Neurovascular Complications of Iatrogenic Fusarium solani Meningitis
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...
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| Published in | The New England journal of medicine Vol. 390; no. 6; pp. 522 - 529 |
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| Main Authors | , , , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Massachusetts Medical Society
08.02.2024
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| Series | Brief Report |
| Subjects | |
| Online Access | Get full text |
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| 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.
An outbreak of iatrogenic
Fusarium solani
meningitis occurred in early 2023 in association with epidural anesthesia in Mexico. Descriptions of 13 cases and associated management are presented. |
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| AbstractList | SummaryA 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. 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. An outbreak of iatrogenic Fusarium solani meningitis occurred in early 2023 in association with epidural anesthesia in Mexico. Descriptions of 13 cases and associated management are presented. 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. 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.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. |
| Author | Campo Maldonado, Jose Strong, Nora Barreto, Andrew Hassan, Ameer E. Parada, Victoria Ostrosky-Zeichner, Luis Gold, Jeremy A.W. Reagan-Steiner, Sarah Shaltoni, Hashem Wanger, Audrey McCullough, Louise Tan, Chunfeng Chiller, Tom Smith, Dallas J. Kan, Peter Sheth, Sunil A. Meeks, Grant McDonald, Michelle Villalba, Julian A. |
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| Cites_doi | 10.1093/cid/ciad570 10.1016/j.ajpath.2013.05.007 10.1056/NEJMoa1304879 10.1056/NEJMra1216008 |
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| References | (r2) 2023 (r8) 2023 Chiller, TM, Roy, M, Nguyen, D (r5) 2013; 369 (r1) 2023 Smith, DJ, Gold, JAW, Chiller, T (r3) 2023 McCarthy, M, Rosengart, A, Schuetz, AN, Kontoyiannis, DP, Walsh, TJ (r9) 2014; 371 (r7) 2023 Ritter, JM, Muehlenbachs, A, Blau, DM (r6) 2013; 183 (r4) 2015 e_1_3_5_2_2 e_1_3_5_10_2 e_1_3_5_8_2 e_1_3_5_7_2 e_1_3_5_9_2 e_1_3_5_4_2 e_1_3_5_3_2 e_1_3_5_6_2 e_1_3_5_5_2 |
| References_xml | – year: 2023 ident: r7 article-title: Interim recommendations for diagnosing and managing suspected fungal meningitis associated with epidural anesthesia administered in Matamoros, Mexico ;(https://emergency.cdc.gov/coca/calls/2023/callinfo_060823.asp) – year: 2023 ident: r3 article-title: Update on outbreak of fungal meningitis among U.S. residents who received epidural anesthesia at two clinics in Matamoros, Mexico. publication-title: Clin Infect Dis ;(Epub ahead of print) – volume: 369 start-page: 1610 year: 2013 end-page: 1619 ident: r5 article-title: Clinical findings for fungal infections caused by methylprednisolone injections. publication-title: N Engl J Med – year: 2023 ident: r1 article-title: Interim recommendations for diagnosis and management of fungal meningitis associated with epidural anesthesia administered in Matamoros, Mexico ;(https://funguseducationhub.org/wp-content/uploads/2023/06/interim-recommendations-Matamoros-FM-outbreak-6_09_23.pdf) – year: 2023 ident: r2 article-title: Fungal meningitis outbreak associated with procedures performed under epidural anesthesia in Matamoros, Mexico ;(https://www.cdc.gov/hai/outbreaks/meningitis-epidural-anesthesia.html) – volume: 371 start-page: 150 year: 2014 end-page: 160 ident: r9 article-title: Mold infections of the central nervous system. publication-title: N Engl J Med – volume: 183 start-page: 881 year: 2013 end-page: 892 ident: r6 article-title: Exserohilum infections associated with contaminated steroid injections: a clinicopathologic review of 40 cases. publication-title: Am J Pathol – year: 2015 ident: r4 article-title: Multistate outbreak of fungal meningitis and other infections ;(https://www.cdc.gov/hai/outbreaks/meningitis.html) – year: 2023 ident: r8 article-title: (https://www.gob.mx/cms/uploads/attachment/file/874853/COMUNICADO_TECNICO_SEMANAL_28NOVIEMBRE2023.pdf) publication-title: Comunicado técnico semanal — meningitis, Durango – ident: e_1_3_5_4_2 doi: 10.1093/cid/ciad570 – ident: e_1_3_5_7_2 doi: 10.1016/j.ajpath.2013.05.007 – ident: e_1_3_5_9_2 – ident: e_1_3_5_3_2 – ident: e_1_3_5_6_2 doi: 10.1056/NEJMoa1304879 – ident: e_1_3_5_8_2 – ident: e_1_3_5_10_2 doi: 10.1056/NEJMra1216008 – ident: e_1_3_5_5_2 – ident: e_1_3_5_2_2 |
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| Snippet | A multinational outbreak of nosocomial fusarium meningitis occurred among immunocompetent patients who had undergone surgery with epidural anesthesia in... SummaryA multinational outbreak of nosocomial fusarium meningitis occurred among immunocompetent patients who had undergone surgery with epidural anesthesia in... |
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| SubjectTerms | Analgesia, Epidural - adverse effects Anesthesia Aneurysms Antifungal agents Antifungal Agents - therapeutic use Autopsies Brain stem Contamination Disease Outbreaks - statistics & numerical data Drug Resistance, Fungal Encephalitis Epidemics Epidural Fungal Infections Fusariosis - epidemiology Fusariosis - etiology Fusarium - isolation & purification Global Health Hemorrhage Hospital systems Hospitals Human subjects Humans Iatrogenic Disease - epidemiology Immunocompetence Infections Infectious Disease Infectious Disease General Inflammation Internationality Meningitis Meningitis, Fungal - epidemiology Meningitis, Fungal - etiology Mexico - epidemiology Neurology Neurosurgery Neurosurgery General Outbreaks Pain Pathogens Pathology Patients Surgery Surgery General |
| SubjectTermsDisplay | Fungal Infections Global Health Infectious Disease Infectious Disease General Meningitis/Encephalitis Neurology/Neurosurgery Neurology/Neurosurgery General Pain Surgery Surgery General |
| Title | Neurovascular Complications of Iatrogenic Fusarium solani Meningitis |
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