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US medical tourists in Tijuana suffer a rare, antibiotic-resistant infection

Tamika Arnold Capone walks slowly down the stairs to take her daughter's apron off at work. (Andrea Morales / for The Washington Post)

Tamika Capone believed that she made a smart phone call when she traveled to Mexico for a bariatric surgery. Her doctor had urged her to have a procedure to reduce her runaway weight and blood pressure. But her husband's health insurance would not cover the $ 17,500 dollars. After a friend had received the operation in Tijuana for $ 4,000, Capone decided for the same.

About four months later, the Arkansas woman is one of at least a dozen US citizens who returned from operations in Tijuana with a rare and potentially fatal accident, making bacterial strains resistant to virtually all antibiotics, federal health officials say. Some in the group recovered, but Capone, 40, remains seriously ill despite [20] treatment with medications .

When the bacteria spread in their bloodstream, the doctors say it could be deadly. "I have not had a patient with zero options yet, but that's as close as I had it," said Ryan Dare, an infectious disease doctor at the University of Arkansas Medical Sciences in Little Rock, who treats her. 19659006] The Tijuana outbreak, which included a death, caused the Centers for Disease Control and Prevention to issue an unusual warning this month calling on travelers to avoid operations at the Grand View Hospital, which was linked to eight of the infections were until the Mexican authorities confirmed this security. Hospital officials did not answer to receive a comment. Also, the medical tourism agency Weight Loss Agents, which books a procedure there and in other hospitals, not.

A woman who responded to the weight loss agent's phone, accused reports of infection on "a competition campaign". She declined to give her name

The Mexican authorities said they had temporarily closed the hospital's operating unit in December, but the facility has resumed operations and resumed operations, according to the patients posted on their website to have.

Capone went for bariatric surgery and Grand View Hospital in Tijuana is one of at least 12 patients who returned with a rare and potentially fatal antibiotic-resistant strain of Pseudomonas aeruginosa bacteria. (Andrea Morales / for The Washington Post)

The cases in Tijuana highlight the growing numbers of Americans receiving antibiotic-resistant infections overseas for medical treatment abroad. Some, who were not on medical trips, but were ill and went to foreign hospitals, also suffer from such infections.

Officials say they absolutely wanted to prevent such pathogens from gaining a foothold in the United States because they are so difficult to treat.

"We crash when we see them [extremely antibiotic-resistant infections] because we know they can smolder and spread," said Maroya Spalding Walters, an epidemiologist who heads the CDC team investigating the outbreak. "And no one can see it until this becomes a runaway wildfire."

According to Patients Beyond Borders, a guide to medical tourism, 1.7 million Americans traveled to other countries in 2017 to seek medical care. Many like Capone travel to save money. Mexico is among the top 10 destinations. According to the Medical Tourism Association, a US-based organization whose members include hospitals, clinicians and insurance companies, includes weight loss surgery, in vitro fertility procedures and cosmetic surgery.

There are only a few data from infectious diseases associated with medical tourism . However, the CDC has documented multiple outbreaks, including severe skin infections in dozens of patients undergoing cosmetic surgery in the Dominican Republic 2013 and . Some of the infections were drug-resistant. In 2014, five residents of New York suffered from Q fever, a feverish disease caused by bacteria found in goats, sheep and cows after they had been injected with fetal sheep cells in Germany.

The World Health Organization considers the Superbug infecting Capone – carbapenem-resistant Pseudomonas aeruginosa – one of the top three priorities for new antibiotics.

The organism seizes "a double hit," said Walters, because he has a genetic mutation that his antibiotic can transmit – destruction of the gene against other bacteria to make them resistant.

Humans can carry the pathogens in their bodies and do not become infected themselves. In hospitals where the most serious infections occur, the germ may be deposited on the hands of healthcare professionals or on equipment that is contaminated and not properly cleaned.

In the United States, only 86 cases of stress were reported Until 2017, officials said.

Capone's legs have been shattered from the over 30 surgeries she had been struck by a drunken driver in 2011. (Andrea Morales / for The Washington Post)

Half of the 12 individuals who returned from Tijuana with confirmed cases were hospitalized when they moved to Arkansas, Arizona, Oregon, Utah, Texas, and Washington West Virginia returned. according to the CDC officials. Most people had a weight loss surgery. Eight had operated on at Grand View Hospital. The remainder were operated in other Tijuana clinics that did not identify the CDC. The CDC is investigating two more cases. Most patients were women in their thirties and forties and had surgeries between August and December.

Many describe devastating experiences for themselves and their families.

An unidentified Oregon man died in November according to state and federal health officials. They say they do not know if the infection caused death because of other health problems .

45-year-old Mindy Blohm from Riverton, Utah, said she and her husband were forced to sell their home to pay over $ 50,000 in hospital bills to treat their infection of a less-resistant Pseudomonas after her weight loss at Grand View on October 31st. Her wound healed last week, she said.

Capone, whose weight loss surgery to reduce her stomach by about 80 percent, was on Oct. 8, said she is still sick. The doctors had urged her to perform the procedure because she weighed 291 pounds at 5 feet 7 inches. Her blood pressure "got out of control," she said.

Three days after surgery in Grand View, as she waited for her return flight at San Diego Airport, she said her main cut was licking. Back in Jonesboro, she felt worse again. Over the next few weeks she said she had been hospitalized twice and developed an abscess that doctors had to cut open and drain.

Until then, tests showed that she had no normal infection. The health department in Arkansas told Capone that it was the first time they had seen this organism.

"They were afraid that other people would catch it, especially other medical personnel," recalls Capone. "They told me if I see a doctor, I have to inform them."

The CDC network for antimicrobial resistance laboratories knew of three other patients with the same infection. However, no pattern was evident until Capone was reported in mid-November – it was the second one associated with Grand View Hospital.

"That really was the aha moment," said epidemiologist Walters. Within days, the agency alerted state health officials to the Superbug and asked them to test antibiotic-resistant organisms in humans who had traveled to Mexico for invasive surgery.

Capone's condition worsened in the meantime. In mid-December, she was referred to Dare, the specialist for Little Rock. He said her only option was Colistin, an antibiotic that was discovered in the late 1940s and is rarely used because it causes kidney and nerve damage. However, the drug was revived as a last resort against multidrug-resistant organisms.

On her second day with the antibiotic, Capone's lips swelled. Her tongue and her face went numb. "I've reached a point where I could hardly speak," she said. She had to stop the treatment.

Now she has a hole in her stomach that needs daily cleaning. Capone wears gloves to clean her wound and throws her used bandages in the trash. Her husband and daughter are not at risk, as is the general public. The bacteria do not spread in the air. She had received more than $ 30,000 in medical bills related to her infection.

"The wound is not healed and it hurts a lot," said Capone. "They told me that they had done everything they could do."

She tried to warn others of her experiences on a Facebook page for Grand View bariatric patients, but said that she had her contributions

A few days ago, she received even more worrying news. Arkansas and other state health officials contact Capone and other infected patients to inform them that they may be at risk for diseases transmitted by blood or other bodily fluids (19459059), such as HIV, hepatitis B and hepatitis C Tijuana may not have been properly sterilized. Officials urge patients to talk to their clinicians about extra checkups or tests.

"I'm at a breakpoint," Capone said. "I'm so scared I do not want to lose my life for it I do not want my family to suffer because I decided to go to Mexico."

Tamika Arnold Capone in her car (Andrea Morales / For The Washington Post)

Alice Crites and Andrea Morales contributed to this report.

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