bacteria , viruses , fungi , and parasites . Fungal meningitis can develop systemically from a fungal infection somewhere else in the body to the central nervous system . 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 ( HAI ) can cause severe illness or mortality . An example of this type of healthcare-associated fungal meningitis outbreak has occurred from spinal anesthesia . Fungal Meningitis Outbreak Associated with Procedures
Performed under Epidural Anesthesia in Matamoros , Mexico
In a report from the Centers for Disease Control and Prevention ( CDC ), the Mexican Ministry of Health , and U . S . health and local health departments are responding to a multinational outbreak of fungal meningitis among people who had procedures under epidural anesthesia in Matamoros , Tamaulipas , Mexico . Officials identified two clinics associated with the outbreak : River Side Surgical Center and Clinica K-3 . These clinics were closed on May 13 , 2023 .
Epidemiology Situation
On May 11 , 2023 , the CDC notified the Mexico General Directorate of Epidemiology [ DGE ] through the International Health Regulations National Focal Point ( IHR NFP ), the identification of five female cases with central nervous system infection ( CNSI ) in the U . S ., with a history of undergoing surgical procedures performed under spinal anesthesia in two private clinics in a city in Mexico , bordering the U . S .
As of May 26 , 2023 , the health authorities from Mexico and the U . S . reported a total of 20 cases presenting with signs and symptoms compatible with CNSI , including two deaths reported by the CDC . 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 located in the city of Matamoros , Tamaulipas state in Mexico , on the border with the US between January and April 2023 .
The Mexico Epidemiological Diagnosis and Reference Institute ( InDRE per its acronym in Spanish ) has received five samples of cerebrospinal fluid ( CSF ) that tested positive for a fungus , Fusarium solani by real-time polymerase chain reaction ( RT-PCR ). Additionally , according to the health authorities from the US , the laboratory results from nine suspected cases were consistent with meningitis , of which two CSF and two blood samples showed elevated levels of ( 1,3 ) -beta-D-glucan , a biomarker for fungal infection . Two pan-fungal PCR tests were negative .
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 percent ) reside in Mexico , 237 ( 43 percent ) in the United States , and one in Canada .
Anyone who had procedures under epidural anesthesia in these clinics from January 1 to May 13 , 2023 , is at risk for
fungal meningitis . Anyone who is at risk for fungal meningitis should go to the nearest emergency room right away to be tested . Testing is done by a lumbar puncture ( LP ), also called a spinal tap . People who are infected should begin antifungal treatment as soon as possible .
Information for those at Risk If you had epidural anesthesia in Matamoros , Mexico , at River Side Surgical Center or Clinica K-3 from January 1 to May 13 , 2023 :
Early testing and treatment , especially before symptoms start or worsen , can save lives . The typical signs and symptoms of fungal meningitis include fever , headache , stiff neck , nausea , vomiting , sensitivity to light , and confusion .
It can take weeks to months for symptoms to develop , and they may be very mild or absent at first . However , once symptoms start , they can quickly become severe and life-threatening . If you know or believe you are at risk , follow the instructions below :
●Go to the nearest emergency room as soon as possible to be evaluated for fungal meningitis , even if you do not currently have symptoms .
●Some people without symptoms or with mild symptoms have tested positive for infection and started treatment . Receiving treatment early can prevent severe illness .
●Fungal meningitis can start off mild and very quickly become a life-threatening illness .
●Consider printing and sharing this web page to help make sure staff and healthcare providers are aware of the situation and recommended tests .
●If you cannot go to an emergency room ( for example , because it is too far away ), consider calling your local health center or urgent care facility to see if they can do spinal taps . In most situations , the emergency room will be the best or only option for testing .
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 healthcareassociated infection ( HAI ) can cause severe illness or mortality .”
When you arrive , inform the emergency room staff that you need to be evaluated for possible fungal meningitis . Tell them that you recently had epidural anesthesia at one of the clinics in Mexico involved in this outbreak .
For more information on this infection , see World Health Organization Report and CDC Report .
Rodney E . Rohde , PhD , MS , SM ( ASCP ) CM , SVCM , MBCM , FACSc , is the Regents ’ Professor , Texas State University System ; University Distinguished Chair & Professor , Clinical Laboratory Science ( CLS ); TEDx Speaker & Global Fellow – Global Citizenship Alliance ; Texas State Honorary Professor of International Studies ; associate director , Translational Health Research Initiative ; Past President , Texas Association for CLS .
8 • www . healthcarehygienemagazine . com • june 2024