They went to Mexico for surgery. They came back with a deadly superbug.
Tamika Capone thought she was making a smart call by traveling to Mexico for bariatric surgery. Her doctor had urged her to have the procedure to reduce her out-of-control weight and blood pressure. But her husband's health insurance would not cover the $17,500 bill. After a friend got the surgery in Tijuana for $4,000, Capone decided to do the same.
Nearly four months later, the Arkansas woman is one of at least a dozen U.S. residents who returned from surgeries in Tijuana with a rare and potentially deadly strain of bacteria resistant to virtually all antibiotics, say federal health officials. Some in the group recovered, but Capone, 40, remains seriously ill despite being treated witha barrage of drugs.
If the bacteria spreads to her bloodstream, doctors say it could be fatal. "I've not yet had a patient with zero options, but this is as close as I've had," said Ryan Dare, an infectious disease doctor at the University of Arkansas for Medical Sciences College of Medicine in Little Rock who is treating her.
The Tijuana outbreak, which includes one death, prompted the Centers for Disease Control and Prevention to issue an unusual warning this month, urging travelers to avoid surgery at Grand View hospital linked to eight of the infections until Mexican authorities confirm its safety. Hospital officials did not return calls seeking comment. Nor did the medical tourism agency, Weight Loss Agents, which books procedures there and at other hospitals.
A woman who answered the weight loss agent's telephone blamed reports of infections on "a competitor's smear campaign." She declined to give her name.
Mexican authorities said they temporarily closed the hospital's operating unit in December, but the facility has since reopened and resumed surgeries, according to patients posting on its website.
The Tijuana cases highlight the growing number of Americans getting antibiotic-resistant infections overseas after traveling to get medical care abroad. Some who were not traveling for medical procedures but fell ill and went to foreign hospitals have also contracted such infections.
Officials say they are anxious to prevent such pathogens from gaining a foothold in the United States because they are so difficult to treat.
"We pounce when we see them [extremely antibiotic-resistant infections] because we know they can smolder and spread," said Maroya Spalding Walters, an epidemiologist leading the CDC team investigating the outbreak. "And no one may recognize it until this becomes an out-of-control wildfire."
According to Patients Beyond Borders, a medical tourism guidebook, 1.7 million Americans traveled to other countries in 2017 for medical care, and that number is expected to increase. Many like Capone travel to save money. Mexico is among the top 10 destinations. Weight-loss surgery, in vitro fertility procedures and cosmetic surgery are among the most sought treatments generally, according to the Medical Tourism Association, a U.S.-based organization whose members include hospitals, clinicians and insurance companies.
There is little data about infectious diseases related to medical tourism. But the CDC has documented several outbreaks, including severe skin infections among dozens of patients who had cosmetic surgery in theDominican Republic in 2013 and 2017. Several of the infections were drug-resistant. In 2014, five New York residents contracted Q fever, a flulike illness caused by a bacteria found in goats, sheep and cows, after getting injections of fetal sheep cells in Germany.
The World Health Organization considers the superbug that infects Capone - carbapenem-resistant Pseudomonas aeruginosa - one of its three highest priorities for new antibiotics.
The organism packs "a double whammy," Walters said, because it has a genetic mutation that allows it to transmit its antibiotic-destroying gene to other bacteria to make them resistant as well.
People can carry the pathogens in their bodies and not become infected themselves. In hospitals, where the most serious infections occur, the germ can spread on the hands of health-care workers or equipment that gets contaminated and is not properly cleaned.
There have been only 86 cases of the strain reported in the United States through 2017, officials said.
Half of the 12 people who came back from Tijuana with confirmed cases were hospitalizedonce they returned home to Arkansas, Arizona, Oregon, Utah, Texas, Washington and West Virginia, according to CDC officials. Most people had weight-loss surgery. Eight had had surgery at Grand View Hospital. The remainder had surgery at other Tijuana clinics the CDC did not identify. The CDC is investigating two additional cases. Most of the patients were women in their 30s and 40s and had surgeries between August and December, the officials said.
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 whether the infection caused his death because he had other health problems.
Even patients who were infected with a less resistant strain of Pseudomonas describe devastating experiences. Mindy Blohm, 45, of Riverton, Utah, said she and her husband were forced to sell their home to pay over $50,000 in hospital bills for treatment of her infection, a less resistant Pseudomonas, after her weight-loss surgery at Grand View on Oct. 31. Her wound finally 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 ill. Doctors had urged her to have the procedure because at 5 foot 7 inches, she weighed 291 pounds. Her blood pressure "was getting way out of control," she said.
Three days after the procedure at Grand View, as she waited in the San Diego airport for her return flight, she said her main incision started to leak. Back home in Jonesboro, she got worse. Over the next few weeks, she said she was hospitalized twice and developed an abscess that doctors had to cut open and drain.
By then, tests showed she had no ordinary infection. The Arkansas health department told Capone it was the first time they had seen this organism.
"They were worried about other people catching it, especially other medical staff," Capone recalled. "They told me if I see any doctor, I have to inform them."
CDC's Antimicrobial Resistance Laboratory Network knew of three other patients with the same infection. But there was no discernible pattern until Capone's was reported in mid-November - it was the second linked to Grand View Hospital.
"That was really the 'aha' moment," said Walters, the epidemiologist. Within days, the agency alerted state health departments about the superbug and urged them to test antibiotic-resistant organisms in people who had traveled to Mexico for invasive procedures.
Capone's condition, meanwhile, grew worse. In mid-December, she was referred to Dare, the Little Rock specialist. He said her only option was colistin, an antibiotic discovered in the late 1940s that is seldom used because it causes kidney and nerve damage. But the drug has resurfaced as a last-line treatment for multidrug-resistant organisms.
On her second day on the antibiotic, Capone's lips swelled. Her tongue and face went numb. "I got to the point where I could barely talk," she said. She had to stop treatment.
Now she has a hole in her stomach that requires daily cleaning. Capone wears gloves to clean her wound, then throws her used bandages in the trash outside. Her husband and teenage daughter are not at risk, nor is the general public; the bacteria does not spread in the air. She has incurred more than $30,000 in medical bills related to her infection.
"The wound has not healed, and it hurts a lot," Capone said. "They told me they've done all they could do."
She has tried to warn others about her experience on a Facebook page established for bariatric patients of Grand View, but she said her posts have been quickly taken down.
A few days ago, she received even more worrisome news. Arkansas and other state health officials are contacting Capone and other infected patients to tell them they may be at risk for diseases that can be transmitted by blood or other bodily fluids, such as HIV, hepatitis B and hepatitis C, because equipment in Tijuana may not have been properly sterilized. Officials are urging patients to talk to their clinicians about additional screening or testing.
"I'm at a breaking point," Capone said. "I'm so scared. I don't want to lose my life for this. I don't want to have my family suffer because I chose to go to Mexico."
This article was written by Lena H. Sun, a reporter for The Washington Post. The Washington Post's Alice Crites and Andrea Morales contributed to this report.