News Flash

June 1, 2023

Action Requested 

• Be aware that patients who underwent medical or surgical procedures under epidural anesthesia in Matamoros, Mexico, and who have developed signs or symptoms of possible meningitis (e.g., fever, headache, stiff neck, nausea, vomiting, photophobia, altered mental status) should promptly seek evaluation by a healthcare provider and convey that medical history.
• For patients who underwent a medical or surgical procedure under epidural anesthesia in Matamoros, Mexico, after January 1, 2023, and who have developed symptoms consistent with fungal meningitis, perform brain imaging (i.e., computerized tomography [CT] or magnetic resonance imaging [MRI]) and a diagnostic lumbar puncture (LP) unless contraindicated (e.g., because of skin infection over the puncture site or a brain mass causing increased intracranial pressure). 
  • Some patients with fungal meningitis may initially present with mild or non-specific symptoms. Healthcare providers should have a low threshold for performing brain imaging and LP.
• Consider ordering bacterial and fungal cultures of CSF fluid, as well as serum and CSF levels of (1,3)-beta-D-glucan. Healthcare providers can consider ordering other diagnostic tests including serum and CSF Aspergillus galactomannan and fungal polymerase chain reaction (PCR) testing.
• If fungal meningitis is suspected, treatment should be initiated as soon as possible after obtaining CSF; treatment should not be withheld because of negative fungal culture or (1,3)-beta-D-glucan results. Consultation with an infectious disease specialist is recommended. 
  • Treatment should involve broad-spectrum antifungal medications that have adequate central nervous system penetration. Dual agent antifungal therapy can be considered and has been used in previous fungal meningitis outbreaks. 
• Although vaccines are available to prevent certain types bacterial and viral meningitis, no vaccine is available to prevent fungal meningitis.
• Healthcare providers should immediately report suspected fungal meningitis cases in Snohomish County to the Snohomish County Health Department.

• Call 425-339-3503 to reach the Communicable Disease program by phone.
• Please complete and fax the Communicable Disease Report Form (PDF) and any accompanying lab reports to 425-339-8706. 

See full HAN alert for more information

Resources

• Meningitis (CDC)

• Fungal meningitis (CDC)
• Mexico Traveler Health
• Medical Tourism: CDC Yellow Book 2024
• Fungal Infections Following Surgical Procedures in Mexico - Alert - Level 2, Practice Enhanced Precautions - Travel Health Notices | Travelers' Health | CDC