Millions of people travel from the US to Mexico or distant destinations in search of medical care – either because the procedure is too expensive in this country, because they have relatives to help them abroad, there are long delays in receiving care, or the operation they are looking for is not available here. Many people become infected by this; some die.
Cases of fungal meningitis have been reported this month following cosmetic procedures, mainly liposuction, in two Matamoros clinics, the River Side Surgical Center and Clinica K-3. The surgeries used epidural (around the spine) injections for anesthesia. Patients developed headache and symptoms of meningitis such as confusion, light sensitivity, stiff neck and nausea or vomiting 2-4 weeks later. As of May 12, 2023, five patients have been diagnosed with fungal meningitis; 1 died. More infections are expected. The specific fungus has not yet been identified and studies are ongoing.
There was a similar outbreak of fungal meningitis last year Durango, Mexico. As of May 10, 80 people have developed meningitis after epidural anesthesia, most of them during childbirth. Eighty cases and 39 deaths have been identified. It is believed that an anesthetist supplying his own drugs from multidose vials is the likely source of infection. Fusarium solani, a soil fungus, was isolated from two patients.
A big one in the US outbreak of fungal meningitis in 2012 which was traced to epidural injections of a preservative-free steroid formulated by the New England Compounding Center (NECC). The multi-state outbreak included 749 reported cases in 20 states, leading to 61 deaths (8%).
Other infections from medical tourism
Most common destinations for medical tourism are Mexico, Thailand, India, Pakistan, Ecuador and the Caribbean.
Infections are the most common complication among medical tourists. These include not only “normal” surgical site infections, but also those with unusual organismsas carbapenem resistant Enterobacter (CRE) And Pseudomonas of operations in (Tijuana) Mexico and Q fever from Germany. Atypical mycobacteria (non-tuberculous or NTM) infections are mainly seen in surgeries in Latin America and Southeast Asia. Patients are also at higher risk of blood-borne infections such as hepatitis B or C, cytomegalovirus (CMV), or HIV due to inadequate infection control procedures.
Tips for travelers
In addition to surgical risks and complications, tourists are at risk of insect-borne infections such as malaria, dengue fever, chikungunya, Chagas disease and leishmaniasis, which can be endemic in parts of Latin America and Southeast Asia.
Before traveling for medical care, you should be up to date on vaccinations (e.g. hepatitis, tetanus) and seek advice on precautions for your destination country, such as the need for anti-malarials. A travel consultation should take place at least two months before departure to allow time for vaccinations. Try to arrange for care from facilities that are internationally recognized and from board-certified surgeons or health care providers (although this does not guarantee success). Several general and plastic surgery associations should have information about providers.
Patients seeking an organ transplant abroad are at particular risk. This review offers specific advice for these travelers.
Please note that counterfeit medicines are common in some countries. For example, try to get anti-malarials from the US.
If you have an infection or other problem when you return, be sure to give your doctor a travel history so they can be aware of the need for any special cultures or tests.
The CDC advises that anyone who has had epidural anesthesia in Matamoros since January 2023 and develops symptoms of meningitis should be seen urgently and notify the doctor of the procedure and travel. This allows proper cultures and tests to be performed and specific antifungal treatment to be initiated.
Higher costs and better availability of procedures are driving some patients to seek care abroad. This is not without risk, but there are steps you can take to make your choice safer.