Neurovascular Complications of Iatrogenic Fusarium solani Meningitis

Authors

Nora Strong
Grant Meeks
Sunil A Sheth
Louise McCullough
Julian A Villalba
Chunfeng Tan
Andrew Barreto
Audrey Wanger
Michelle McDonald
Peter Kan
Hashem Shaltoni
Jose Campo Maldonado
Victoria Parada
Ameer E Hassan
Sarah Reagan-Steiner
Tom Chiller
Jeremy A W Gold
Dallas J Smith
Luis Ostrosky-Zeichner

Publication Date

2-8-2024

Journal

The New England Journal of Medicine

Abstract

A multinational outbreak of nosocomial fusarium meningitis occurred among immunocompetent patients who had undergone surgery with epidural anesthesia in Mexico. The pathogen involved had a high predilection for the brain stem and vertebrobasilar arterial system and was associated with high mortality from vessel injury. Effective treatment options remain limited; in vitro susceptibility testing of the organism suggested that it is resistant to all currently approved antifungal medications in the United States. To highlight the severe complications associated with fusarium infection acquired in this manner, we report data, clinical courses, and outcomes from 13 patients in the outbreak who presented with symptoms after a median delay of 39 days.

Keywords

Humans, Antifungal Agents, Fusariosis, Fusarium, Iatrogenic Disease, Meningitis, Fungal, Mexico, Disease Outbreaks, Internationality, Immunocompetence, Drug Resistance, Fungal, Analgesia, Epidural

DOI

10.1056/NEJMoa2308192

PMID

38324485

PMCID

PMC11905984

PubMedCentral® Posted Date

3-13-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes