Aggressive fungus caused meningitis outbreak tied to clinics in Mexico
Experts say the revelations further highlight the dangers of medical tourism, especially when the procedures involve epidural anesthesia, which can introduce harmful pathogens into the delicate system surrounding the brain and spinal cord.
To date, the Centers for Disease Control and Prevention has documented 14 probable and 10 confirmed cases of fungal meningitis linked to patients who traveled to Matamoros, Mexico, for elective cosmetic procedures in 2023.
In the new study, the authors identified patients who had undergone procedures involving epidural anesthesia at Clinica K-3 or River Side Surgical Center between Jan. 1 and May 17, 2023, and were later admitted to one of three hospital systems in southeastern Texas for evaluation of fungal meningitis. They combed through the clinical records for 13 people tied to the outbreak, and found that the fungus was primarily attacking blood vessels in their brainstems.
The fungus, Fusarium solani, is commonly found in the environment, according to Luis Ostrosky, division director of infectious diseases at UTHealth Houston and the paper’s senior author. However, when this type of pathogen is injected directly into the spinal canal during an epidural, it poses a significant threat.
The spinal canal is part of the central nervous system, and fluids surrounding the spine can circulate into the brain region. The brain is mostly protected by a membrane called the blood-brain barrier, which is intended to shield the delicate organ from potentially harmful substances in the blood. But it also limits the access of immune cells and antibodies carried by blood, making these areas more vulnerable to infections and immune-related issues.
When the fungus was injected into this vulnerable system, patients developed severe infections.
“This fungus has a predilection to damage the blood vessels in the base of the brain. … It can eventually cause strokes and hemorrhages,” Ostrosky said. “We got to see what happens when it goes rampant.”
He added that the study “really rings the alarm” that medical tourism has a degree of risk, even if it seems similar to the care you would get in the United States.
Loved ones left behind
Many of those who died left behind family members wondering how their loved one appeared to be healthy one month and then gone the next.
LaJuana Robinson lost her sister to the fungal meningitis outbreak. She said Cherokee Rose Torres, 36, died in June 2023 after receiving cosmetic procedures at Clinica K-3.
“I definitely feel like that the CDC and government should put information out there so that other people could see what’s going on and have second chances,” Robinson said. “I just wish they would have put more coverage nationwide on the news. Maybe even do some commercials and have them teach [about this on] social media platforms. … I would have never known so much if nothing happened to my sister.”
The CDC began documenting the cases in 2023 when patients who had procedures in Matamoros presented with symptoms that could indicate a possible fungal infection.
“This was a sad and tragic outbreak and CDC’s heartfelt condolences go out to all of those families who lost loved ones,” CDC spokesperson Thomas Skinner said in an email.
He said the agency used social media and published daily messages across CDC channels in English and Spanish during the initial weeks of the outbreak.
“Federal, state, and local health officials exhausted all efforts over many weeks to try to reach those who were affected by this outbreak,” Skinner said.
The agency issued alerts calling for those who traveled to Mexico for medical procedures to contact their local health-care providers for testing. But in some cases, the infection had spread too far, and since medical experts were unsure of the specific type of fungus, treatment took more work to pinpoint.
Later research found that the fungus involved is resistant to most antifungal treatments in the United States.
Robinson said that if she could advise other women considering going outside the United States for any cosmetic procedure, she would tell them not to do it.
“I know some [people] turn out fine, but some end up losing their life afterward,” Robinson said. She had planned to also undergo an elective cosmetic procedure in Mexico but decided to cancel after losing her sister.
Drug shortages in Mexico
Experts warn that while such procedures may be cheaper in Mexico, pathogens can be introduced to patients because of supply shortages there.
The CDC suspects the fungus was introduced to the Matamoros patients via a contaminated epidural anesthesia needle, with a possible link to black-market morphine. Morphine is legal in Mexico, but physicians have trouble getting the medication for their procedures because of supply issues. That not only affects medical tourists, but Mexican residents as well.
The country has grappled with persistent challenges related to the availability of essential medications, including morphine, according to the Associated Press. The shortages have led some physicians to resort to backdoor purchases and double-dipping from the same vial, the AP reported.
In December, Mexican President Andrés Manuel López Obrador announced a “super pharmacy” that will supply medications to hospitals to quell some of these issues. The announcement came on the heels of two fungal outbreaks in one year that left many dead.
“Not all care is regulated as it is here. The way drugs are handled and manufactured is very defined, and when you don’t know how a drug is being used or accessed, then you run into the problem,” Ostrosky said.
Katrina Byrd, an epidemiologist at the CDC who works on a team dedicated to medical tourism, said obtaining care for infections as early as possible is vital to maximize the chances of any treatment working.
“Some people were kind of like, ‘Oh, I just have a headache’ … and weren’t sure if they should see a health-care provider,” Byrd said.
“But the take-home message is as soon as you get back, even if you don’t have symptoms, please tell someone you traveled and that you received a procedure outside the United States, because the longer you have an infection, then the worse that infection has the potential to get.”
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