“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.
