BROWNSVILLE, Texas (AP) — Federal authorities say more than 200 patients may be at risk of contracting fungal meningitis after undergoing surgical procedures at clinics in a Mexico border city.

The federal Centers for Disease Control and Prevention said Wednesday that it is working with Mexico’s Ministry of Health and US state and local health departments to respond to the outbreak among patients who traveled to Matamoros, al across the border from Brownsville, Texas.

Authorities identified and closed two clinics linked to the outbreak, the River Side Surgical Center and the K-3 Clinic.

The Mexican Ministry of Health sent the CDC a list of 221 US patients who may be at risk of meningitis based on surgical procedures recorded at any of the clinics from January through May 13. Three additional patients not on the list were also identified, bringing the total number of people in the United States known to have potential exposure to 224, the CDC said.

The CDC is working with more than two dozen state and local health departments to contact people with potential exposure and urge them to go to their nearest medical center to get tested. Tests for meningitis include an MRI and a lumbar puncture, also called a lumbar puncture.

last week, the CDC issued a warning US residents to cancel surgeries in Matamoros, saying five people from Texas who underwent procedures there developed suspected cases of fungal meningitis. One of them died. A second person with a suspected case also died, the CDC said Wednesday.

Meningitis is inflammation of the protective covering of the brain and spinal cord and must be treated urgently. Symptoms include fever, headache, stiff neck, nausea, vomiting, confusion, and sensitivity to light. Cases of meningitis can be caused by viruses, bacteria, trauma, or fungi.

Patients in the Texas cases began showing symptoms between three days and six weeks after surgery in Matamoros.

People leaving the U.S. for prescription drugs, dental procedures, surgeries, and other medical treatment, also known as medical tourism — is common, the experts say. Mexico, Canada, India and Thailand are popular destinations.

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