Suspected Fungal Meningitis Outbreak Associated with Procedures Performed under Epidural Anesthesia in Matamoros, Mexico

CDC is collaborating with the Mexican Ministry of Health and U.S. state and local health departments to respond to an outbreak of suspected fungal meningitis among patients who had surgical procedures under epidural anesthesia in Matamoros, Tamaulipas, Mexico. Officials have identified two clinics associated with the outbreak, River Side Surgical Center and Clinica K-3. These clinics were closed on May 13, 2023.

CDC is working with 24 states and local health departments to contact people in the United States with potential exposure and advise them to go to their nearest health center, urgent care, or emergency room for diagnostic testing for meningitis. Testing includes an MRI and a lumbar puncture (LP), also called a spinal tap.

Given the binational collaboration, the Mexican Ministry of Health shared with CDC a list of 221 U.S. patients who might be at risk for meningitis based on their recorded surgical procedures at either River Side Surgical Center or Clinica K-3 from January 1 to May 13, 2023. After further investigation, CDC and partners found that 6 of the 221 listed patients did not have epidural anesthesia, and therefore are not considered at risk. CDC and partners also identified five additional patients with potential exposure who were not on the original list. With these findings, an overall total of 220 people in the United States are known to have potential exposure.

Information for Patients

If you had epidural anesthesia in Matamoros, Mexico, at River Side Surgical Center or Clinica K-3 from January 1 to May 13, 2023:

• You should go to the nearest health center, urgent care, or emergency room as soon as possible to be evaluated for fungal meningitis, even if you do not currently have symptoms.
• When you arrive, tell triage and emergency room staff and healthcare providers that you need to be evaluated for possible fungal meningitis. Inform them that you recently had epidural anesthesia at one of the clinics in Mexico involved in this outbreak.
  • Inform the staff and your healthcare provider that CDC recommends you undergo a lumbar puncture (LP) and a MRI, even if you do not have fungal meningitis symptoms.
  • Consider printing and sharing this web page to help make sure staff and healthcare providers are aware of the situation.

What to Expect

• Health center, urgent care, emergency room healthcare providers will order an MRI scan of your head to look for evidence of infection or complications of meningitis.
• Healthcare providers will perform a spinal tap by inserting a needle into your lower back in a space around your spine to collect fluid for laboratory testing. This is recommended even if you do not currently have symptoms.
• The fluid will be tested in a laboratory to determine if you have fungal meningitis.
• If you test positive for infection: your healthcare team will treat you with antifungal medicines. It is possible that you will need to take antifungal medicine for several months to completely cure the infection.
• If you test negative for infection: continue to watch for symptoms for at least 4 weeks.
  • It is possible to test negative at first but still develop meningitis. Return to the emergency room if you develop new or worsening symptoms.
  • If you remain without symptoms, some clinicians may recommend repeating the spinal tap around 2 weeks after your first spinal tap to ensure that you have not developed an infection.

U.S. Cases under Investigation, Case Counts, and Deaths as of 5/26/23

¹ Meningitis symptoms include fever, headache, stiff neck, nausea, vomiting, photophobia, and altered mental status.

² Cerebrospinal fluid (CSF) profile with >5 WBCs/mm³, accounting for the presence of red cells (i.e., subtracting 1 white cell for every 500 RBCs present).

³ Fungus could be detected by culture, polymerase chain reaction (PCR) testing, or metagenomic next generation sequencing (mNGS) testing of CSF or tissue.

⁴ Both patients who died were classified as having probable cases.

Current Outbreak Response Status and Activities

• CDC is aware of at least 220 people in 24 U.S. states and jurisdictions who had epidural anesthesia at River Side Surgical Center and Clinica K-3 in Matamoros, Mexico, from January 1 to May 13, 2023, and who might therefore be at risk for developing meningitis.
• State and local health departments are directly contacting people who are known to have had procedures at these two clinics since January 2023 with instructions to go to their nearest health clinic, urgent care, or emergency room for diagnostic testing including an MRI and a spinal tap.

Continued Investigations

• CDC and partners are investigating which organism(s) is causing the outbreak. A fungal infection is suspected based on elevated cerebrospinal fluid (CSF) and serum levels of the fungal biomarker (1,3)-beta-D-glucan in several patients.
• The Mexican national laboratory (InDRE) has reported that 4 patients in Mexico have had spinal fluid test positive by a DNA test for the fungus Fusarium solani.
• CDC and partners are investigating to determine how people were exposed to the infectious organism(s) during the procedures.
• Officials are investigating whether any additional clinics were involved.

Information for Healthcare Providers

• Interim recommendations for diagnosis and management of cases of suspected fungal meningitis associated with epidural anesthesia administered in Matamoros, Mexico, are available at this website: Interim Recommendations.
  • The document provides diagnostic and management recommendations for clinicians caring for patients who underwent a procedure under epidural anesthesia in the city of Matamoros.
  • These recommendations are based on the clinical experience and expert opinion of clinicians caring for patients during the current outbreak or during previous outbreaks of healthcare-associated fungal meningitis in Durango, Mexico, and the United States.

This page will be updated as new information becomes available.

Information for Health Departments

• CDC has notified states and local jurisdictions where any patients live who were listed by the Mexican Ministry of Health as potentially at risk.
• Health departments are notifying patients and telling them to seek care (or be evaluated).
• CDC developed resources to assist with patient notification.
• Health departments can email CDC at fungaloutbreak@cdc.gov for resources and additional support.
• For more information about medical tourism and risk mitigation, see CDC Yellow Book 2024: Medical Tourism or contact medicaltourism@cdc.gov.

What CDC Is Doing

• Published a Travel Health Notice on May 16, 2023.
• Distributed a Health Alert Notice (HAN) Health Advisory on May 17, 2023
• Collaborated with the Mycoses Study Group to develop Interim Recommendations
• Coordinating and performing specimen testing.
• Continuing to investigate the source of the outbreak with colleagues in Mexico.
• Disseminating information and strategic outreach to clinicians, the public, and partners.
• Providing technical, diagnostic, and clinical advice as requested.