3
|
Becerril-Gaitan A, Bindal S, Parker SL, Mullarkey MP, Zeineddine HA, Chen JM, Choi HA, Chen PR, Blackburn S, Day A, Torres LF, Brown RJ, Bowry R, Chen CJ. Cerebrovascular Complications Associated With Iatrogenic Fungal Meningitis Following Surgical Procedures in Mexico. Stroke 2024; 55:177-181. [PMID: 38018835 DOI: 10.1161/strokeaha.123.044768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/26/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The current fungal meningitis outbreak caused by contaminated epidural anesthesia with Fusarium solani among patients who underwent surgical procedures in Matamoros, Mexico remains a cause of concern. Its association with an increased susceptibility for cerebrovascular complications (CVC) has not been reported. This single-center study describes 3 patients with a unique pattern of CVC attributed to fungal meningitis. METHODS A retrospective case series of patients diagnosed with fungal meningitis following surgical procedures under contaminated epidural anesthesia who developed a unique pattern of CVC during their hospitalization. RESULTS Three female patients (mean age, 35 years) with CVC due to iatrogenic fungal meningitis were included. Positive Fungitell β-D-glucan assay in cerebrospinal fluid was documented in all cases, and F. solani was confirmed by polymerase chain reaction in case 3. All cases were complicated by severe vertebrobasilar circulation vasculopathy and arterial dissections with resultant subarachnoid hemorrhage and intraventricular hemorrhage, ultimately leading to patients' death. CONCLUSIONS The death toll from the ongoing fungal meningitis outbreak keeps rising, underscoring the need for early recognition and aggressive treatment. We highlight the risk for vertebrobasilar circulation CVC among these patients. The angioinvasive nature of F. solani is yet to be clarified; however, a clear pattern has been observed. Public health awareness should be raised and a strong response should be pursued.
Collapse
Affiliation(s)
- Andrea Becerril-Gaitan
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Shivani Bindal
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Samantha L Parker
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Matthew P Mullarkey
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Hussein A Zeineddine
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | | | - Huimahn A Choi
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Peng R Chen
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Spiros Blackburn
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Arthur Day
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Luis F Torres
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Robert J Brown
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Ritvij Bowry
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Ching-Jen Chen
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| |
Collapse
|
4
|
Wang JEH, Tsai SJ, Wang YP, Chen TJ, Wang TJ, Chen MH. Bacterial Pneumonia and Stroke Risk: A Nationwide Longitudinal Followup Study. Curr Neurovasc Res 2024; 20:578-585. [PMID: 38288840 DOI: 10.2174/0115672026280736240108093755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 07/16/2024]
Abstract
BACKGROUND Pneumonia causes significant morbidity and mortality and has been associated with cardiovascular complications. Our study aimed to investigate the incidence of ischemic and hemorrhagic strokes following bacterial pneumonia. METHODS Between 1997 and 2012, 10,931 subjects with bacterial pneumonia and 109,310 controls were enrolled from the Taiwan National Health Insurance Research Database, and were followed up to the end of 2013. The risk of stroke was estimated in Cox regression analyses with hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS When compared to the control group, subjects in the bacterial pneumonia group had a higher incidence of developing ischemic stroke (2.7% versus 0.4%, p <0.001) and hemorrhagic stroke (0.7% versus 0.1%, p <0.001). The risk of stroke increases with repeated hospitalizations due to bacterial pneumonia. Across bacterial etiologies, bacterial pneumonia was a significant risk factor among 775 subjects who developed ischemic stroke (HR, 5.72; 95% CI, 4.92-6.65) and 193 subjects who developed hemorrhagic stroke (HR, 5.33; 95% CI, 3.91-7.26). CONCLUSION The risks of developing ischemic stroke and hemorrhagic stroke are significant following bacterial pneumonia infection. The risk factors, clinical outcomes, and the disease course should also be profiled to better inform the monitoring of stroke development and the clinical management of bacterial pneumonia patients.
Collapse
Grants
- V111C-010, V111C-040, V111C-029, V112C-033, V113C-010, V113C-011, V113C-039 Taipei Veterans General Hospital
- CI-109-21, CI-109-22, CI-110-30, CI-113-30, CI-113-31, CI-113-32 Yen Tjing Ling Medical Foundation
- MOST110-2314-B-075-026, MOST110-2314-B-075-024 -MY3, MOST 109-2314-B-010-050-MY3, MOST111-2314-B-075 -014 -MY2, MOST 111-2314-B-075 -013, NSTC111-2314-B-A49-089-MY2 Ministry of Science and Technology, Taiwan
- VTA112-V1-6-1, VTA113-V1-5-1 Taipei, Taichung, Kaohsiung Veterans General Hospital, Tri-Service General Hospital, Academia Sinica Joint Research Program
- VGHUST112-G1-8-1, VGHUST113-G1-8-1 Veterans General Hospitals and University System of Taiwan Joint Research Program
Collapse
Affiliation(s)
- Joyce En-Hua Wang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Georgetown University School of Medicine, Washington, DC, USA
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Po Wang
- Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Endoscopy Center for Diagnosis of Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tso-Jen Wang
- Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, 33058, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|