CANDIDA AURIS ANOTHER DEADLY FUNGUS ON RAMPAGE

Antibiotic resistance is a current global crisis and it has been estimated that antibiotic-resistant bacteria will kill more people than other infectious diseases in the coming decades if it continues unabated. It is no doubt that global attention has been given to bacteria as the major culprit in antimicrobial resistance particularly antibiotics. Bacteria such as Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae, Mycobacterium tuberculosis to mention few. Little is known about potential abilities of other pathogens such as fungi in development of antimicrobial resistance which could also be of significant health impact. Candida auris is just one of the unsuspecting fungi that slipped out of our fingers. Believe me, this fungus is fast emerging as a deadly killer in the hospital settings.

A QUICK LOOK AT CANDIDA AURIS AS A FUNGAL PATHOGEN

Candida auris is a species of a yeast-like fungus with characteristics that fit into the genus Candida and was first isolated as an infectious agent from a patient’s ear. It can cause severe infections and illness in some hospitalized patients. It was first described in 2009 and is known to cause sepsis in humans. Of note is its multidrug resistance to multiple classes of antifungal drugs that are commercially available.

Candida auris is an emerging fungus that is currently a global health threat, not only because of its multidrug resistant ability to various antifungal drugs but also because it is often acquired in the hospital and is very difficult to identify by normal standard laboratory methods for fungus except with the use of specific microbial technology such as whole-genome sequencing (WGS) which has the highest specificity of strain identification. Identification of C. auris is important because a wrong identification often leads to wrong diagnosis and therapy and may consequently lead to the death of the patient.

In 2016, the Centers for Disease Control and Prevention (CDC) issued a C. auris clinical alert which was later updated in 2017. Shortly after that, precisely a year later an Oklahoma hospital reported a case of a patient with the multidrug resistant fungus Candia auris, although it was quickly contained and prevented from spreading by the intervention of CDC. C. auris can spread from person to person in the hospital or any health-related facility and it is often difficult to control, it can survive well on surfaces for several weeks and it is resistant to treatment. The mortality rate is high, according to published reports, at least one in three patients with an invasive C. auris infection dies.

BLOODSTREAM INFECTION IS ONE OF CANDIDA AURIS DEADLY INFECTION

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Bloodstream infection is also known as sepsis is an infection that is spreading to the other parts of the body via the bloodstream. It is usually life-threatening because the whole body fights to prevent the infection and will likely develop a low blood pressure which can lead to poor blood circulation especially to vital tissues and organ. What happens next is organ failure if appropriate treatment is delayed in this case.

C. auris is also known to be responsible for certain bloodstream infections especially among those who are hospitalized, diabetic, those who are recovering from surgery or those under broad-spectrum antibiotic/antifungal treatment. This pathogen’s infection may be confused with bacteremia or other fungal infection. That is why proper diagnosis is required for the identification and isolation of this pathogen. In most case, whole-genome sequencing is the best and most accurate method of identifying it. C. auris is also responsible for other types of infection such as wound and ear infection. It has been isolated from the respiratory specimen and urine but it is not clear whether this pathogen causes lungs or bladder infections.

GLOBAL SPREAD OF C. AURIS AND THE RISK FOR TRAVELERS

Unlike bacteria with resistant mechanisms to last line antibiotics that are disseminated via mobile genetic elements, C. auris, according to whole-genome sequencing fingerprinting data, has suggested that C. auris emerged independently in multiple regions at roughly the same time and these regions include South and eastern Asia, Southern Africa and South America. For the fact that C. auris is endemic in these regions doesn’t mean travelers are at risk of the infection. Travelers may only be at risk of infection if they are admitted to the hospital in such region. C. auris are treatable but with a class of antifungal drugs called echinocandins.

Echinocandins. are a new class of antifungal drugs that act by inhibition of β (1, 3)-D- glucan synthase, a key enzyme necessary for integrity of the fungal cell wall. The use of this drug is necessary due to increase in invasive fungal infections. Antifungals such as Amphotericin B and azole antifungals have been the mainstay of antifungal therapy so far. However, due to high incidence of infusion related toxicity and nephrotoxicity with amphotericin B and the development of resistance by certain strains Candida glabrata to fluconazole necessitate the search for alternatives.

PREVENTION OF C. auris is very important. The CDC has a detailed catalog for the recommended procedure for prevention such as isolation of patient and special therapy for a positive patient, however, basic hospital hygiene such as hand washing and disinfection of the environment can go a long way to prevent this pathogen.

Image Credits pixabay

References
Echinocandins: A ray of hope in antifungal drug therapy
Bloodstream Infections by Carlos Franco-Paredes MD, MPH
Candida auris | Fungal Diseases | CDC
Recommendations for Infection Prevention and Control for Candida