Evidence map›Paper›PMID 40696772›Full record

ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2026

Fungal Meningitis in US Patients Who Received Epidural Anesthesia in Matamoros, Mexico.

Dallas J Smith, Elizabeth Misas, Jeremy A W Gold, Nicole Evert, Thi Dang, Emilie Prot, Simone Godwin, JulieAnna Rivas, Jessica Pearson, Lori Koenecke and 20 more

Abstract read
In one paragraph

Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. New Perspectives on Antimicrobial Agents: Fosmanogepix.Antimicrobial agents and chemotherapy · 2026
    Review
  2. Article
  3. Invasive Fusariosis-Time to Break the Mold.Transplant infectious disease : an official journal of the Transplantation Society
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

30 authors.

Dallas J SmithMycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.ORCID 0000-0001-5707-528X
Elizabeth MisasMycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.ORCID 0000-0001-6243-7716
Jeremy A W GoldMycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.ORCID 0000-0002-5054-7616
Nicole EvertTexas Department of State Health Services, Austin, Texas, USA.ORCID 0009-0000-3072-0461
Thi DangTexas Department of State Health Services, Austin, Texas, USA.ORCID 0009-0009-6156-0240
Emilie ProtTexas Department of State Health Services, Austin, Texas, USA.
Simone GodwinTennessee Department of Health, Nashville, Tennessee, USA.ORCID 0009-0009-9591-7279
JulieAnna RivasArizona Department of Health Services, Phoenix, Arizona, USA.
Jessica PearsonMissouri Department of Health and Senior Services, Raytown, Missouri, USA.
Lori KoeneckeSouth Dakota Department of Health, Pierre, South Dakota, USA.
Nirma D BustamanteDivision of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.ORCID 0000-0002-0282-544X
Maria Julia MarinissenUS Section, US-Mexico Border Health Commission, US Department of Health and Human Services, Health Attaché, US Embassy-Mexico City, Washington, DC, USA.
Gabriel Garcia RodriquezEpidemiology, Ministry of Health Mexico, Mexico City, Mexico.
Irma López-MartínezDiagnosis and Reference, Institute of Diagnostic and Epidemiological Reference "Dr. Manuel Martínez Báez" (InDRE), Ministry of Health, Mexico City, Mexico.
Caitlyn LutfyMycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Samantha WilliamsMycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Axel A Vazquez DeidaEpidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.ORCID 0000-0002-5949-1460
Katrina M ByrdDivision of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.ORCID 0000-0001-5678-480X
Julian A VillalbaInfectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.ORCID 0000-0001-9230-8747
Sarah Reagan-SteinerInfectious Diseases Pathology Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Lindsay ParnellMycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Lalitha GadeMycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.ORCID 0000-0002-9264-9952
Romney M HumphriesPathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Nathan P WiederholdDepartment of Pathology and Laboratory Medicine, The University of Texas Health Science Center, San Antonio, Texas, USA.ORCID 0000-0002-2225-5122
Charles Y ChiuDepartment of Laboratory Medicine and Medicine, Division of Infectious Diseases, University of California San Francisco Medical Center, San Francisco, California, USA.
Joshua A LiebermanDepartment of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, Washington, USA.ORCID 0000-0002-0376-1337
Anastasia P LitvintsevaMycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Tom ChillerMycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.ORCID 0000-0002-2251-8033
Luis Ostrosky-ZeichnerDivision of Infectious Diseases, McGovern Medical School, Houston, Texas, USA.ORCID 0000-0002-4784-7589
Fungal Meningitis Response Team

Funding

NCATS NIH HHSNIH HHSUTHealth-CCTS UL1TR003167
6 · The paper itself

Abstract

backgroundFungal meningitis outbreaks are rare and entail high mortality rates. Beginning May 2023, we investigated fungal meningitis caused by Fusarium solani species complex occurring in US patients who received epidural anesthesia in Matamoros, Mexico.

methodsEarly epidemiological information suggested US patients with suspected fungal meningitis had undergone mostly cosmetic procedures under epidural anesthesia performed in 2 Matamoros clinics. US patients known to have received surgery at these clinics during 1 January-13 May 2023 (clinic closures date) were identified and notified by public health officials. Epidemiological and clinical data were used to update diagnostic and clinical guidance for outbreak response, including use of the experimental antifungal fosmanogepix. Whole-genome sequencing was conducted on outbreak isolates.

resultsUS public health officials attempted to contact 233 potentially exposed US residents who underwent surgeries, mostly cosmetic, in Mexico, reaching 170 (73%). Of those, 104 (61%) reported receiving epidural anesthesia and were therefore considered potentially at risk of fungal meningitis. At least 30/104 (29%) at-risk patients received a diagnostic lumbar puncture; 24 (23 women, 17 Hispanic or Latino) were diagnosed with fungal meningitis, and 6 were not. Twelve (50%) with fungal meningitis died. All cases involved epidural anesthesia administered by the same anesthesiologist in Mexico. Whole-genome sequencing showed that patient isolates of Fusarium from the 2 implicated clinics in Matamoros, Mexico, were genetically closely related.

conclusionsClinicians should maintain suspicion for fungal meningitis in patients with negative bacterial culture, viral culture, and molecular testing with a history of epidural anesthesia for any reason.

Indexed as

Anesthesia, EpiduralFusariumMeningitis, FungalAdolescentAdultAgedChildChild, PreschoolDisease OutbreaksFemaleHumansMaleMexicoMiddle AgedUnited StatesWhole Genome Sequencingfungal meningitisFusariummedical tourismoutbreak

Identifiers

PMID40696772
PMCPMC13017540

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.