By Dominique Mosbergen

U.S. officials said they are contacting people who recently underwent cosmetic procedures at two clinics in Mexico tied to a suspected outbreak of fungal meningitis that has killed two and sickened dozens.

All of the infected people received epidural anesthesia during surgical procedures including liposuction and breast augmentation at one of two clinics in Mexico near the Texas border, the Centers for Disease Control and Prevention said.

“We don’t want people who were possibly exposed to wait,” said Dr. Tom Chiller, head of the CDC’s fungal-disease branch.

One of the people who died was an otherwise healthy woman in her early 30s, Chiller said. She developed a headache shortly after returning to Houston from Mexico and was later hospitalized with fever and other meningitis symptoms, he said. She was diagnosed after death with a probable case of fungal meningitis, in which a fungal infection causes swelling of the protective membranes covering the brain and spinal cord.

The other person who died was a woman in her early 50s, Chiller said. Both women had undergone cosmetic surgery including liposuction before their deaths.

Severe fungal disease is a growing threat in the U.S. and globally. At least 7,199 people died from fungal infections in the U.S. in 2021, the CDC said, a 50% increase from 2018.

At least 220 people in 24 states and Washington, D.C., are at risk of fungal meningitis after receiving epidural anesthesia during recent procedures at Clinica K-3 or River Side Surgical Center in Matamoros, Mexico, the CDC said. The clinics, across the border from Brownsville, Texas, were closed by officials in Mexico on May 13.

CDC officials said a component of the epidural anesthesia, which is injected near the spinal cord, could have been contaminated. Poor infection control practices could also have caused the outbreak, officials said. At least 11 people in the U.S. have been diagnosed with probable fungal meningitis and 14 have suspected cases of infection, the CDC said. Most of the cases have involved women but at least one man has been diagnosed with a probable case of meningitis, the agency said.

People who had epidural anesthesia at either of the two clinics between January and mid-May should immediately see a doctor to be evaluated for fungal meningitis even if they don’t have symptoms, the CDC said. Fungal meningitis symptoms include fever, headache and nausea, which can develop days to weeks after infection. The CDC said states have been provided with lists of at-risk patients.

“Getting treatment on board early is key,” Chiller said.

Officials were investigating whether the outbreak was connected to a spate of fungal meningitis cases that started in Durango, Mexico, in November. The earlier outbreak was also linked to epidural anesthesia, said Dallas Smith, a CDC epidemiologist. At least 80 people were sickened with fungal meningitis in the Durango outbreak and almost half of them died.

The fungus Fusarium solani was identified as a possible culprit in the Durango outbreak, Smith said. U.S. officials are still investigating the cause of the current outbreak, but Mexican officials said Fusarium solani had been isolated in the spinal fluid of four patients there. Meningitis caused by Fusarium solani is rare and very difficult to treat effectively, infectious-disease specialists said.

“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,” Smith said.