Study: Fatal Fungal Infection Contracted During Surgery in Mexico Resulted in Death and Damage to Brainstem and Blood Supply

Release date:2024-05-13 Source: Author: University of Texas Health Science Center at Houston

A study led by Nora Strong, MD, and Luis Ostrosky-Zeichner, MD, published in the New England Journal of Medicine, detailed the experience and analysis of 13 hospitalized patients across multiple centers who suffered from a severe outbreak of Fusarium solani meningitis. This outbreak occurred between Jan. 1, 2023, and May 13, 2023, at two clinics in Matamoros, Tamaulipas, Mexico, affecting individuals with healthy immune systems who had undergone surgeries involving epidural anesthesia. The Centers for Disease Control and Prevention issued a Health Alert Network Health Advisory regarding this incident on May 17, 2023.


Nora Strong, a second-year postdoctoral fellow in infectious diseases at McGovern Medical School at UTHealth Houston, highlighted that this outbreak primarily affected young and healthy individuals due to medical tourism, resulting in severe neurological and vascular injuries, often leading to fatalities.


Among the 13 identified patients, all of whom underwent procedures involving epidural anesthesia, there was a unique observation: despite typically affecting severely immunocompromised individuals, direct inoculation of Fusarium species into the cerebrospinal fluid caused severe meningitis in otherwise healthy patients, with a high mortality rate.


These patients experienced brainstem involvement with injuries to the basilar and vertebral arteries, which progressed over time, leading to narrowing of crucial blood vessels in the brain, resulting in strokes or severe hemorrhages and, tragically, death for many patients. Nine of the 13 patients died due to vessel injuries.


The surviving patients received systemic antifungal therapy, with three on Fosmanogepix monotherapy, an experimental treatment for invasive mold infections. One patient who remained on therapy experienced abulia, while the others showed no cognitive, sensory, or motor deficits from the infection.


Initially, antifungal therapy showed improvement in symptoms and cerebrospinal fluid parameters, but there was later evidence of rapid fungal growth, indicating resistance to all antifungal agents except Fosmanogepix. Utilizing this experimental drug, alongside advanced neurosurgical and endovascular techniques, significantly impacted the course of the outbreak, highlighting the importance of multidisciplinary collaboration across institutions and agencies in saving patients' lives.