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Outbreak of Fusarium solani Meningitis in Immunocompetent Persons Associated With Neuraxial Blockade in Durango,
Gabriel García-Rodríguez1, Célida Duque-Molina2, Irasema Kondo-Padilla3
1Dirección General de Epidemiología, Secretaría de Salud, Mexico City, Mexico.
Background:
Fungal meningitis can be associated with epidural anesthesia procedures. Fusariosis is a rare infection typically affecting immunocompromised patients and rarely causes meningitis. During 2022-2023, public health officials responded to a large outbreak of Fusarium solani meningitis associated with epidural anesthesia in Durango, Mexico.
Methods:
The public health response and epidemiological and clinical features of patients affected by this outbreak were described. Coordinated actions were addressed to identify the etiological agent, determine its drug susceptibility, develop diagnostic tests, and implement clinical and epidemiological protocols. Retrospective analyses of clinical variables and outcomes were performed to determine association with better patient survival.
Results:
A total of 1801 persons exposed to epidural anesthesia were identified, of whom 80 developed meningitis. Fusarium solani was found in 3 brain biopsies and showed susceptibility to voriconazole and amphotericin B. After F solani polymerase chain reaction (PCR) implementation, 57 patients with meningitis were PCR-screened, and 31 (38.8%) had a positive result. Most patients were female (95%), and cesarean section was the most common surgical procedure (76.3%). The case fatality rate was 51.3% (41 patients) and the median hospitalization duration was 39.5 days (interquartile range, 18-86 days). Seventy-one patients (88.8%) received voriconazole/amphotericin B and 64 subjects (80%) additionally received steroids. Cox regression analysis showed an increased lethality risk in patients who received antifungal treatment after 5 days (hazard ratio, 2.1 [95% confidence interval, 1.01-4.48], P < .05).
Conclusions:
The F solani meningitis outbreak in Durango was an unprecedented medical challenge. Timely treatment and effective healthcare management were associated with better survival outcomes.
Insights
An outbreak of Fusarium solani meningitis linked to epidural anesthesia in Durango affected 80 individuals, resulting in a 51.3% fatality rate. Timely antifungal treatment improved survival outcomes in this rare fungal meningitis outbreak.
Area of Science:
- Infectious Diseases
- Epidemiology
- Public Health
Background:
- Fungal meningitis, particularly Fusarium solani meningitis, is a rare complication associated with invasive procedures like epidural anesthesia.
- An unprecedented outbreak of Fusarium solani meningitis occurred in Durango, Mexico, during 2022-2023, primarily linked to epidural anesthesia procedures.
- The outbreak disproportionately affected women undergoing cesarean sections, highlighting a specific at-risk population.
Purpose of the Study:
- To describe the public health response, epidemiological characteristics, and clinical features of the Fusarium solani meningitis outbreak.
- To identify the causative agent, determine its drug susceptibility, and develop diagnostic and clinical protocols.
- To analyze clinical variables and outcomes to identify factors associated with improved patient survival.
Main Methods:
- Epidemiological investigation and retrospective analysis of clinical data from 1801 individuals exposed to epidural anesthesia.
- Identification of Fusarium solani through brain biopsies and polymerase chain reaction (PCR) testing.
- Assessment of antifungal drug susceptibility (voriconazole, amphotericin B) and evaluation of treatment outcomes, including time to treatment and use of steroids.
Main Results:
- Eighty cases of meningitis were identified among 1801 exposed individuals, with Fusarium solani confirmed as the etiological agent.
- Fusarium solani demonstrated susceptibility to voriconazole and amphotericin B. PCR confirmed 31 cases.
- The case fatality rate was 51.3%, with a median hospitalization of 39.5 days. Delayed antifungal treatment (after 5 days) was associated with increased lethality (HR 2.1).
Conclusions:
- The Fusarium solani meningitis outbreak in Durango presented a significant medical and public health challenge.
- Prompt diagnosis and administration of appropriate antifungal therapy, specifically voriconazole or amphotericin B, are critical for improving survival.
- Effective healthcare management and timely intervention are associated with better outcomes in managing rare fungal meningitis outbreaks.
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