How Candida auris – a deadly drug-resistant fungus – presents in patients
Long-term care facilities are at risk of becoming hotbeds of growth for the fungus that is rapidly spreading across the United States
In 2009, a team of Japanese researchers made a startling discovery when they identified a new species of fungus that was causing persistent ear infections in a patient.
The patient was an 80-year-old Japanese woman who had been suffering from a chronic ear infection for several months. Despite her being treated with antifungal medication, the infection persisted and eventually spread to her bloodstream. The researchers collected samples of the fungus from the patient's ear and blood, and sent them to a laboratory for analysis.
When the results came back, the researchers were surprised to find that the fungus was a new species that had never been identified before. They named the fungus Candida auris (C. auris) and published their findings in a 2009 scientific journal.
Since then, C. auris has been identified in more than 30 countries around the world, including the United States. It has become a significant public health concern due to its ability to cause severe infections in vulnerable populations, such as those in hospitals and long-term care facilities.
According to a CDC analysis, the number of infections from C. auris in the U.S. increased by 59% from 2019 to 2020, and additional 95% in 2021. An outbreak of the fungus was recently discovered in Mississippi, where 12 people have been infected, including four “potentially associated deaths,” according to Dr. Paul Byers, the state’s epidemiologist, NBC News reported.
"Unfortunately, multi-drug resistant organisms such as C. auris have become more prevalent among our highest risk individuals, such as residents in long-term care facilities," Byers said.
Presenting symptoms of C. auris
Symptoms of C. auris can vary depending on the site of infection, but some common ones include:
- Fever. Patients with C. auris infections often experience a high fever that does not respond to standard treatments.
- Skin infections. C. auris can cause skin infections that appear as red, itchy patches or bumps.
- Respiratory infections. Infections of the lungs can lead to coughing, shortness of breath and chest pain.
- Bloodstream infections. In severe cases, C. auris can cause bloodstream infections that can lead to sepsis, a life-threatening condition.
Who is at risk of contracting and suffering from C. auris?
If present in healthy individuals, C. auris is often not life-threatening. However, one-third of those infected with the fungus will die, according to the CDC. Those at higher risk include:
- Elderly individuals
- Immunocompromised individuals
- Individuals who use medical devices, such as catheters
Healthy individuals, though they are less likely to be infected, are at risk of being “colonized” by the fungus, meaning they can carry the fungus on their body and transmit it to others. According to the CDC, the number of people colonized by C. auris rose by more than 200% in 2021.
Why is C. auris a problem for public health officials?
The fungus is causing concern among public health leaders as they attempt to understand and treat those infected by it.
- Difficult to diagnose and treat. The fungus is often resistant to multiple classes of antifungal medications, making it challenging to eradicate from infected patients. This can lead to persistent and recurrent infections that are difficult to control.
- Easily spread. C. auris can spread rapidly in healthcare facilities, leading to outbreaks that can be difficult to contain. The fungus can survive on surfaces for long periods and can be transmitted from person to person through direct contact or through the air. This makes it a significant threat to vulnerable populations, including patients in hospitals and long-term care facilities.
- Eludes recognition. C. auris is often misidentified or undetected, which can lead to delays in treatment and increased risk of transmission. The fungus can be mistaken for other types of Candida or may not show up on routine laboratory tests.
- Minimal research. Finally, there is limited understanding of the biology and epidemiology of C. auris, which makes it difficult to develop effective prevention and control strategies. Researchers continue to study the fungus to better understand its origins, transmission and pathogenesis, and to develop new treatments and prevention measures.
Mitigating the spread of C. auris in pre-hospital and medical settings
Preventing the spread of C. auris requires a multifaceted approach that includes proper infection control measures, such as hand hygiene, use of personal protective equipment and isolation precautions for infected patients.
Healthcare facilities also need to be vigilant in identifying and treating infections to prevent outbreaks. In the prehospital setting, medical providers should wear proper PPE when transporting a patient with C. auris and afterwards disinfect the ambulance and all equipment with a bleach solution.
In a July 2021 announcement regarding the fungus, Montgomery County Fire and Rescue directed emergency providers to alert the receiving medical facility of the patient’s status prior to arrival.
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