Fungal meningitis in U.S. Patients who Received Epidural Anesthesia in Matamoros, Mexico.

Summary

Among 233 potentially exposed U.S. residents who underwent mostly cosmetic surgeries in Matamoros, 170 were contacted, 104 reported epidurals, and 24 were diagnosed with Fusarium meningitis with 50% mortality. All cases shared the same anesthesiologist; WGS confirmed closely related strains, and guidance included consideration of fosmanogepix.

Key Findings

• Of 233 potentially exposed individuals, 170 (73%) were contacted; 104 (61%) reported epidural anesthesia and 24 were diagnosed with Fusarium meningitis.
• Case fatality was 50% (12/24). All cases involved the same anesthesiologist in Mexico.
• Whole genome sequencing demonstrated closely related Fusarium isolates across the two implicated clinics; guidance updated to include fosmanogepix.

Clinical Implications

Maintain high suspicion for fungal meningitis after any epidural anesthesia in medical tourists; promptly perform lumbar puncture and targeted fungal testing, and consider advanced antifungals (e.g., fosmanogepix) per evolving guidance.

Limitations

• Incomplete ascertainment: only 29% of at-risk individuals underwent lumbar puncture; potential underdiagnosis.
• Observational design without a control group; reliance on contactability may introduce selection bias.

Future Directions

Standardize peri-procedural infection control for cosmetic clinics, develop rapid diagnostics for Fusarium CNS disease, and evaluate optimal antifungal regimens including novel agents in prospective studies.