Doomsday fungus: Candida auris kills a third of those infected, American doctors are powerless
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American epidemiologists are sounding the alarm: the pathogenic fungus Candida auris is rapidly spreading in the country with high drug resistance and a mortality rate of at least 30% (our scientists give other figures – from 60%). So far, it mainly affects patients in long-term care hospitals and medical departments where seriously ill people are located. Since 2019, the number of cases has grown by 200% and continues to grow. The World Health Organization has already identified Candida auris as one of the most dangerous fungal pathogens of our time.
The scientists, who shared their findings in the Annals of Internal Medicine, are full of pessimism. Russian doctors, as MK found out, are also familiar with this fungus, the invasion of which began during the pandemic.
According to the US Centers for Disease Control and Prevention CDC, the number of fungal infections caused by Candida auris has tripled in just a couple of years, from 476 cases in 2019 to 1,471 cases as of December 31, 2021. Cases of asymptomatic carriage of this fungus have quadrupled: from 1077 to 4040 over the same period. And the growth continues.
So far, there is no evidence that this fungus poses a threat to healthy people whose immune system is able to fight it. It is also held back by the fact that this type of candida lives mainly in the tubes of ventilators, in catheters and other medical devices, so the count is still in the thousands of cases. Still, the new fungus poses a serious threat to people in poor health, including nursing home patients on ventilators and cancer patients undergoing chemotherapy. Candida auris can cause fatal infections in the bloodstream, heart, and brain. It is estimated that 30 to 70% of hospitalized people who develop bloodstream infections as a result of infection with this fungus die. The number of cases of infection, the authors of the publication note, is probably underestimated, since screening requires special equipment, which is not available everywhere. It cannot be ruled out that the number of victims is much higher – even in America, far from all patients who die after mechanical ventilation are tested for it.
CDC experts talk about the need to develop robust infection control plans to reduce transmission of the fungus. According to doctors, if the fungi settle in the hospital, they are very difficult to control and eliminate: they are very tenacious, can cause infections for a significant period of time, despite the efforts of the sanitary services. The fungus spreads through contact with infected patients and objects. The authors of the publication note that many disinfectants commonly used in medical settings do not work against this fungus.
And the coronavirus pandemic has only exacerbated these problems. Scientists from the Kazan State Medical University conducted research among patients with COVID-19: up to 62% of those hospitalized with various forms of the disease turned out to be carriers of Candida fungi; among intensive care patients, up to 90%.
According to Irina Nikolaeva, head of the Department of Infectious Diseases at Kazan State Medical University, more than 200 varieties of the Candida fungus are known today, and 30 of them are pathogenic for humans: “Today, candidiasis has become the most common invasive mycosis in patients with COVID-19 – up to 10% of cases. However, fungal infections in patients with covid often go undiagnosed with us, so their actual impact on mortality, hospital stay, and other complications remains unknown. Accession of a fungal infection usually occurs 7 or more days after hospitalization. In patients with COVID-19 and candidiasis, the mortality rate is 40-50%, and without antifungal treatment, everyone dies. Candida auris is a multidrug-resistant species that spreads rapidly among critically ill patients and causes outbreaks of nosocomial infections with high fatality rates of over 60%. This fungus is highly contagious and is easily transmitted from person to person and survives for a long time on surfaces. Severe pathologies develop in patients with reduced immunity and diabetes.”
…Scientists discovered Candida auris just over ten years ago: it was found in India, South Africa and South America. Fungi often cannot withstand human body temperature, but one of the leading theories suggests that Candida is now able to do so because it has evolved to survive global warming. This variety of Candida was first discovered in the United States in 2016 – the pathogen began to spread very quickly, including in the multidrug-resistant variant in the form of a nosocomial infection. The fungus is now found in more than half of the states, with 17 states reporting their first case between 2019 and 2021. In Russia, Candida has become one of the main nosocomial infections: it accounts for about 4,000 bloodstream infections with high mortality.
Candida auris is considered a major global public health threat because it is resistant to various classes of antifungal drugs, including the most effective against the Candida family, the echinocandins. According to US data, the number of echinocandin-resistant Cauris cases in 2021 was about 3 times higher than in each of the previous two years. There are several antifungal drugs in development, so this offers some hope. In Russian realities, the fungus demonstrates a slightly different drug resistance: as Irina Nikolaeva says, Candida auris in Russian hospitals is 100% resistant to the popular antifungal fluconazole (that is, it does not work at all), echinocandins are still working. But the most curious thing is that, despite the generally very high resistance to antimycotics, Russian patients with Candida auris respond well to the long-obsolete nystatin, which, according to Kazan doctors, “actualizes the return of the drug to practice.”
“Today we are seeing an increase in the resistance of circulating Candida fungi to antimycotics. This is an urgent situation – the emergence of such species with very high resistance and very high mortality. The manifestations of the disease are different: from an asymptomatic course to fulminant sepsis with multiple organ disorders. Diagnosis is difficult, the clinic is similar to bacterial sepsis. The risk factor is the prolonged use of a central venous catheter, the use of antibiotics, mechanical ventilation, the serious condition of patients, parenteral nutrition, ”says Dr. Nikolaeva.
American scientists are calling for increased testing, screening programs, special attention to surveillance, hand hygiene and deep cleaning with proper disinfectants. Because it is unlikely that it will be possible to create a vaccine against a dangerous fungus, and there is nothing special to treat it with yet. Well, pray that in the course of further evolution of Candida it does not cause a zombie apocalypse, as the creators of the Last of Us series have already prophesied.
Newspaper headline:
doomsday fungus
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