A mysterious and dangerous fungal infection called Candida auris has emerged around the world. It is resistant to many antifungal medications, placing it among a growing number of germs that have evolved defenses against common medicines. Here are some basic facts about it. What is Candida auris? Candida auris is a fungus that, when it gets into the bloodstream, can cause dangerous infections that can be life-threatening. Scientists first identified it in 2009 in a patient in Japan. In recent years, it has emerged around the world, largely in hospitals and nursing homes. There have been 587 C. auris cases reported in the United States, according to the Centers for Disease Control and Prevention, most of them in New York, New Jersey and Illinois. [Like the Science Times page on Facebook. | Sign up for the Science Times newsletter.] Why is it so dangerous? C. auris is often resistant to major antifungal drugs that are typically used to treat such infections. The C.D.C. says that more than 90 percent of C. auris infections are resistant to at least one such drug, while 30 percent are resistant to two or more major drugs. Once the germ is present, it is hard to eradicate from a facility. Some hospitals have had to bring in special cleaning equipment and even rip out floor and ceiling tiles to get rid of it.<doc-sep>Dr Shawn Lockhart, a fungal disease specialist, holds a microscope slide with inactive Candida auris, in Atlanta. (Melissa Golden/The New York Times) Dr Shawn Lockhart, a fungal disease specialist, holds a microscope slide with inactive Candida auris, in Atlanta. (Melissa Golden/The New York Times) In May, an elderly man was admitted to the Brooklyn branch of Mount Sinai Hospital for abdominal surgery. A blood test revealed that he was infected with a newly discovered germ as deadly as it was mysterious. The germ, a fungus called Candida auris, preys on people with weakened immune systems, and it is quietly spreading across the globe. Recently C. auris reached New York, New Jersey and Illinois, leading the federal Centers for Disease Control and Prevention to add it to a list of germs deemed “urgent threats.” The man at Mount Sinai died after 90 days in the hospital, but C. auris did not. Tests showed it was everywhere in his room, so invasive that the hospital needed special cleaning equipment and had to rip out some of the ceiling and floor tiles to eradicate it. C. auris is so tenacious, in part, because it is impervious to major antifungal medications, making it a new example of one of the world’s most intractable health threats: the rise of drug-resistant infections. For decades, public health experts have warned that the overuse of antibiotics was reducing the effectiveness of drugs that have lengthened life spans by curing bacterial infections once commonly fatal. But lately, there has been an explosion of resistant fungi as well. “It’s an enormous problem,” said Matthew Fisher, a professor of fungal epidemiology at Imperial College London. “We depend on being able to treat those patients with antifungals.” Simply put, fungi, just like bacteria, are evolving defenses to survive modern medicines. A study the British government funded projects that if policies are not put in place to slow the rise of drug resistance, 10 million people could die worldwide of all such infections in 2050, eclipsing the 8 million expected to die that year from cancer. Antibiotics and antifungals are essential to combat infections in people, but antibiotics are also used widely to prevent disease in farm animals, and antifungals are also applied to prevent agricultural plants from rotting. Some scientists cite evidence that rampant use of fungicides on crops is contributing to the surge in drug-resistant fungi infecting humans. Yet as the problem grows, it is little understood by the public — in part because the very existence of resistant infections is often cloaked in secrecy. With bacteria and fungi alike, hospitals and local governments are reluctant to disclose outbreaks for fear of being seen as infection hubs. C. auris, which infected the man at Mount Sinai, is one of dozens of dangerous bacteria and fungi that have developed resistance. Yet, like most of them, it is a threat that is virtually unknown to the public. Dr Tom Chiller heads the fungal division at the Centers for Disease Control and Prevention, leading the team researching the emerging Candida Auris crisis, in Atlanta, August 23, 2018. (Melissa Golden/The New York Times) Dr Tom Chiller heads the fungal division at the Centers for Disease Control and Prevention, leading the team researching the emerging Candida Auris crisis, in Atlanta, August 23, 2018. (Melissa Golden/The New York Times) Other prominent strains of the fungus Candida — one of the most common causes of bloodstream infections in hospitals — have not developed significant resistance to drugs, but more than 90 percent of C. auris infections are resistant to at least one drug, and 30 percent are resistant to two or more drugs, the CDC said. Nearly half of patients who contract C. auris die within 90 days, according to the CDC. Yet the world’s experts have not nailed down where it came from in the first place. “It is a creature from the black lagoon,” said Dr Tom Chiller, who heads the fungal branch at the CDC. “It bubbled up and now it is everywhere.” ‘No Need’ to Tell the Public In late 2015, Dr Johanna Rhodes, an infectious disease expert at Imperial College London, got a panicked call from the Royal Brompton Hospital outside London. C. auris had taken root there months earlier, and the hospital couldn’t clear it. “‘We have no idea where it’s coming from. We’ve never heard of it. It’s just spread like wildfire,’” Rhodes said she was told. She agreed to help the hospital identify the fungus’ genetic profile and clean it from rooms. It was spreading, but word of it was not. The hospital, a specialty lung and heart center that draws wealthy patients from the Middle East and around Europe, alerted the British government and told infected patients, but made no public announcement. This hushed panic is playing out in hospitals around the world. Individual institutions and national, state and local governments have been reluctant to publicize outbreaks of resistant infections, arguing there is no point in scaring patients — or prospective ones. Dr Johanna Rhodes, an infectious disease expert, in her lab at the Department of Infectious Disease Epidemiology, Imperial College School of Public Health, St. Mary’s Campus London, August 13, 2018. (Tom Jamieson/The New York Times) Dr Johanna Rhodes, an infectious disease expert, in her lab at the Department of Infectious Disease Epidemiology, Imperial College School of Public Health, St. Mary’s Campus London, August 13, 2018. (Tom Jamieson/The New York Times) Dr Silke Schelenz, Royal Brompton’s infectious disease specialist, found the lack of urgency from the government and hospital in the early stages of the outbreak “very, very frustrating.” “They obviously didn’t want to lose reputation,” Schelenz said. “It hadn’t impacted our surgical outcomes.” By the end of June 2016, a scientific paper reported “an ongoing outbreak of 50 C. auris cases” at Royal Brompton, and the hospital took an extraordinary step: It shut down its ICU for 11 days, again with no announcement. Days later the hospital finally acknowledged to a newspaper that it had a problem. A headline in The Daily Telegraph warned, “Intensive Care Unit Closed After Deadly New Superbug Emerges in the U.K.” Yet the issue remained little known internationally, while an even bigger outbreak had begun in Valencia, Spain, at the Hospital Universitari i Politècnic La Fe. As with Royal Brompton, the hospital in Spain did not make any public announcement. It still has not. The secrecy infuriates patient advocates, who say people have a right to know if there is an outbreak. “Why the heck are we reading about an outbreak almost a year and a half later — and not have it front-page news the day after it happens?” said Dr Kevin Kavanagh, chairman of Health Watch USA, a nonprofit patient advocacy group. Health officials say that disclosing outbreaks frightens patients about a situation they can do nothing about, particularly when the risks are unclear. “It’s hard enough with these organisms for health care providers to wrap their heads around it,” said Dr Anna Yaffee, a former CDC outbreak investigator. “It’s really impossible to message to the public.” Officials in London did alert the CDC to the Royal Brompton outbreak while it was occurring. And the CDC realized it needed to get the word to U.S. hospitals. On June 24, 2016, the CDC blasted a nationwide warning and set up an email address, candidaauris@cdc.gov, to field queries. Dr Snigdha Vallabhaneni, a key member of the fungal team, expected to get a trickle — “maybe a message every month.” Dr Snighdha Vallabhaneni is a fungal expert and epidemiologist at the Centers for Disease Control and Prevention and has been closely involved with the emerging Candida Auris crisis. (Melissa Golden/The New York Times) Dr Snighdha Vallabhaneni is a fungal expert and epidemiologist at the Centers for Disease Control and Prevention and has been closely involved with the emerging Candida Auris crisis. (Melissa Golden/The New York Times) Instead, within weeks, her inbox exploded. In the United States, 587 cases of people having contracted C. auris have been reported, according to the CDC. The symptoms — fever, aches and fatigue — are seemingly ordinary, but when a person gets infected, particularly someone already unhealthy, such commonplace symptoms can be fatal.<doc-sep>SINGAPORE - At least three people in Singapore were found to be infected with Candida auris, a deadly drug-resistant fungus that has been spreading worldwide. One patient recovered, another left Singapore against medical advice, and the last died. Last July, Dr Tan Yen Ee and Associate Professor Tan Ai Ling from the Singapore General Hospital's department of microbiology reported the cases in a letter to local medical journal Annals. C. auris is resistant to major anti-fungal medications and is especially deadly for patients with compromised immune systems, the New York Times reported. [[nid:424615]] According to the United States Centres for Disease Control and Prevention, it kills about half of all patients who contract it within 90 days. The first case in Singapore was detected in a 52-year-old Singapore-born woman who suffered several limb fractures following a traffic accident in India in 2012. She was treated at an Indian hospital and later transferred to a hospital here for further treatment. The fungus and other organisms were detected in her fractured right thigh bone, or femur. She was given several medications, including antibiotics and an antifungal medication called fluconazole. The fungus was later found to be resistant to fluconazole, but the patient was not given other antifungal drugs as she was recovering well and was later discharged. [[nid:414147]] The second case involved a 24-year-old Bangladeshi man who came to Singapore for medical treatment in 2016. He had been admitted to three hospitals in Bangladesh for a metastatic carcinoma, a type of cancer. He was given chemotherapy in Singapore but was later found to have fluconazole-resistant C. auris in his bloodstream. Another antifungal called anidulafungin, which was effective against the fungus, was prescribed. However, the man later returned to Bangladesh against medical advice after just 10 days of treatment here. The last case involved a 69-year-old American man who suffered an infection that exacerbated his chronic obstructive pulmonary disease (lung disease) while touring Bangladesh in late 2016. The man was admitted to the intensive care unit of a hospital in Bangladesh, where he was treated with antibiotics, and was transferred to Singapore in early 2017. He suffered further complications, including cardiac arrest. C. auris was later found in his blood. No antifungal treatment was given following discussions with the patient's family. He was given palliative care and eventually died. This article was first published in The Straits Times. Permission required for reproduction.<doc-sep>
Doctor explains causes and treatments of thrush Candida auris is a fungus which has spread all over the world, raising alarm in the medical community. Discovered in 2009, the fungus has spread through at least 15 countries with deadly consequences. An elderly man was admitted to Brooklyn’s Mount Sinai Hospital last year, and blood tests revealed he was positive for candida. He was quickly confined to an intensive care unit but died three months after he was admitted. Even after it kills someone, candida auris remains active and continues to multiply. According to Dr Scott Lorin, Mount Sinai Hospital’s president, the fungus spread through the entire room the patient was quarantined in. Talking to the New York Times, he said: “Everything was positive — the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump. “The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive.” Candida auris: Mysterious infection labelled ‘serious threat’ as it spreads over the globe Hospital workers were forced to pry tiles from the floor and ceiling and use special cleaning equipment to get rid of the fungus. Candida also preys on those with a weakened immune system, making it even more deadly. In particular, it takes hold in hospital wards and breeds in people who are already sick. Hospitals in India, Pakistan, South Africa, Spain and a neonatal unit in Venezuela have all fallen victim to the fungus. Candida auris attacks those with a weakened immune system The Royal Brompton Hospital in the UK was forced to close its intensive care unit for two weeks in 2016 as candida swept through patients. Professor Hugh Pennington, professor of bacteriology at Aberdeen University said intensive care patients are among those most at risk. Talking to the Daily Telegraph, he said: “Candida is in itself a normal fungus which can be found in various places in the body, most notably as thrush. “When that happens, it’s a nuisance but it’s not life-threatening. “It becomes life-threatening in the situations we are seeing here, where it is infecting patients whose immune system is down.” Alternatives to antibiotics need to be developed to curb resistance Normally, fungal infections are treated with antifungal medication Fluconazole, but candida is resistant to this. This makes it a ‘superbug’, one of many infections which are developing a resistance to antibiotics. As a result, the Centre for Disease Control (CDC) has put the fungus on a ‘serious threats’ list. Scientists have warned unless a more viable treatment is made for viruses like this candida could start to infect those with a healthy immune system.