Infection and Drug Resistance | Volume 15 - Dove Press Open ...
Three More Dead In Fungal Meningitis Outbreak Linked To Tainted Surgeries
Enlarge / One of the medical clinics suspended by Mexican health authorities in Matamoros, Tamaulipas, Mexico, on May 19, 2023. GettyAFP reader comments 16 withThree more people in the US have died from fungal meningitis in an outbreak linked to tainted surgeries in Mexico, bringing the total deaths to seven, the Centers for Disease Control and Prevention reported Thursday.
Further Reading Deadly fungal meningitis cases nearly double as CDC rushes to find exposed The total case count remains unchanged from an update earlier this month, with 34 cases in the US: nine confirmed, 10 probable, and 15 suspected. Health officials are investigating 161 others who may have been exposed.The outbreak is linked to cosmetic surgeries involving epidural anesthesia at two clinics in Matamoros, Mexico, just across the border from Brownsville, Texas. Mexican and US officials suspect that a component of the anesthetic was contaminated, resulting in the pathogenic fungus Fusarium solani being injected directly into people's spinal cords. The tainted surgeries are thought to have occurred between January 1, 2023, to May 13, 2023, around when the clinics were shut down by local health officials.
In an interview earlier this month, Dr. Tom Chiller, Mycotic Diseases Branch chief for the CDC, told Ars that Mexican officials suspect that morphine used in the epidural may be the culprit. The painkiller is mixed in with a widely used anesthetic, but morphine is in short supply in Mexico currently, which may have led to the use of gray- or black-market drugs.
AdvertisementAnother possibility is simply poor hygiene practices by anesthesiologists. In Mexico, anesthesiologists do not use clinic or hospital stores for drugs; they procure their own medications and bring them into the facilities where they practice. This makes it hard to track down the specific drugs used in the outbreak cases.
Further Reading Two dead in US from tainted surgeries in Mexico; 206 more may have brain infections Fungal meningitis is also difficult to test for and treat, Chiller noted. Tests looking for genetic traces of the fungus in the spinal fluid often miss it when it's present, he said. "The fungus itself isn't hanging out in that fluid; it's getting into the tissues," Chiller said. "It's wedging itself into the meninges and into the brain." There, it can stay indolent and quiet for weeks to months, "but then it can boom, then it can move rapidly," Chiller said. In the current outbreak, officials have seen cases with symptoms beginning 102 days after a contaminated surgery.The CDC is urging anyone who had procedures at either of the two clinics—River Side Surgical Center or Clinica K-3—from January 1 to May 13, 2023, to get medical care immediately, even if there are no symptoms of infection. Health care providers are advised to give anyone exposed a lumbar puncture to look for signs of infection.
If symptoms have developed, they can include fever, headache, stiff neck, nausea, vomiting, sensitivity to light, and confusion.
What Is The Fatality Rate Of Meningitis?
The fatality rate of meningitis depends largely on the infection type and how quickly a person receives appropriate medical care.
Meningitis is an infection of the protective membranes or "meninges" surrounding the brain and spinal cord. Most infections are due to a bacteria or virus, but some result from fungi or parasites.
It is vital that anyone experiencing symptoms of meningitis seeks immediate medical care.
This article outlines meningitis fatality rates and survival rates and provides information on the prevalence of the disease. We also discuss some factors that can affect outlook.
According to the World Health Organization (WHO), meningitis is a global public health concern with a high fatality rate.
Among the different types of meningitis, bacterial meningitis (BM) carries the highest fatality rate. According to the WHO, 1 in 6 people dies from BM, and 1 in 5 who survives develops serious complications.
A 2019 study found that global meningitis cases increased from 2.5 million in 1990 to 2.82 million in 2016. Despite this increase, overall deaths decreased by 21%. Still, the fatality rate of meningitis remains high, especially compared with other vaccine-preventable diseases such as measles and tetanus.
A 2019 IMHE study found that meningitis caused 236,000 deaths worldwide. Around 112,000 of these deaths were among children under 5 years of age.
Bacterial meningitisA 2021 study notes that at least 1.2 million cases of BM develop yearly and that 135,000 of these result in death. According to the WHO, death from BM can occur within 24 hours.
The Illinois Department of Public Health notes that, before antibiotics became the standard treatment for BM, around 70 in 100 BM cases resulted in death. Today, with antibiotic treatment, this figure is around 15 in 100 or fewer.
Four types of bacteria produce the majority of BM infections. These are:
Vaccines are the best protection from BM, preventing Hib, meningococcus, and pneumococcus.
Viral meningitisViral meningitis (VM) is more common than BM and is usually less severe. Doctors may also call VM "aseptic meningitis."
Most people with healthy immune systems can recover from VM. However, anyone with symptoms of meningitis should see a doctor, as all types of the disease can be severe.
The majority of VM cases are due to enteroviruses. These are common viruses that typically cause only mild symptoms.
Other viruses that may cause VM include:
The arbovirus "West Nile virus" is spread via infected mosquitos and causes VM with a fatality rate of 4–13%.
Meningitis survival statistics differ according to meningitis type. Below are the survival statistics for the two most common forms of meningitis — bacterial and viral.
Bacterial meningitisBM has the highest fatality rate. The WHO states that, among people who contract BM, 5 in 6 survive. However, 1 in 5 survivors goes on to develop a permanent disability, such as:
Viral meningitisScientists need to conduct more research into the survival statistics of VM. However, a 2021 review states that people usually recover from this type of illness.
The odds of surviving meningitis strongly relate to the type of meningitis a person has and the speed with which the person begins treatment.
In developed countries where medical care is available more quickly, an individual who develops meningitis has a good chance of survival. Conversely, in developing nations with lower vaccination rates and decreased availability of medical care, fatality rates are higher.
People who survive BM often develop long-term health effects that require ongoing treatment. These may include brain damage and problems with hearing, speech, or vision.
Rates of meningitis remain high in some areas of the world, such as sub-Saharan Africa, but are low in the United States. In 2020, the Centers for Disease Control and Prevention (CDC) recorded around 240 reported cases of meningitis in the U.S.
The risk of a meningitis outbreak increases when people live or spend time in close proximity, such as:
Rates of meningitis are highest among children under 1 year of age, followed by children in adolescence.
PrevalenceAccording to the IMHE's 2019 study, the global prevalence of meningitis was equivalent to 99.9 cases per 100,000 people.
Meningitis rates equated to 98.8 cases per 100,000 females and 101 cases per 100,000 males. These figures represent a 13.1% decrease in meningitis cases from 2010–2019 for both sexes.
Two key factors that affect meningitis fatality are vaccinations and access to prompt and appropriate medical care.
Vaccination significantly reduces the likelihood of developing meningitis. A BM vaccine can protect against bacterial causes of meningitis, while a VM vaccine can protect against viral causes of meningitis, such as:
If symptoms of meningitis develop, a person should seek immediate medical attention. Some possible symptoms to look out for include:
Meningitis is the medical term for inflammation of the protective meninges surrounding the brain and spinal cord. This inflammation typically occurs as a result of a bacterial or viral infection. Less commonly, fungi or parasites can cause meningitis.
In the U.S., deaths from meningitis have decreased since the introduction of meningitis vaccines. However, the disease is still a serious health concern in some areas of the world.
One key factor that can impact survival and outlook is immediate access to appropriate medical care. As such, anyone experiencing symptoms of meningitis should seek immediate medical attention.
Meningitis B Almost Took This Young Woman's Life
This article is SponsoredThis story was created by Content Works, Postmedia's commercial content division, on behalf of a client.
by one of Canada's leading health-care companies Breadcrumb Trail LinksKate Healy thought she had a cold, but less than 24 hours later she almost died. Today, she has a message for anyone heading to summer camp or a university campus this fall: Talk to your doctor about meningitis B
Author of the article:
Wendy Haaf • Postmedia Content WorksPublished Jun 22, 2023 • Last updated Jun 22, 2023 • 4 minute read
"If my story makes one person realize, maybe I should get my child vaccinated — that would mean the world to me," says Kate Healy. Photos: Missing B Article contentWhen Kate Healy was 16, she woke up one summer morning with achy muscles and a mild fever. As she had just wrapped up a job as a camp counsellor, Healy assumed she had a cold or other garden-variety viral bug. But by that evening, as she was being rushed to a rural hospital, she was so weak she could barely hold a popsicle.
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Just 24 hours after those first symptoms, Healy lay in the intensive care unit in a medically induced coma, as the medical team broke the news to her parents that their daughter's chances of survival were just five per cent.
The culprit behind this blindsiding illness: a type of bacteria that can cause meningitis B.
Article contentHealy miraculously beat the odds and survived. Today, she is determined to share her experience and the importance of talking to your health-care provider about protection against infection.
"We do immunize for meningitis, but we immunize for other types," says Dr. Vivien Brown, a family physician and assistant professor in the department of family and community medicine at the University of Toronto. She explains that, while there are vaccines available that can prevent meningitis B, they're not included in most routine childhood vaccine schedules in Canada.
In Ontario, for example, children are immunized at 12 months for meningitis C, and again when they are in Grade 7, with a quadrivalent meningitis shot for serotypes A, C, W135 and Y.
"Parents think their children are being immunized for meningococcal meningitis — and they are — just not for the type that's most prevalent right now," says family physician Dr. Vivien Brown.Dr. Brown says the most common kind of meningococcal meningitis in Canada is meningitis B, "yet, we're not immunizing against it in the routine schedule. Parents think their children are being immunized for meningococcal meningitis — and they are — just not for the type that's most prevalent right now. It's confusing."
Admittedly, meningitis B infections are relatively rare, with 983 cases in Canada between 2012 and 2019, but due to the swift, severe nature of the disease, Dr. Brown recommends to her patients that they get immunized against it. "It's uncommon, but it has a high mortality, and high morbidity," she says. Up to one in 10 people infected die, and as many as one in five are left with serious, lifelong consequences such as hearing loss, visual impairment, learning difficulties or limb amputations.
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Article content"One of the problems is that when an infant or an adolescent contracts meningitis B, they have a fever, they have a headache — it looks like influenza," says Dr. Brown. Consequently, on average, people with the infection aren't admitted to hospital until 19 hours after the first symptoms appear. "Since death can occur at 24 hours," she says, "it's often too late to do anything about it."
The age groups most likely to contract a meningitis B infection are babies under one year, children under five and adolescents, "particularly those going into university or college and living in dorms," says Dr. Brown. Last year, for instance, cases were reported at two Canadian universities and one outbreak.
The age groups most likely to contract a meningitis B infection are babies under one year, children under five and adolescents, particularly those going into university or college and living in dorms.
Transmitted in much the same way as a cold or flu, the bacterial infection is most likely to spread via behaviours like sharing water bottles and kissing, but can travel in enclosed spaces. The best protection against infection is vaccination.
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Play VideoConsequently, 13 countries, including the U.K., routinely vaccinate against the B strain. That's not the case in Canada, where meningitis B vaccines aren't publicly funded by most provinces and territories — with two recent exceptions. Nova Scotia and Prince Edward Island recently announced they will provide meningitis B immunization to eligible post-secondary students living in residence.
Kate Healy believes that's a step in the right direction. "I wouldn't want anyone to go through what my family and I went through," she says. In addition to the trauma she and her family endured during her acute illness, they had to cope with a long list of lingering effects in its wake.
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Article content"I had to relearn how to walk again," she explains. "I had a portion of one of my toes removed. I had several corrective surgeries for significant scarring on my legs. Whenever I had an appointment or a visitor, I'd have to rest for hours afterwards — that lasted for months. I dealt with wound care, physiotherapy, and specialist appointments. And I missed months of school.
"If my story makes one person realize, maybe I should get my child vaccinated before they go off to university or college or camp — that would mean the world to me. Because even if people are lucky enough to survive this disease, so many have serious lasting side-effects. I was very fortunate."
Talk to your doctor and learn more at: missingb.Ca.
This story was created by Content Works, Healthing.Ca's commercial content division, on behalf of one of Canada's leading health-care companies.
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