More than 100 people suffered complications associated with a fungal infection in the eyes after undergoing a group of cataract surgeries, part of the Mais Visão program, in Macapá, capital of Amapá, in early September. At least 7 of them had to undergo evisceration (removal of the eyeball) and lost their vision. The case is investigated by the state Public Ministry (MP-AP).
According to the Amapá State Health Department (Sesa), 141 patients underwent the procedure on September 4, of which 104 had complications. The investigation by the Health Surveillance Superintendence (SVS) identified the presence of the Fusarium fungus, which causes fusariosis infection. When this microorganism penetrates the inner part of the eye, as occurred in the state, the condition is serious and called endophthalmitis.
What is Fusarium fungus?
According to information from the Ministry of Health, fungi of the genus Fusarium are present in the environment and can be found in air, water, soil, plants and organic substrates. They are more common in places with a tropical and subtropical climate. There are more than 200 species belonging to the genus, which cause fusariosis.
How is the fungus transmitted?
The disease is transmitted by inhalation of fungal spores, reproductive cells released by fungi, allowing the reproduction and spread of these organisms. Fusarium can also be acquired by directly inoculating it into the skin, for example through a surgical wound, as was the case in Amapá.
According to the folder, the most common places for the fungus to enter are the paranasal sinuses, lungs and skin. As a result, it can cause skin lesions, keratitis, sinusitis, otitis, brain abscess, bloodstream infection, arthritis, onychomycosis, peritonitis, pneumonia, osteomyelitis and the endophthalmitis reported in patients from Amapá.
What are the symptoms of the fungus?
recirculation=”Article links”>The infection causes symptoms that vary depending on the location of the contamination. Some non-specific signs include persistent fever, decreased consciousness, reddened mucosa and nasal edema, paleness, tachycardia, muscle pain, dry cough, shortness of breath, red and watery eyes, eye pain, among others.
The main measure to protect yourself is to adopt hygiene habits to avoid exposure to the fungus. Fusarium wilt is one of the three most common fungal infections, but it is considered relatively rare. Cases are recorded more frequently in immunosuppressed patients, with hematological cancer or undergoing bone marrow transplants. Treatment involves the use of antifungal medications.
recirculation=”Article links”>Infection in the inner part of the eye, endophthalmitis, is rarer, but also more serious. In this case, intraocular injections or surgeries called vitrectomy may be necessary, in which part of the vitreous gel is removed, a gelatinous substance present in the eye, but which serves as a culture medium for the proliferation of infectious agents.
In the case of Amapá, 55 patients underwent surgery to try to reverse the infection, but Sesa did not specify whether it was vitrectomy. Another 14 had cornea transplants. According to a statement from the department, “patients are receiving 24-hour medical services, medication, transportation, travel to other states and psychological care.”
Mais Visão began in 2020 and has already provided more than 100 thousand services. The state maintains the resource with parliamentary amendment transfers. The program is implemented through a service provision contract with the religious institution Centro de Promoção Humana Frei Daniel de Samarate (Capuchinhos). The center, in turn, hires another company, Saúde Link.
The last transfer of funds to Capuchinhos was made in September and, on the 6th, the program was suspended due to reports of infection. The secretariat and the Public Ministry of Amapá are investigating the case.
On the 23rd, the MP-AP heard those involved in the matter as part of the investigation. At the time, representatives from Saúde Link reported that they had not found a suitable location to continue Mais Visão in the state. Regarding patients, they said they were evaluating the incidents, “providing full support and making adjustments”.
Also present at the meeting with the MP were the governor of Amapá, Clécio Luis; the Secretary of State for Health, Silvana Vedovelli, researcher Francis da Silva Pereira, from the Central Laboratory (LACEN); Elena Rocha, from the State Public Defender’s Office (DPE); Tiago Albuquerque, State Attorney General (PGE), Marco Antônio Barbosa and Luciano Goulart, directors of Mais Visão; Ana Cláudia Monteiro, Superintendent of Health Surveillance (SVS), and Frei José Carlos, from Capuchinhos.
— The MP-AP has been following this case since we became aware of it through the press and individual complaints. We do not want to interfere in the work that is in progress by the bodies linked to the subject, nor do we want the Mais Visão Program to be closed, but rather, to share and update information, so that we know, in fact, what happened and the measures that will be taken with the patients, so that Mais Visão can continue without putting any human life at risk — said Attorney General Paulo Celso Ramos.
