Investigational antifungal added to recommendations following fungal meningitis outbreak

October 05, 2023

2 min read

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Disclosures:
Smith reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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Key takeaways:

• As of late September, 24 cases and 12 deaths have been reported in the outbreak.
• No new cases or deaths have been reported in the last 30 days.

Investigational antifungal fosmanogepix has been added as a first-line treatment in recommendations penned following the emergence of an ongoing fungal meningitis outbreak, researchers said.

“Public health authorities continue to respond to a multinational outbreak of fungal meningitis among people who had procedures under epidural anesthesia in Matamoros, Tamaulipas, Mexico,” Dallas J. Smith, PharmD, epidemiologist in CDC’s Mycotic Diseases Branch, told Healio. “This update on the ongoing fungal meningitis outbreak was published to raise awareness of patient complications and interim diagnostic and treatment recommendations.”

Smith DJ, et al. Clin Infect Dis. 2023;doi:10.1093/cid/ciad570.

The outbreak began on May 8, 2023, when CDC learned of two patients in Texas with suspected fungal meningitis after undergoing procedures under epidural anesthesia in Matamoros, Tamaulipas, Mexico. In the following data, CDC and the Texas Department of Health and Human Services identified additional suspected cases among Texas residents, prompting an investigation done in partnership with Mexican Health Authorities. The investigation led to the closure of two clinics in Matamoros — River Side Surgical Center and Clinica K-3.

By July 7, 2023, the investigation evolved into a multistate and multinational fungal meningitis outbreak, with a total of 185 residents in 22 U.S. states and jurisdictions identified as being at risk of fungal meningitis because they received epidural anesthesia at either of the two closed clinics.

According to Smith, as of late September, 24 cases had been confirmed and 12 deaths were reported. He added, though, that no new cases or deaths had been reported for 30 days.

The investigation revealed that Fusarium solani species complex was the cause of the outbreak and, according to CDC, optimal therapy for patients with F. solani fungal meningitis infections has not been established. Through this investigation, though, Smith and colleagues developed interim recommendations.

These recommendations include treatment with fosmanogepix, a new antifungal still in clinical trials, as a first-line treatment option. Patients who had procedures under epidural anesthesia at the two closed clinics between Jan. 1 and May 13, 2023, should also receive a lumbar puncture regardless of if they are experiencing symptoms of meningitis. Smith said this is because past outbreaks have shown that patients who were started on treatment early, even those without symptoms, had better outcomes.

Finally, to test for a fungal cause, the recommendations suggest obtaining a beta-d-glucan level in the cerebrospinal fluid and that doctors test for that level if the patient has an abnormal lumbar puncture. Smith explained that beta-d-glucan has rapid results and is highly accurate, which would allow doctors to start fungal therapy early.

“Fungal meningitis is a very serious disease, with a case-mortality rate of 50% in this outbreak,” Smith said. “Clinicians should ask about a patient’s medical tourism history and symptoms of meningitis to prevent delayed diagnoses.”

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