Fungal Meningitis in US Patients Who Received Epidural Anesthesia in Matamoros, Mexico

Fungal meningitis outbreaks are rare and entail high mortality rates. Beginning May 2023, we investigated fungal meningitis caused by Fusarium solani species complex occurring in US patients who received epidural anesthesia in Matamoros, Mexico.

Early epidemiological information suggested US patients with suspected fungal meningitis had undergone mostly cosmetic procedures under epidural anesthesia performed in 2 Matamoros clinics. US patients known to have received surgery at these clinics during 1 January-13 May 2023 (clinic closures date) were identified and notified by public health officials. Epidemiological and clinical data were used to update diagnostic and clinical guidance for outbreak response, including use of the experimental antifungal fosmanogepix. Whole-genome sequencing was conducted on outbreak isolates.

US public health officials attempted to contact 233 potentially exposed US residents who underwent surgeries, mostly cosmetic, in Mexico, reaching 170 (73%). Of those, 104 (61%) reported receiving epidural anesthesia and were therefore considered potentially at risk of fungal meningitis. At least 30/104 (29%) at-risk patients received a diagnostic lumbar puncture; 24 (23 women, 17 Hispanic or Latino) were diagnosed with fungal meningitis, and 6 were not. Twelve (50%) with fungal meningitis died. All cases involved epidural anesthesia administered by the same anesthesiologist in Mexico. Whole-genome sequencing showed that patient isolates of Fusarium from the 2 implicated clinics in Matamoros, Mexico, were genetically closely related.

Clinicians should maintain suspicion for fungal meningitis in patients with negative bacterial culture, viral culture, and molecular testing with a history of epidural anesthesia for any reason.