969. Outbreak of Fungal Meningitis in US Patients who Received Surgical Procedures under Epidural Anesthesia in Matamoros, Mexico
Authors: Smith Dallas J , Williams Samantha , Litvintseva Anastasia P , Bustamante Nirma D , Ostrosky-Zeichner Luis , Godwin Simone , Pearson Jessica C , Rivas JulieAnna , Evert Nicole , Dang Thi , Guevara Angel , Koenecke Lori , Chiller Tom M , Gold Jeremy A W 
Published: November 2023

Abstract

Background
US public health officials are responding to a multinational, multistate fungal meningitis outbreak involving travelers who had primarily cosmetic procedures (e.g., liposuction) under epidural anesthesia at 2 Matamoros, Mexico clinics (closed 5/13/2023 by Mexican authorities). Fusarium solani species complex fungal DNA was identified in cerebral spinal fluid (CSF) by polymerase chain reaction and next-generation metagenomic sequencing; a highly resistant strain was isolated from a single tissue culture. We describe epidemiology, demographics, and clinical features to inform prevention messaging, guidance, and future responses.

Methods
Public health officials collected data on confirmed and probable cases (1/1/23–7/25/2023) using a standardized case report form; data were analyzed in Microsoft Excel.

Results
In total, 10 probable (1 death) and 10 confirmed (8 deaths) US fungal meningitis cases were identified; all involved epidural anesthesia from the same anesthesiologist at both clinics. Most cases (80%) occurred in Texas residents. Median patient age was 31 years (range: 23–52); 19 patients were women; 13 were Hispanic/Latino. None had underlying conditions reported. At least 4 patients were uninsured, with several reporting associated care-seeking delays. Common symptoms were headache (n=18), nausea (n=13), fever (n=12), and stiff neck (n=12). Median (IQR) initial CSF results were white blood cell count (498/µL [343–825]), glucose (31 mg/dL [26–40]), and protein (99 mg/dL [52–2140]). In 8 patients, CSF (1,3)-β-D-Glucan was ≥ 500 pg/ml. From procedure date, average days (range) to symptom onset was 19 (0–58), to hospitalization was 52 (14–106).

Conclusion
In the US, the fungal meningitis outbreak has primarily affected young, healthy Hispanic/Latino women travelling to Matamoros, Mexico, for procedures and resulted in a high mortality rate (40%). CDC advises US residents against having elective procedures in Matamoros involving epidural anesthetic injection. Insurance barriers may have led to medical tourism to Mexico and subsequent delayed treatment for fungal meningitis, highlighting the need for preparation to address healthcare access disparities in future outbreaks.

Disclosures
Luis Ostrosky-Zeichner, MD, FACP, FIDSA, FSHEA, FECMM, CMQ, Astellas: Advisor/Consultant|Astellas: Grant/Research Support|Astellas: Honoraria|F2G: Advisor/Consultant|F2G: Grant/Research Support|F2G: Honoraria|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|GSK: Advisor/Consultant|GSK: Grant/Research Support|GSK: Honoraria|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Melinta: Honoraria|NIH: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Expert Testimony|Pfizer: Honoraria|Pulmocide: Advisor/Consultant|Pulmocide: Grant/Research Support|Pulmocide: Honoraria|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Scynexis: Honoraria|T2 biosystems: Advisor/Consultant|T2 biosystems: Grant/Research Support|T2 biosystems: Honoraria|Viracor: Advisor/Consultant|Viracor: Grant/Research Support|Viracor: Honoraria