Cameron County Public Health, the Texas Department of State Health Services (DSHS), and the Centers for Disease Control and Prevention (CDC) are investigating an outbreak of fungal meningitis among patients hospitalized in Texas after undergoing cosmetic procedures involving epidural anesthesia in Matamoros, Mexico. This is an evolving situation and public health authorities are actively working to determine the source causing the outbreak and the routes of exposure.

DSHS is issuing this Health Alert to ask Texas healthcare providers to consider fungal meningitis in the differential diagnosis for individuals who:

  • Traveled to Matamoros, Mexico, in 2023 to undergo a medical or surgical procedure involving epidural anesthesia, and who have developed headaches and any of the following symptoms consistent with fungal meningitis:
    – Fever ≥ 101°F (38.3°C)
    – Stiff neck
    – Nausea/vomiting
    – Photophobia (sensitivity to light)
    – Confusion, disorientation, or another form of altered mental status

These individuals should promptly seek evaluation by a healthcare provider or visit the nearest emergency room.


The organism causing the outbreak is currently unknown, but current clinical findings suggest the infection is fungal. The individuals affected received medical procedures at a minimum of two clinics in Matamoros, Mexico, namely River Side Surgical Center and Clinica K-3. As the investigation progresses, there is a possibility of discovering additional clinics involved.

On May 23rd, DSHS was notified of seven cases among Texas residents, all of which have been hospitalized. Since then, six Texas residents have passed away. The cases span a range of ages from 20s to early 50, and the majority of the affected individuals are women.

As part of the collaboration between the United States and Mexico, the Mexican Ministry of Health provided the CDC with a list of U.S. residents who underwent procedures at River Side Surgical Center or Clinica K-3 between January 1st and May 13th, 2023. The CDC, along with state and local health departments, is actively working to contact all individuals who may have been exposed and advising them to visit the nearest emergency room for diagnostic testing for fungal meningitis. The testing procedure involves a lumbar puncture (LP), also known as a spinal tap.

Through public health investigations, outreach efforts, social media, and information shared by family and friends, additional individuals who may have been exposed but were not initially included on the original list are being identified and contacted.



If you received epidural anesthesia in Matamoros, Mexico, specifically at River Side Surgical Center or Clinica K-3 between January 1st and May 13th, 2023, please take note of the following important information:

  • Symptoms of fungal meningitis include fever, headache, stiff neck, nausea, vomiting, sensitivity to light, and confusion.

  • The onset of symptoms can be delayed by several weeks, and they may initially be mild or even absent. However, once symptoms begin, they can rapidly escalate and pose a severe, life-threatening risk.

  • Some individuals without symptoms or with mild symptoms have tested positive for the infection and commenced treatment. Early treatment can help prevent severe illness.

  • It is crucial to visit the nearest emergency room promptly, even if you currently do not exhibit any symptoms, for an evaluation regarding fungal meningitis.

  • Consider contacting your local health center or urgent care facility to inquire if they can perform spinal taps. In most cases, the emergency room will be the most suitable or only option for testing.

  • Upon arrival at the emergency room, inform the staff that you need to undergo evaluation for possible fungal meningitis and specify that you recently received epidural anesthesia at one of the implicated clinics in Mexico.



Healthcare providers should consider the following diagnostic tests:

  1. Lumbar puncture (unless contraindicated).
  2. Brain imaging, preferably an MRI with and without contrast.
  3. Bacterial and fungal culture of cerebrospinal fluid (CSF).
  4. Serum and CSF levels of (1,3)-beta-D-glucan.
  5. Serum and CSF Aspergillus galactomannan.
  6. CSF and/or tissue for pan-fungal polymerase chain reaction (PCR) testing.

If you receive a positive infection diagnosis, your healthcare team will provide antifungal treatment in the hospital for a minimum of 2 weeks. Following discharge, you will need to continue taking antifungal medication for 3-6 months to completely eradicate the infection.

If you receive a negative lumbar puncture result, your healthcare provider will request a follow-up after 2 weeks. Please continue to monitor your symptoms and return for a second series of diagnostic testing.

It is possible to test negative during the early stages, known as a false negative. If you experience new or worsening symptoms, it is essential to return to the emergency room as soon as possible.

Be vigilant for symptoms for at least 30 days after the initial spinal tap.



Healthcare providers should include fungal meningitis in the list of possible diagnoses for patients who traveled to Matamoros, Mexico in 2023 for a medical or surgical procedure involving epidural anesthesia and are displaying symptoms consistent with the condition.

Healthcare providers should promptly seek consultation with Cameron County Public Health at:

(956) 247-3650 | ccphepi@co.cameron.tx.us