Becker's Clinical Quality & Infection Control

7 INFECTION CONTROL 'Nobody knows why': Neurovascular complications arise in fungal meningitis outbreak By Paige Twenter P hysicians are noting brain blood vessel issues and recurrence among the dozens of people who contracted fungal meningitis linked to two cosmetic clinics in Mexico, NBC News reported July 3. The outbreak was made public in May after one patient died. Since then, the CDC has reported six more deaths, and health departments are monitoring about three dozen cases of Fusarium solani. Most of the patients are young women who received cosmetic surgery procedures between Jan. 1 and May 1 at the now-closed clinics. Jose Campo Maldonado, MD, an infectious disease specialist at Harlingen, Texas-based Valley Baptist Medical Center, told NBC News nearly all of the infected patients have neurovascular complications, including spasms of brain arteries and mycotic aneurysms. Many of the fungal meningitis outbreak patients at Valley Baptist Medical Center were showing improvement after being treated — which takes three to six months — before their condition worsened, physicians told the news outlet. "It looks like a stroke where they suddenly can go unconscious," said James Castillo, MD, health authority for Cameron County, Texas, told NBC News. "For some reason, the aneurysms and the spasms are all happening around the brainstem, but nobody knows why it's happening." The complications are leading to permanent vision loss and hydrocephalus in some patients. n to spend more time indoors, which could give COVID-19 more opportunities to spread. But correlations do not spell causation, and experts are encouraging caution before making the link of air-conditioned gatherings to the recent upward swing of COVID-19 cases. Michael Osterholm, PhD, director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis, told Bloomberg he has been critical of reasoning that attributes COVID-19 surges to changes in human behavior and there is more to learn about the ecology of viruses. For instance, even when COVID-19 cases increased in the winter, they oen declined well before the weather changed enough to allow more outdoor activities. ere is also a data vacuum, with little evidence that people are spending much more time indoors now than they were in spring, or evidence that most people ever spend enough time outside to affect the global patterns of respiratory viruses. Access to COVID-19 vaccines has been reduced as the U.S. stopped purchasing them from drugmakers for the public, and protection is waning for those who were immunized months ago — whether through vaccination or contracting the virus. e new COVID-19 strain, EG.5, recently became the most prevalent in the U.S., but there's no evidence that it spreads more easily than its predecessors, a CDC spokesperson told Bloomberg. More broadly, it's not clear whether COVID-19 will continue to tick upward every summer. 2023 marks the fourth year it's done so, but it's possible that waning immunity and new variants have created the appearance of a pattern. n US confirms 1st local malaria cases since 2003 By Paige Twenter T wenty years aer the U.S. noted eight locally acquired malaria cases, Florida has confirmed four malaria infections and Texas has seen one in june, the CDC said June 26. e CDC is working with the two state governments to investigate the locally acquired mosquito-transmitted Plasmodium vivax malaria cases, and the agency said the cases in the two states are not related. e last time the U.S. reported local malaria cases was 2003, when eight infections were found in Palm Beach County, Fla. For the four recent cases in Sarasota County, Fla., all individuals have been treated and have recovered, the state's health department said June 26. In Texas, a malaria case was detected in a person who works outdoors in Cameron County, the Texas Department of State Health Services said June 23, and the patient has received treatment and is improving, according to the CDC. Texas has not reported a locally acquired malaria case since 1994. For one of the Florida cases, the CDC said June 2 it was collaborating with the state's health department and "conducted both aerial and truck spraying in the general area where the individual lives" for the "sporadic local case of malaria." e risk of locally acquired malaria remains extremely low, according to the CDC. e agency recommends clinicians "consider the diagnosis of malaria in any person with a fever of unknown origin, regardless of international travel history, particularly if they have been to the areas with recent locally acquired malaria." Hospitals are advised to stock malaria diagnostic tests, intravenous artesunate, artemether-lumefantrine and atovaquone-proguanil. If malaria is le untreated, the illness can "progress to severe disease, a life-threatening stage, where mental status changes, seizures, renal failure, acute respiratory distress syndrome and coma may occur," the CDC said. n

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