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Nearly four months later, the Arkansas woman is one of a dozen or more American residents who have returned from surgery in Tijuana with a rare and potentially deadly strain of bacteria resistant to virtually all antibiotics, reported federal health officials. Some members of the group have recovered, but Capone, 40, remains seriously ill despite being treated with many drugs.
If the bacteria spread in his blood, the doctors say that it could be fatal. "I have not had a patient with zero options yet, but it's as close as I've had it," said Ryan Dare, an infectious disease specialist at the University of Toronto. University of Arkansas for the Medical Sciences College of Medicine in Little Rock. her.
The Tijuana epidemic, which resulted in one death, prompted the Centers for Disease Control and Prevention to issue an unusual warning this month, calling on travelers to avoid surgery at the Grand Hospital. View linked to eight of the infections until the Mexican authorities confirm his safety. Hospital officials did not respond to calls to solicit feedback. The Weight Loss Agents medical travel agency also did not record the procedures on-site or in other hospitals.
A woman who answered the phone 's weight loss agent has imputed to reports of infections the "smear campaign of a competitor". She refused to give her name.
Mexican authorities said they have temporarily closed the hospital's operation unit in December, but the facility has since reopened and resumed surgery, according to patients posted on his website.
The cases in Tijuana highlight the growing number of Americans who contract an antibiotic-resistant infection abroad after traveling for treatment abroad. Some who did not go for medical procedures but became ill and went to foreign hospitals also contracted such infections.
Officials are concerned to prevent such pathogens from growing in the United States because they are so difficult to treat.
"We jump when we see them [extremely antibiotic-resistant infections] because we know that they can burn and spread, "said Maroya Spalding Walters, an epidemiologist at the head of the CDC team investigating the outbreak, and no one can recognize it before that. it does not become an uncontrollable forest fire. "
According to Patients Beyond Borders, a medical tourism guide, 1.7 million Americans have traveled to other countries in 2017 for treatment, and this number is expected to increase. Many like Capone travel to save money. Mexico is one of the top 10 destinations. According to the Medical Tourism Association, an American organization whose members include hospitals, clinicians and insurance companies, weight loss surgery, in vitro fertility procedures and cosmetic surgery are among the most sought after treatments.
There is little data on infectious diseases related to medical tourism. But the CDC has documented several epidemics, including severe skin infections among dozens of patients who underwent cosmetic surgery in the Dominican Republic in 2013 and 2017. Many of these infections were drug-resistant. In 2014, five New York residents contracted Q fever, an influenza illness caused by a bacterium found in goats, sheep and cows, after receiving injections of fetal sheep cells in Germany.
The World Health Organization considers the Superbacterium that infects Capone – Pseudomonas aeruginosa resistant to carbapenem – is one of its top three priorities for new antibiotics.
The body is "a double whammy," Walters said, as it carries a genetic mutation that allows it to pbad its destructive gene of antibiotics to other bacteria to make them equally resistant.
People can carry pathogens in their bodies and not infect themselves. In hospitals, where the most serious infections occur, the germ can spread on the hands of caregivers or on contaminated and poorly cleaned equipment.
There have been only 86 cases of the strain reported in the United States until 2017, officials said.
According to CDC officials, half of the 12 people who returned from Tijuana with confirmed cases were hospitalized upon their return to Arkansas, Arizona, Oregon, the United States. Utah, Texas, Washington State and West Virginia. Most people have had weight loss surgery. Eight had been operated at Grand View Hospital. The rest was operated in other clinics in Tijuana that the CDC has not identified. The CDC is investigating two other cases. Most of the patients were women in their 30s and 40s and underwent surgery between August and December, officials said.
Many describe devastating experiences for themselves and their families.
An unidentified man from Oregon died in November, according to state health officials and the federal government. They say that they do not know if the infection caused his death because he had other health problems.
Even patients infected with a less resistant strain of Pseudomonas describe devastating experiences. Mindy Blohm, 45, of Riverton, Utah, said that she and her husband had been forced to sell their homes to pay over $ 50,000 in hospitalization fees for treatment of his infection, a less resistant Pseudomonas, after his weight loss surgery at Grand View on October. 31. Her wound finally healed last week, she said.
Capone, whose weight loss surgery aimed at reducing her stomach by about 80% went on Oct. 8, said she was still sick. The doctors had urged her to undergo the procedure because at 5 feet 7 inches she weighed 291 pounds. Her blood pressure "was starting to get out of control," she said.
Three days after the Grand View procedure, while she was waiting for her flight back to the San Diego airport, she stated that her main incision had begun to sink. Back home at Jonesboro, she got worse. Over the next few weeks, she said she was hospitalized twice and developed an abscess that doctors had to open and drain.
At that time, tests showed that she had no ordinary infection. The Arkansas Department of Health told Capone that it was the first time that he saw this body.
"They were worried that other people would catch him, especially other medical staff," Capone said. "They told me that if I saw a doctor, I had to inform them."
CDC's Antimicrobial Resistance Laboratory Network was aware of three other patients with the same infection. But there was no discernible trend until Capone was reported in mid-November – it was the second link with the Grand View Hospital.
"It was really the moment" aha ", said epidemiologist Walters. Within a few days, the agency alerted state health departments about the superbug and urged them to test antibiotic-resistant organisms in those who had visited the hospital. Mexico as a result of invasive procedures.
The condition of Capone, meanwhile, has worsened. In mid-December, she was referred to Dare, the Little Rock specialist. He said his only option was colistin, an antibiotic discovered in the late 1940s that is rarely used because it causes kidney and nerve damage. But the drug has resurfaced as a last-line treatment for multidrug-resistant organisms.
On his second day of antibiotic, Capone's lips swelled. His tongue and face became numb. "I got to the point where I could barely speak," she said. She had to stop the treatment.
She now has a hole in the stomach that requires daily cleaning. Capone wears gloves to clean his wound, and then throws his used bandages in the trash on the outside. Her husband and teenage daughter are not in danger, any more than the general public; the bacteria do not spread in the air. She has committed more than $ 30,000 in medical bills related to her infection.
"The injury is not cured and it hurts a lot," said Capone. "They told me that they had done everything they could."
She tried to warn others about her experience on a Facebook page created for Grand View's bariatric patients, but added that her posts were quickly removed.
A few days ago she received even more disturbing news. Health officials from Arkansas and other states are contacting Capone and other infected patients to tell them that they are at risk of contracting blood – borne diseases or dementia. other body fluids, such as HIV, hepatitis B and hepatitis C, because Tijuana equipment is not at risk. have been properly sterilized. The leaders urge patients to talk to their clinicians about screening tests or additional tests.
"I'm at a breaking point," said Capone. "I'm so scared, I do not want to lose my life for that, I do not want my family to suffer because I chose to go to Mexico."
This article was written by Lena H. Sun, a Washington Post reporter. Alice Crites and Andrea Morales of the Washington Post contributed to this report.
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