The Perils of Medical Tourism: Investigating Fungal Meningitis


Earlier this year, cases of fungal meningitis were discovered at 2 surgical clinics in Matamoros, Mexico. The CDC offers an update on this deadly outbreak.

According to the Centers for Disease Control (CDC) medical tourism—the practice of traveling to other countries to receive medical care—has been growing, with millions of Americans traveling abroad to receive medical care annually.

Reasons that people might travel internationally for medical care include: cost savings; shared cultures between clinicians and patients; and getting unapproved or unavailable procedures.

In some cases, what can transpire is severe health issues. For example, earlier this year, there was an outbreak of fungal meningitis linked to epidural anesthesia in 2 surgical clinics in Mexico. Unfortunately, this involved numerous Americans who suffered dire consequences.

Dallas J. Smith, PharmD, epidemiologist, Mycotic Diseases Branch, CDC, says there has been 24 cases of fungal meningitis and 12 deaths, leaving a 50% mortality rate. He says CDC has been working with Mexican authorities and says they have narrowed down the cause.

“The cases that were diagnosed with fungal meningitis have been linked to 1 anesthesiologist,” Smith stated. “And so, we think that the medicine that this anesthesiologist used was contaminated in some way with this fungus…it had been injected straight into the spinal cord during the epidural.”

3 Key Takeaways

The motivations for medical tourism include cost savings, cultural familiarity with clinicians, and access to procedures that may not be approved or available domestically.

A fungal meningitis outbreak in 2 surgical clinics in Mexico resulted in severe health consequences, including a 50% mortality rate among affected individuals, emphasizing the importance of considering risks when seeking medical treatment abroad.

CDC epidemiologist, Dallas J. Smith, PharmD, underscores the significance of diagnostic testing for fungal infections, particularly when encountering cases of meningitis with unidentified viral or bacterial causes.

At this week’s IDWeek2023, Smith is presenting his late breaking abstract, "Outbreak of Fungal Meningitis in US Patients Who Received Surgical Procedures Under Epidural Anesthesia in Matamoros, Mexico."

Smith credits his laboratory colleagues on helping to narrow down potential treatment, especially as fungal infections can often be multidrug resistant.

“We were able to work with our laboratory colleagues to do antifungal susceptibility testing. And when those tests came back, when we finally got an isolate, we found a lot of them had high MICs [minimum inhibitory concentration of antibiotics] or it looked like they were highly resistant, or potentially resistant to most of our antifungals,” Smith said. “However, we did see that 1 novel phase 2 clinical trial antifungal called fosmanogepix looked like it had a favorable profile for resistance. So, we updated our guidelines based on those results. And we've seen a dramatic turnaround in patients' course of illness, we've seen a dramatic drop in case mortality rates. Patients are sent home on monotherapy, and are doing pretty well. I think [it's about] the importance of working with our laboratory colleagues, and making sure we're giving updated recommendations based on different diagnostic tests.”

When Clinicians Should Consider Fungal Infections

Smith says clinicians should consider testing for fungal infections if they encounter a unique case of meningitis and they can’t identify a virus or bacteria.

“We do encourage clinicians to maybe use, like a beta d glucan test or some type of broad fungal test that may be able to indicate that hey, this is actually a fungus causing the meningitis.” Smith said. “And because we've seen these 2 different outbreaks in Mexico linked to epidural anesthesia, if you do a good patient history, and you see that these patients have had this medical tourism history, we think it could be a good idea to think fungus early on and maybe test for fungal etiology.”

Contagion spoke to Smith who offered further insights on the outbreak and considerations for clinicians in diagnosing fungal infection and patients who participate in medical tourism.

Smith DJ, Williams S, Litvintseva AP, et al. 969 - Outbreak of Fungal Meningitis in US Patients who Received Surgical Procedures under Epidural Anesthesia in Matamoros, Mexico. Presented at: IDWeek 2023. October 11-15, 2023; Boston, MA.
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