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Biological Health Hazard – (fatal) Invasive, Multi drug-Resistant Candida auris: USA


Published Date: 2017-03-12 14:21:26
Subject: PRO/EDR> Candida auris – USA
Archive Number: 20170312.4895788

Date: Fri 10 Mar 2017
Source: Washington Post [edited]

Nearly 3 dozen people in the USA have been diagnosed with a deadly and highly drug-resistant fungal infection since federal health officials first warned clinicians in June 2016 to be on the lookout for the emerging pathogen that has been spreading around the world. The fungus, a strain of a kind of yeast known as _Candida auris_, has been reported in a dozen countries on 5 continents starting in 2009, where it was first found in an ear infection in a patient in Japan. Since then, the fungus has been reported in Colombia, India, Israel, Kenya, Kuwait, Pakistan, South Korea, Venezuela, and the United Kingdom.

Unlike garden variety yeast infections, this one [not only can] cause serious bloodstream infections, but spreads easily from person to person in health-care settings, and survives for months on skin and for weeks on bed rails, chairs, and other hospital equipment. Some strains are resistant to all 3 major classes of antifungal drugs. Based on information from a limited number of patients, up to 60 per cent of people with these infections have died. Many of them also had other serious underlying illnesses. Those at greatest risk are individuals who have been in intensive care for a long time or who are on ventilators or have central line catheters inserted into a large vein.

In the USA, the largest number of infections has been reported in New York, with at least 28 cases, according to the Centers for Disease Control and Prevention [CDC]. Infections have also been reported in Illinois, Maryland, Massachusetts, and New Jersey. Last June 2016, CDC sent an urgent alert to clinicians to start looking for the infections, which are difficult to identify with standard laboratory methods.

As soon as we put out that alert, we started to get information about cases and now we know more about how it spreads and how it’s acting,” Tom Chiller, CDC’s top fungal expert, said in an interview on [Thu 9 Mar 2017]. CDC now tracks the number of infections, updating the case count every few weeks. In addition to the 35 infected patients, an additional 18 were carrying the organism but weren’t sickened by it.

The microbe is among a group of newly emerging drug-resistant threats, health officials said. “These pathogens are increasing, they’re new, they’re scary and they’re very difficult to combat,” Anne Schuchat, CDC’s acting director, said during a briefing in Washington this week [week of 6 Mar 2017] about growing antimicrobial resistance. Of the 1st 7 cases that were reported to CDC last fall [2016], 4 patients had bloodstream infections and died during the weeks to months after the pathogen was identified. Officials said they couldn’t be sure whether the deaths were caused by the infection because all the individuals had other serious medical conditions. 5 patients had the fungus initially isolated from blood, one from urine, and one from the ear.

The infection is still relatively rare. “It’s really hitting the sickest of the sick,” Chiller said. So far, the fungus doesn’t seem to be evolving into new strains within the United States. Because the country doesn’t yet have any “homegrown” strains of the deadly fungus, “it gives us a better opportunity to contain it and stop it from spreading,” Chiller said. In other countries, infections have been resistant to all 3 major types of antifungal drugs, but so far the US cases have been treatable with existing drugs.

Because invasive bloodstream infections with candida are common in hospitalized patients in the United States, health officials are concerned that this deadly strain could “get into that mix,” Chiller said. Unlike candida infections in the mouth, throat or vagina (which are typically called yeast infections), invasive yeast infections can affect the blood, heart, brain, eyes, bones, and other parts of the body and are more dangerous.

Among infectious disease clinicians and laboratory personnel, infections involving fungi don’t typically ring the same kind of alarm bells as antibiotic-resistant bacteria — until now. “This is a paradigm shift, because candida is not generally thought of as highly resistant or passed person to person,” Chiller said. Since CDC issued its alert in June [2016], the agency has provided funds and additional expertise to help regional laboratories and hospitals identify the organism.

[byline: Lena H Sun]

communicated by:

[_C. auris_ phenotypically resembles _Candida haemulonii_. Commercially available biochemical-based tests, including API strips and VITEK-2, used in many US laboratories to identify fungi, cannot differentiate _C. auris_ from related species. Because of these challenges, clinical laboratories have misidentified the organism as _C. haemulonii_ and _Saccharomyces cerevisiae_. Many clinical laboratories do not fully identify all candida to the species level, and _C. auris_ isolates have been reported as “other _Candida_ spp and many do not perform antifungal sensitivities on the isolates. Isolates of _C. auris_ have been sensitive to the echinocandin type of antifungals which are only available for intravenous administration, not orally. – Mod.LL

A HealthMap/ProMED-mail map can be accessed at:]

See Also


Candida auris – Americas (02): USA, 1st isolates 20161105.4608846
Candida auris – Americas: emerg, drug-resist, nosocom pathogen, PAHO/WHO, alert 20161005.4537152
Candida auris: emerging, drug-resistant, nosocomial pathogen, alert 20160702.4322149

A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases

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