A day after hospital officials found the first two cases of the fungus Candida auris in Louisiana, health experts are predicting there are likely more cases of the drug-resistant yeast lurking in hospitals and causing mysterious, hard-to-treat infections.
But despite the “superbug” status given to C. auris because it is so hard to kill, its presence is not cause for panic in the general public, doctors and researchers said. C. auris doesn’t typically impact most people even if it is an issue for hospitals already taxed by COVID-19 patients and people who are hospitalized with complicated health problems.
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“Candida auris is going to be on the suspect list now,” said Jeffery Hobden, a professor of microbiology at LSU Health Sciences Center, noting that it’s not something that’s typically on the minds of doctors. But he was quick to note that just a small subset of patients need to be concerned.
“This is not the end of the world,” said Hobden. “Most normal healthy people, this is just one more bug that is going to grow on you.”
It’s only among some patients and health care workers that the presence of the fungus is Louisiana is setting off alarm bells. Almost immediately after hearing about the two patients at University Medical Center, Dr. Alfred Luk, a physician who specializes in infectious disease in transplant patients at Tulane Health System, put on a medical gown and swabbed a patient for C. auris himself. He’s never treated a patient for this rare type of fungus, but it’s been lurking in the back of his mind as a possibility after outbreaks in Miami and Texas hospitals last year.
“It has an uncanny ability to colonize people,” said Luk. “It became a big problem for closed units – it can quickly spread from patient to patient.”
Candida auris was first detected in the U.S. in 2009, and infections have been growing each year. It spreads easily – from skin to skin or even by an infected health care worker who touches an object like a bedsheet.
C. auris is part of a family of yeast fungi, some of which naturally grow on the skin, gut and genital tract. But this strain is what’s known as an opportunistic fungus – it grows out of control in some people, entering the body through a wound or medical device and causing deadly infections when it reaches other organs, such as the kidney or brain.
When that happens, doctors don’t have as many options as they do with other fungi. The yeast evolved to be resistant to the few antibiotics in the infectious disease toolkit, a product of the overuse of antibiotics in people and on farms.
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“Ever since they introduced penicillin back in the ‘40s, there’s been an arms race between microorganisms and mankind,” Hobden said. “Whenever we come up with new antibiotics and introduce them clinically, the organism finds ways to compete, they evolve and develop resistance.”
What happens next will largely depend on the source of C. auris. Past outbreaks in other areas have shown that sometimes the spread can be traced to a single source, which is easier to eliminate, said Luk.
In one instance reported in the New England Journal of Medicine, a reusable temperature probe was transferring the pathogen between patients. Because University Medical Center in New Orleans had two patients diagnosed with C. auris, they should be following protocols that compare all the common potential sources between those patients, said Hobden.
C. auris can also so thoroughly contaminate a hospital room that ceiling tiles and drywall may have to be removed, said Luk, recalling a case in New York City.
A representative for University Medical Center, which is owned by LCMC Health, said there were no updates to share on additional patients or a common source of infection.
COVID-19 further primes hospital settings for Candida auris outbreaks, health experts said.
While infection precautions like wearing gowns, masks and handwashing may seem like they would help prevent spread of infectious disease, C. auris preys upon people who have long hospital stays, such as COVID patients in intensive care units. The steroids doctors have found work well against the coronavirus put patients at risk for pathogens like C. auris because they work by tamping down the immune system’s response. And the devices that help keep patients alive while fighting COVID – ventilators, IV lines, catheters – give the germ additional points of entry into the body.
“They’re a perfect colonization risk,” said Luk, of COVID patients. “Their immune systems are blunted, so they’re definitely at risk for getting an invasive infection.”
The mortality risk is high among people who are identified with C. auris – between 30% and 60% – but it can be very difficult to diagnose and is often only detected in very sick people for whom all other causes have been ruled out.
Symptoms are common, like fever and headache, and the fungus often infects people who have a host of other medical problems, said Dr. Hong Xin, who researches the development of vaccines and monoclonal antibodies for Candida infection at LSU Health Sciences Center. Newborns and people in nursing homes with infections should be tested more often to check for the fungus.
“They can deteriorate really quickly without even being diagnosed or knowing what’s going on,” said Xin.
But the fungus will not kill the majority of people, even if it does happen to start growing on their skin. It is considered a secondary infection that happens after someone has already been hospitalized for something else. Deaths usually occur in people fighting a number of conditions. However, the cost and burden on an already strapped medical system is high, said Xin, totaling in the billions yearly. According to one study published in Clinical Infectious Diseases in 2020, the average cost of hospitalization for someone with invasive candida was between $64,723 to $153,090 depending on insurance.
Emily Woodruff covers public health for The Times-Picayune | The New Orleans Advocate as a Report For America corps member.
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