Cars Entering Mexico at Border (Photo by David Butow/Corbis via Getty Images)
Millions of people travel from the US to Mexico or far-off destinations seeking medical care—either because the procedure is too expensive in this country, they have family to help them overseas, there are long delays in receiving care, or the operation they seek is not available here. Many people become infected doing so; some die.
This month, cases of fungal meningitis have been reported following cosmetic procedures, primarily liposuction, in two Matamoros clinics, the River Side Surgical Center and Clinica K-3. The operations used epidural (around the spine) injections for anesthesia. Patients developed headaches 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 suspected fungal meningitis; 1 died. More infections are expected. The specific fungus has not yet been identified, and investigations are ongoing.
There was a similar fungal meningitis outbreak over the past year in Durango, Mexico. As of May 10, 80 people have developed meningitis following epidural anesthesia, most of them during deliveries. Eighty cases and 39 deaths have been identified. It is thought that an anesthesiologist supplying his own drugs from multi-use vials is the likely source of infection. Fusarium solani, a soil fungus, was isolated from two patients.
In the US, a large outbreak of fungal meningitis in 2012 which was traced to epidural injections of a preservative-free steroid compounded 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
The most common destinations for medical tourism include Mexico, Thailand, India, Pakistan, Ecuador and the Caribbean.
Infections are the most common complication among medical tourists. These include not only “normal” post-operative wound infections but also those with unusual organisms, such as carbapenem-resistant Enterobacter (CRE) and Pseudomonas from surgeries in (Tijuana) Mexico and Q fever from Germany. Atypical mycobacteria (nontuberculous, or NTM) infections are primarily seen from 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 from inadequate infection control procedures.
Tips for travelers
In addition to surgical risks and complications, tourists are at risk from insect-borne infections such as malaria, dengue fever, chikungunya, Chagas disease, and leishmaniasis, which may be endemic in parts of Latin America and Southeast Asia.
Before you travel for medical care, be up to date on immunizations (e.g., hepatitis, tetanus) and seek advice for precautions for your destination country, such as the need for antimalarials. A travel consultation should occur at least two months before travel to allow time for vaccinations. Try to arrange care at facilities that are internationally accredited and from certified surgeons or providers (although this is not a guarantee of success). Various general and plastic surgery societies should have information available about providers.
Patients seeking organ transplants abroad are at particular risk. This review offers specific advice for these travelers.
Be aware that counterfeit medications are common in some countries. Try to take antimalarials from the US, for example.
If you have an infection or other problem when you return, be sure to give your physician a travel history so they can be aware of the need for special cultures or tests.
The CDC is advising that anyone who has had an epidural anesthesia done in Matamoros since January 2023 and that develops meningitis symptoms be seen urgently and notify the physician of the procedure and travel. This will enable the appropriate cultures and testing to be done and specific antifungal treatment to be started.
Higher costs and better availability of procedures drives some patients to seek care overseas. This is not without risk, but there are steps you can take to make your choice safer.