Faculty, Staff and Student Publications

Language

English

Publication Date

3-17-2026

Journal

Clinical Infectious Diseases

DOI

10.1093/cid/ciaf399

PMID

40696772

PMCID

PMC13017540

PubMedCentral® Posted Date

7-22-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords

Humans, Mexico, Female, Male, Meningitis, Fungal, Adult, Middle Aged, Disease Outbreaks, Anesthesia, Epidural, Aged, Young Adult, Adolescent, Fusarium, Child, United States, Whole Genome Sequencing, Child, Preschool

Published Open-Access

yes

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.