#17,487
Although medical tourism can offer an attractive price for elective surgery it has occasionally been linked to the acquisition - and importation - of resistant bacterial or fungal infections. In 2019, we followed a multi-state outbreak of Carbapenem-resistant Pseudomonas aeruginosa Infection linked to hospitals and clinics in Tijuana, Baja California, Mexico.
The CDC issued an advisory that read, in part:
All of the travelers with this particular infection had an invasive medical procedure performed in Tijuana. Most (but not all) of them had weight-loss surgery. About half of those infected had their surgery done at the Grand View Hospital.
Based on information provided by the CDC, the Mexican government has closed the Grand View Hospital until further notice.
CDC recommends that travelers to Tijuana, Mexico, not have surgery at the Grand View Hospital until the Mexican government can confirm that the drug-resistant form of Pseudomonas aeruginosa bacteria is no longer there.
A few journal articles on point include:
High Morbidity of Mycobacterial Infections Following Cosmetic Surgery Tourism - Massand, Sameer MD∗; Butterfield, James A. MD∗; Lee, Charles C. BS∗; Ingraham, John M. MD∗,†; Potochny, John D. MD∗
The Globalization of Healthcare: Implications of Medical Tourism for the Infectious Disease Clinician- Lin H. Chen Mary E. Wilson
Multistate US Outbreak of Rapidly Growing Mycobacterial Infections Associated With Medical Tourism to the Dominican Republic, 2013–2014 - EID Journal
Medical Tourism and Postoperative Infections: A Systematic Literature Review of Causative Organisms and Empiric Treatment - Plast Reconstr Surg. 2018 Dec
Last month a similar report - again from Mexico (Matamoros) was issued by the CDC, including the following excerpt from a June 1st HAN Update:
As of June 1, 2023, a multistate outbreak of fungal meningitis is ongoing among patients who underwent procedures under epidural anesthesia in the city of Matamoros, Tamaulipas, Mexico, at two clinics: River Side Surgical Center and Clinica K-3. Three U.S. laboratories (CDC Mycotic Diseases Branch’s Laboratory, UCSF Clinical Microbiology Laboratory, and UW Medicine Molecular Microbiology laboratory) and the Mexican national laboratory (InDRE) have detected fungal signals consistent with the Fusarium solani species complex from the cerebrospinal fluid (CSF) of patients receiving follow-up care in Mexico or the United States. In addition, elevated levels of beta-D-glucan, a biomarker of fungal infection, have been detected in the CSF of at least six patients. A total of 212 residents in 25 U.S. states and jurisdictions have been identified who might be at risk of fungal meningitis because they received epidural anesthesia at the clinics of interest in 2023. Among these patients, 14 suspected, 11 probable, and two confirmed U.S cases have been diagnosed (see case definitions below); three patients (two probable cases and one confirmed case) have died. Efforts by public health officials are ongoing to find and notify additional patients who might be at risk.
Healthcare providers, public health officials, and the public should be aware that all patients, including those without symptoms, who underwent medical or surgical procedures under epidural anesthesia at River Side Surgical Center or Clinica K-3 in Matamoros, Mexico, since January 1, 2023, should be evaluated for fungal meningitis as soon as possible. Evaluation for fungal meningitis includes a lumbar puncture (LP, also known as spinal tap) and magnetic resonance imaging (MRI) of the brain.
Today (June 8th), the CDC will hold a COCA call for clinicians on recognizing and treating this rare fungal meningitis. These presentations are often technical, and are of greatest interest to clinicians and healthcare providers, but also may be of interest to the general public.
As always, If you are unable to attend the live presentation, these (and past) webinars are archived and available for later viewing at this LINK.
After the break, I'll return with a bit more about another iatrogenic fungal outbreak just over a decade ago.
Interim Recommendations for Diagnosing and Managing Suspected Fungal Meningitis Associated with Epidural Anesthesia Administered in Matamoros, Mexico
Overview
The Centers for Disease Control and Prevention (CDC), the Mexico Ministry of Health, and U.S. state and local health departments are responding to a multinational outbreak of fungal meningitis among patients who underwent surgical procedures under epidural anesthesia in Matamoros, Tamaulipas, Mexico, since January 1, 2023. To date, more than 200 U.S. citizens have been exposed to these procedures with three deaths resulting from this fungal meningitis outbreak.
During this COCA Call, presenters will provide epidemiological updates, give an in-depth description of the clinical course of patients treated in the United States, and discuss what clinicians need to know to evaluate and treat people under investigation and those with suspected and confirmed cases during this fungal meningitis outbreak.
Presenters
Tom Chiller, MD, MPHTM
Chief, Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Dallas Smith, PharmD, MAS
LT, U.S. Public Health Service
Epidemiologist, Mycotic Diseases Branch
Division of Foodborne, Waterborne, and Environmental Diseases
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention
Luis Ostrosky-Zeichner, MD, FACP, FIDSA
Professor and Chief, Division of Infectious Diseases
McGovern Medical School
University of Texas Health Science Center, Houston
Chief Epidemiology Officer
Memorial Hermann Healthcare System
Call Materials
To be posted. Please check back.
Call Details
When:
Thursday, June 8, 2023,
2:00 PM – 3:00 PM ET
Webinar Link:
https://www.zoomgov.com/j/1612361333
Webinar ID: 161 236 1333
Passcode: 370861 fungal infection among patients who were given injections of contaminated methylprednisolone acetate (MPA) from the New England Compounding Center (NECC) in Framingham, Mass.
Telephone:
+1 669 254 5252, or,
+1 646 828 7666, or,
+1 551 285 1373 US
One-tap mobile:
+16692545252,,1612361333#,,,,*370861#
International numbers
In that outbreak at least 720 victims were identified, including 64 deaths. Cases were identified in 20 states, with Michigan and Tennessee hardest hit.
In October of 2012, FDA Statement On Conditions Reported At NECC Facility, we saw a report cited the discovery of unopened vials of preservative-free methylprednisolone during an inspection on October 2nd that were observed to have `greenish black foreign matter’ and/or `white filamentous material’ inside.
In 2014 we saw Criminal Charges Filed In Fungal Meningitis Case against the manufacturers of the steroid, and while it would take another 3 years, the two owners of the firm would be convicted and given lengthy prison sentences.
