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Devastating Effects of Health Care-Associated Fusarium Solani Meningitis
Recent findings from physicians at UTHealth Houston have shed light on a life-threatening mold infection known as health care-associated Fusarium solani meningitis, revealing its potential for delayed but catastrophic damage to the brainstem and its blood supply among those affected.
Research and Analysis
A study published in the New England Journal of Medicine, led by Dr. Nora Strong and Dr. Luis Ostrosky-Zeichner, delved into the clinical presentation, disease progression, and treatment outcomes of 13 hospitalized patients across multiple medical centers. Dr. Strong, a postdoctoral fellow in infectious diseases, worked alongside Dr. Ostrosky, a distinguished professor of medicine and epidemiology at McGovern Medical School.
Between Jan. 1, 2023, and May 13, 2023, a surge of Fusarium solani meningitis cases emerged in two clinics in Matamoros, Tamaulipas, Mexico, impacting individuals with normal immune systems undergoing surgical procedures with epidural anesthesia. This concerning trend prompted the Centers for Disease Control and Prevention to issue a Health Alert Network Health Advisory on May 17, 2023, addressing the outbreak.
“The outbreak of this aggressive mold infection predominantly affected young, otherwise healthy individuals engaging in medical tourism,” remarked Dr. Strong. “Patients from Mexico and the U.S. encountered profound neurologic and vascular damage as a consequence of the infection, resulting in devastating outcomes.”
Nature of the Infection
Despite typically affecting severely immunocompromised patients, the 13 identified cases of fungal meningitis linked to epidural anesthesia procedures underscored the potential for direct inoculation of Fusarium species into the cerebrospinal fluid to trigger severe meningitis in previously healthy individuals, often leading to a distressingly high mortality rate.
Dr. Strong emphasized that all patients exhibited brainstem involvement with injuries extending to the basilar and vertebral arteries, which manifested insidiously at first but progressed over time. Consequently, several patients encountered vascular constrictions in critical brain blood vessels, culminating in strokes or severe hemorrhages that proved fatal for many.
Treatment and Clinical Outcomes
Of the 13 patients, nine succumbed to vessel injuries, while the remaining four underwent systemic antifungal therapy. Three patients continue on Fosmanogepix monotherapy—an experimental treatment for invasive mold infections—while one patient discontinued antifungal medication. A patient under therapy experienced abulia post-subarachnoid hemorrhage, while the other three showed no residual cognitive, sensory, or motor deficits following treatment.
Initial antifungal therapy showcased promising results in alleviating symptoms and normalizing cerebrospinal fluid parameters, but subsequent reports revealed a sudden deterioration indicative of rapid fungal growth resistant to conventional antifungal agents.