by Paul Sisson, The San Diego Union-Tribune 

With several patients in local hospitals struggling to recover, public health officials are warning San Diego doctors to be on the lookout for signs of a deadly infection linked to weight-loss surgeries performed in Tijuana.

The county Health and Human Services Agency this week alerted the medical community that four patients have popped up in local hospitals with drug-resistant superbug infections of the same type that prompted the U.S. Centers for Disease Control and Prevention to issue a travel advisory in early January.

The CDC has continued to caution those who travel to Tijuana for surgery, as the number of cases have more than doubled. Most are connected to patients operated on at Grand View Hospital near the U.S.-Mexico border.

To date, CDC officials said, a total of 25 cases of drug-resistant pseudomonas aeruginosa have been detected among U.S. citizens who crossed the border, usually for “gastric sleeve” surgery that significantly reduces the size of the stomach, accelerating the pace of weight loss.

Pseudomonas is listed among the CDC’s top threats among microbes that can resist antibiotics. According to a 2013 report, the bug kills about 440 people per year in the United States and infects about 6,700.

In January, CDC officials said that the subspecies detected among Tijuana weight-loss patients is particularly nasty due to its ability to destroy carbapenems, one of the most effective and broadly-acting classes of antibiotics available to modern medicine.

Maroya Walters, a CDC epidemiologist with a doctorate in biochemistry and molecular biology, said Tuesday that while the world’s foremost public health agency saw its last Grand View case in late January, additional infections have continued to surface among patients who were operated on at other as-yet-unnamed Tijuana hospitals. The most recent case was detected on Feb. 12.

The current rate of new cases, she said, has not reduced enough for the CDC to remove or change the travel advisory it issued in January.

“Right now, we don’t have any assurance that the infection control issues have been addressed,” Walters said.

In San Diego, Dr. Eric McDonald, medical director of the county public health department’s epidemiology and immunization services branch, said that his office became aware of two local cases, one in October and one in January, after his office issued a preliminary notice to doctors on Jan. 16. Neither of those cases, he said, is a San Diego County resident, with one residing elsewhere in California and another living out of state.

He said two more patients, both who live in San Diego County but who had weight-loss surgeries at Tijuana hospitals other than Grand View, were admitted to area hospitals with pseudomonas infections in late February.

Three of the four cases, he added, remain hospitalized today and are being treated under special protocols designed to keep infectious diseases from spreading.

“At this time, we have no evidence of secondary infections associated with these hospitalized cases,” McDonald said Monday.

He said that having four cases pop up in San Diego hospitals made it important for his office to let all local doctors know that they need to be proactive, asking about surgery in Mexico and responding with extra precaution, including patient isolation, where appropriate.

“We just wanted to reiterate that you shouldn’t wait until after you know that a person has this organism to begin taking contact precautions,” McDonald said. “If you know someone is coming in with an infection, and you know they’ve had surgery in Mexico, then you should take these precautions right away.”

Eighteen of the 25 cases—20 have been confirmed and five are suspected—occurred in patients who were operated on at Grand View Hospital, according to CDC epidemic intelligence officer Ian Kracalik.

He said Mexican health officials told the agency they detected lapses in the procedures used to sterilize medical devices used in weight-loss surgeries. Kracalik said additional information on exactly which devices were improperly handled was not made available by the Mexican health agency that conducted the Grand View investigation.

Initially, he added, Mexico’s La Comision Federal para la Proteccion contra Riesgos Sanitarios or federal commission for the protection against sanitary risks, told the CDC that it had shut down the surgical areas of Grand View on Dec. 19. But there were strong indications that the surgical center near the U.S. border remained open, with several new infections appearing after patients underwent surgeries at Grand View after Dec. 19.

“It is clear there was an ongoing risk during that period when the hospital’s surgical area was not supposed to be operational,” Kracalik said.

Health authorities in Mexico said they were not available to discuss the developments Tuesday.

Kracalik added that the CDC received word that Grand View shut down “sometime after Jan. 31,” which was the last date on which the CDC received a report of an infection case linked to the hospital.

Most of the cases, the CDC representatives added, are associated with Dr. Mario Almanza, a surgeon whose website declares that he is the “leading bariatric weight-loss surgeon in the world.” Almanza received significant media attention in 2018 when he was named in a class-action lawsuit by former patients, including a lead plaintiff who said her procedure left her with complications including internal bleeding, according to coverage by Channel 10 News and others.

Almanza, contacted through weightlossagents.com, the stateside travel agency whose phone number the doctor lists on his website, did not return a request for comment Tuesday.

With Grand View apparently shut down, CDC officials said they noticed that Weight Loss Agents had begun referring weight-loss surgeries to another Tijuana hospital called the “Obesity Goodbye Center.” Reached through their promotional Facebook page Tuesday, the company said that while Almanza “performed procedures for a couple of days at our facility always following our sanitation protocols,” he is not affiliated with the hospital in any way. The center said its own sanitation practices “exceed international standards.”

An attorney for Weight Loss Agents, Glenn Krinsky, said the company has done everything it can to cooperate with the CDC, including providing information on 700 patients it had referred to Grand View since August.

The CDC’s Walters said the agency is following up with those patients to better gauge the spread of pseudomonas or other surgical infections.

©2019 The San Diego Union-Tribune 
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