Authorities in the United States and Mexico asked the World Health Organization to declare a public health emergency of international concern due to a deadly fungal outbreak, an official with the Centers for Disease Control and Prevention said on Friday. The order comes after recruiters attracted hundreds of patients from multiple countries and 24 US states to two facilities in Mexico for cosmetic operations that may have exposed them to the fungus.
The CDC is currently monitoring the condition of 195 people in the US who have had surgery involving epidural anesthesia at the now-closed River Side Surgical Center and K-3 Clinic in Mexico.
Fourteen are “suspected” and 11 are “probable” cases of fungal meningitis – infections of the brain or spinal cord – based on their symptoms or test results. Two of these patients died. Six potential cases have been ruled out since the CDC’s last update on Wednesday.
Most reported headaches before their infections worsened, progressing to symptoms such as fever, vomiting, neck pain and blurred vision. Meningitis can quickly become life-threatening once symptoms begin, warns the CDC.
Recent test results from authorities in Mexico have raised concerns of a repeat of another deadly outbreak that was linked to surgeries in other parts of Mexico earlier this year. In that outbreak, nearly half of all patients diagnosed with meningitis died.
A WHO committee would have to be convened first before an international emergency was declared by the agency’s director-general. Although countries must notify WHO of all potential emergencies, not all reach this stage.
“[We] are notified of hundreds of events every day and assess each one,” WHO spokeswoman Margaret Ann Haris said in an email.
She declined to confirm whether such notification was from the US, saying communications with member states are confidential.
A spokesman for the US Department of Health and Human Services did not respond to a request for comment.
Authorities have urged Americans who have had surgery involving epidural anesthesia at any of these clinics since January to immediately go to the emergency room or an urgent care facility, even if they currently don’t think they have symptoms.
People from 24 northern states to Alaska were potentially exposed during surgeries at one of the two clinics, according to a list provided by Mexican authorities to the CDC. The vast majority – 178 – are Texas residents.
Until now, most patients with symptoms have been female, although a likely male case has also been identified with symptoms of meningitis.
One of the two patients who died was also an organ donor, with five different recipients across the country earlier this year who could be at risk.
“All have been reported and are under evaluation, and we are working with transplant centers and other partners to properly manage these patients who have had these organs transplanted into their bodies,” the CDC’s Dallas Smith told a webinar Friday organized by the Mycoses Study Group.
The consortium has been working with the CDC to advise physicians treating patients who may have been infected by the procedures.
“As patients in Mexico, the United States, Canada and Colombia were on the exposed list, we wanted to ensure that these countries are aware and provide that situational awareness through a public health emergency of international concern,” said Smith.
“Concerned about a high death rate”
Investigators now believe that the two facilities, located near the Mexico-Texas border, attracted patients from all over the Americas for surgical procedures.
“There are these agents who act as recruiters for patients in the US, they link US patients to these clinics to receive certain care and certain procedures, like cosmetic procedures,” Smith said.
From in-depth interviews with a handful of patients, authorities believe that many sought operations such as liposuction, breast augmentation or a Brazilian butt lift.
Authorities have yet to confirm the cause of the outbreak. So far, results from US patients have been inconclusive for tracking the fungus.
However, tests in Mexico produced positive results for a fungus known as Fusarium solani in spinal cord fluid samples. This same type of fungus was seen in a deadly outbreak that began late last year in the Mexican state of Durango, which was also linked to surgeries.
“We’re not sure if these two outbreaks are linked, but the fact that the same organism is likely causing this fungal meningitis worries us about a high mortality rate. That’s why it’s so important to get patients early, even if they are asymptomatic.” , said Smith.
Drugs used during anesthesia in the current outbreak could have been contaminated, Smith said, in the epidural itself or in other drugs that are added together during surgeries, such as morphine.
“There is currently a shortage in Mexico and there could be potential for a black market that could have contaminated medicine,” Smith said.
Another theory is that there were lapses in infection control practices to prevent contamination during surgery, which is currently responsible for the other outbreak.
“The outbreak we’re facing now is very similar and has the capacity to have this high death rate and just devastate families and communities,” Smith said.