HARLINGEN, Texas (ValleyCentral) — An infectious disease expert in the Rio Grande Valley theorizes that a fungal meningitis outbreak in 2022 may be linked to the recent cases following procedures in Matamoros.
ValleyCentral spoke with Dr. Jose Campo Maldonado, an infectious disease physician and Director of Infection Surveillance for the UTRGV School of Medicine and director of antibiotic stewardship at Valley Baptist Medical Center.
Fungal meningitis is a rare, but life-threatening disease that causes swelling in the areas around the brain and spinal cord. The Centers for Disease Control and Prevention announced it is responding to a multinational outbreak of fungal meningitis among patients who had cosmetic procedures under epidural anesthesia in Matamoros.
Sources of outbreak
Dr. Maldonado referenced a similar outbreak in Durango, Mexico, in 2022, which involved the same species of fungi, Fusarium solani. While it has not been confirmed yet, Maldonado believes the two outbreaks may be related.
“We are talking about a rare disease,” he said. “And it’s happening in two different locations in the same country. It’s the same organism, with the same type of procedure, a procedure done by different people in two different locations … How can you explain a rare phenomena with so many similar characteristics?”
Maldonado said it may be too early to fault the individuals who performed the procedure, stating there is a possibility there is a supply of contaminated medication.
In February, the chief prosecutor in Durango announced an anesthesiologist was arrested after the outbreak killed 35 patients and sickened 79, the Associated Press reported.
Authorities alleged the anesthesiologist used contaminated morphine and used “improper procedures” when administering spinal blocks to pregnant women, the AP article stated.
When asked if there is a possibility for outbreaks beyond these two locations, Maldonado replied “I hope not, but it’s a possibility.”
Treatment
According to Dr. Maldonado, fungal meningitis generally is more difficult to treat and tends to present itself in patients later, as opposed to bacterial or viral meningitis. Additionally, not every case is the same, as there are different species of fungi. With previous outbreaks, there were not as many neurovascular complications as are being seen associated with the current outbreak, he said.
“This one seems to be an organism that tends to be a lot more aggressive, and goes into those vessels,” Maldonado said. “The time to present for treatment, is very important we think for the outcome.”
Maldonado said the treatment process is aggressive and has been taking a prolonged period —between three to six months. Treatment includes very high doses of antifungal medication, including liposomal amphotericin B and voriconazole.
Even with treatment, Maldonado said patients may develop other complications over time, including elevated intracranial pressure. It is at that point where interventions are made to relieve this pressure.
One intervention is a shunt procedure, which involves surgically placing a hollow tube in the brain permanently to drain spinal fluid and redirect it to another point of the body. Family members of multiple Valley patients have said their loved ones underwent a shunt procedure.
Maldonado said the majority of the public does not need to worry about these types of infections, as they usually only affect those that are considered immunocompromised or were exposed during a surgical procedure.
Recovery
Maldonado called the 2022 Durango outbreak “devastating,” with the mortality rate exceeding 40%. He said this same mortality rate is being seen in local cases as well.
The road to recovery is not an easy one and officials are still waiting for data from the Durango outbreak. Maldonado said anecdotal accounts showed that some patients needed shunt procedures to relieve pressure while others suffered from blindness or loss of other motor functions.
Additionally, Maldonado said that being in the intensive care unit and separated from loved ones for a long period of time could cause psychological complications or post-traumatic stress disorder.
“I wonder how many of these patients that become survivors will have (post-traumatic stress disorder) because it’s a very negative, close-to-death experience, for anyone who survives this,” he said.
Maldonado said the CDC is meeting with local health authorities to offer its expertise, noting local facilities have the capacity to handle these cases.
He urges those who have been exposed to go to an emergency department, even if they are not displaying symptoms. Testing will be conducted through a spinal tap to determine whether there is a presence of the fungi.
Maldonado reminds the public that early treatment is key to fighting this infection.
