Certain fungal diseases are known to be dangerous and difficult to treat, and now a small number of suspected cases of fungal meningitis, a disease that affects the brain and spinal cord, has raised alarm in Texas. there is State and national health officials issued warnings last week about the cases, all of which are U.S. residents who recently underwent surgery in the Mexican city of Matamoros, which borders Brownsville, Texas, and are critically ill with the infection. He developed symptoms and was hospitalized. 1 person died.
Public health investigations in the state have so far identified at least five cases. All were Texas women in their 30s to 50s who had all undergone epidural surgery in Matamoros, an operation in which an anesthetic is injected around the spinal column. All surgeries were cosmetic surgery such as liposuction.
According to the Centers for Disease Control and Prevention, outbreaks of fungal meningitis are rare, but are known to occur after medical or surgical procedures. A recent alert from the Texas Department of Health (DSHS) said travelers began to develop symptoms anywhere from three days to six weeks after surgery. State health officials and the CDC will consider anyone who has had an epidural during a procedure in Matamoros after January 1 this year to monitor themselves for symptoms and see a healthcare provider. I recommend that you “Meningitis, especially when it is caused by bacteria or fungi, can be a life-threatening illness if not treated promptly,” DSHS Director Jennifer Schford said in a warning.
“This is a truly devastating disease,” says Jessica Brown, an associate professor of microbiology and immunology who studies the fungus that causes meningitis. Cryptococcus neoformans at the University of Utah. “This is tragic, but I hope the patients recover.”
The exact species of the infected person has not been identified, and the situation is being investigated by health officials in the Mexican state of Tamaulipas, where Matamoros is located. Two surgical clinics attended by tourists have been ordered to shut down.
Scientific American We further spoke with Brown about the causes of fungal meningitis, how it develops, how the infection is diagnosed and treated, and why infectious fungi are important pathogens to monitor.
[An edited transcript of the interview follows.]
What is fungal meningitis?
Fungal meningitis is an infection of the central nervous system. Although this is historically called fungal meningitis, it is usually more than just the meninges. [layers of thin tissue surrounding the brain]. Meningoencephalitis, severe inflammation and swelling of both the brain and meninges, is often the cause. So, not just a meningeal infection, but a hole in the brain as with encephalitis.
What causes illness?
Possible causes of fungal meningitis are Candida Not only seeds Aspergillus Race. coccidioides, the soil fungus that causes Valley fever can definitely cause meningitis. There are two other fungi that cause meningitis. Blastomyces, Fungi that live in moist soil and rotting wood, Histoplasma, It is found in soil as well as in bird and bat droppings. Blast Mrs. It’s been in the news lately because we have a big paper mill in Michigan. Blast Mrs. outbreak. The most common causes of fungal meningitis are Cryptococcus neoformans.Cryptococcus Seeds are believed to be present almost everywhere. It is commonly associated with pigeon guano and soil.
Candida It usually occurs naturally in the body and skin. Others are environmental microorganisms. Although we are regularly exposed in the environment, it causes lung infections initially and can spread to the brain in severe cases. Fungal infections of environmental origin are not transmitted from person to person. [Editor’s Note: Some fungi that cause superficial infections can pass from person to person, such as oral thrush, athlete’s foot and ringworm. Candida species also spread easily between people, often in hospitals and long-term care facilities.]
In the case of medical contamination, where drugs are injected directly into the spine, anything goes.After overcoming those walls [that usually protect the central nervous system and brain], many things grow worryingly well. A few years ago, an infection explosion occurred at a dispensing pharmacy. [a fungal] There was contamination and some of the drugs were spinal injections. That is, each individual patient was infected before arriving at the clinic where they were treated. Unusual, isn’t it? That clearly means that a full inspection is needed for such establishments.So maybe something similar [could have happened with the recent cases].
Be careful not to criticize a particular local healthcare product [and would] It just emphasizes the need for oversight. In a way it’s a tragedy that people are trying to get medical care outside of the United States, and in a way it could be an indication of the problem of paying for health care in the United States and how expensive it can be.
How is fungal meningitis diagnosed and treated?
Bacterial meningitis and viral meningitis are classically diagnosed by what is called Babinski’s sign. There are reflexes that connect different parts of the movement along the spine that are not normally connected. So when you bend your neck, your knees will also bend because the meninges are inflamed. Cryptococcal meningitis often does not have Babinski’s sign, so it can be difficult to diagnose. Patients often present with very severe headaches, possibly nausea, vomiting, fever, and photosensitivity, but often without the typical signs of meningitis.
We have very good diagnostic tests. Collect a small amount of cerebrospinal fluid from a spinal puncture and perform a lateral flow assay. This is very similar to a COVID-19 test. But that’s only if the doctor knows to look. If the patient isn’t looking for it, it’s very easy to miss because it seems like a very common symptom, such as a severe headache or fever. Missing this diagnosis can be fatal, as it is almost uniformly fatal without treatment. Treatment is an IV drug called amphotericin B, followed by oral antifungals in varying doses, usually for at least a year.treatment is universal [across fungal species] Because there are no really good antifungal drugs.
How do fungal species such as C. neoformans infect the brain?
It’s very difficult for things to get into the central nervous system, but when fungi bypass the central nervous system, there aren’t many barriers to growth. When humans inhale fungal cell spores from the environment, their viability is truly amazing.
Fungi must escape from the lungs, cross the blood-brain barrier, and enter a very tightly controlled area. And once there, it must grow further under oxygen and nutrient limitations. C. neoformans It grows very well, especially with inositol. [six-carbon] Sugar contained in cerebrospinal fluid. Therefore, once it invades the central nervous system, there are few ways to stop it. Fungi are very good masters, able to adapt and grow in these different environments.
One of the things we’ve been working on is studying the changes in cell shape, so-called morphology. Cells change into different sizes and shapes to facilitate their entry into these organs. And we’re trying to find out how. So there are all sorts of interesting shape changes and transformations. [gene regulation] These are important for environmental adaptation.
Who is at increased risk of developing serious illness from a fungal infection?
Globally, approximately 1.6 million people die annually from fungal infections. Fungal infections strike very vulnerable patients. Many fungal infections in the United States occur in patients receiving cancer chemotherapy that deplete the immune system. Solid organ transplant patients are also very vulnerable. Candida Meningitis is a big problem for premature babies. [Editor’s Note: Cryptococcal meningitis is also one of the leading causes of death in people with HIV/AIDS.] These patients had already undergone stressful treatments and then had completely devastating fungal infections. Medical costs increase due to secondary infections that are very expensive and difficult to treat. In most cases, these drugs are taken for a year, dramatically impacting the patient’s quality of life.
endemic bacteria such as coccidioides, Blast Mrs. and Histoplasma, They tend to attack economically vulnerable people. They are patients who can no longer afford to take, say, a year off from work to treat a fungal infection. Construction workers, gardeners and those who work outdoors for a living are most at risk. [because of higher potential exposure], But they are also financially vulnerable. It’s easy to ignore neglected people in society, but that doesn’t mean these things don’t affect us all. And if we really care about everyone’s health, we have to keep in mind that these diseases are a problem.
