Authorities in the U.S. and Mexico have asked the World Health Organization to declare a public health emergency of international concern over a, a Centers for Disease Control and Prevention official said Friday. The request comes after recruiters lured hundreds of patients from multiple countries and 24 U.S. 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 across the U.S. who got surgeries involving epidural anesthesia at the now-shuttered River Side Surgical Center and Clinica K-3 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 have 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 like fever, vomiting, neck pain, and blurred vision. Meningitis can quickly become life-threatening once symptoms begin, the CDC warns.
Recent test results from authorities in Mexico have sparked concern of a repeat from another deadly outbreak that was linked to surgeries elsewhere in 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 is declared by the agency's director-general. While countries must notify WHO of all potential emergencies, not all end up reaching that stage.
"[We] are notified of hundreds of events every day and assess each one," WHO spokesperson Margaret Ann Haris said in an email.
She declined to confirm whether such a notification had occurred from the U.S., saying communications with member states are confidential.
A spokesperson for the U.S. Department of Health and Human Services did not provide an answer to a request for comment.
Authorities have urged Americans who had surgeries involving epidural anesthesia at either of these clinics since January to go immediately to the emergency room or an urgent care facility, even if they do not currently think they have symptoms.
People from 24 states as far north as 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 residents of Texas.
Most patients with symptoms have been female so far, although one probable 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 around the country earlier this year who could be at risk.
"All have been notified, and are under evaluation, and we were working with transplant centers and other partners to properly manage these patients who had these organs transplanted into their bodies," the CDC's Dallas Smith told a webinar Friday hosted by the Mycoses Study Group.
The consortium has been working with the CDC on guidance for doctors treating patients who may have been infected by the procedures.
"Because patients in Mexico, the United States, Canada, and Colombia were on the exposed list, we wanted to make sure these countries were aware, and provide such situational awareness, through a public health emergency of international concern," said Smith.
"Worried about a high mortality rate"
Investigators now believe that the two facilities, located near Mexico's border with Texas, had drawn patients from across the Americas for surgical procedures.
"There's these agents that act as recruiters in the U.S. for patients, they link U.S. 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, officials believe many had sought operations like liposuction, breast augmentation or Brazilian butt lifts.
Authorities have not yet confirmed the cause of the outbreak. Results from U.S. patients so far have been inconclusive for tracking down the fungus.
However, testing in Mexico has yielded positive results for a fungus known as Fusarium solani in samples of spinal cord fluid. This same kind of fungus was seen in a deadly outbreak that started late last year in the Mexican state of Durango which was also linked to surgeries.
"We are not sure if these two outbreaks are linked, but the fact that the same organism is most likely causing this fungal meningitis makes us worried about a high mortality rate. So that's why it's so important to get patients in early, even if they're asymptomatic," said Smith.
Medications used during anesthesia in the current outbreak may have been contaminated, Smith said, either in the epidural itself or in other medications that are added in conjunction during the surgeries like morphine.
"There's a shortage currently in Mexico, and there could be potential for a black market that could have contaminated medicine," said Smith.
Another theory is that there were lapses in infection control practices to prevent contamination during surgery, which is currently blamed for the other outbreak.
"The outbreak that we're experiencing now is pretty similar, and it has the capacity to have this high mortality rate, and just devastate families and communities," Smith said.