In around the 2000s a fungus called Candida auris started to spread across the world. It’s nothing special to look at – just another member of the sprawling Candida family of yeasts. Most of these yeasts live harmlessly on the skin or moist surfaces of the human body. But some, if they enter the body, can lead to infections.
Of these infecting yeasts, the most widespread is Candida albicans. This fungus causes the infection of the mouth known as “thrush.” Its effects are also sometimes referred to simply as a “yeast infection.” And on whichever part of the body C. albicans infects, it can cause itching and soreness, while sometimes even leading to fevers.
However, whereas C. albicans is generally just a nuisance that can be treated with pills and creams that one can buy over the counter, C. auris poses a new menace. Unheard of until 2009, it’s now spreading across the world. And doctors are at a loss about how to deal with it.
You see, C. auris poses a particular problem for scientists: it’s hard to tell that it’s around unless advanced techniques are used. If it is mistaken for another type of fungus, moreover, there’s a good chance that it won’t be properly managed. And it’s important to get it right because it may end up being transmitted throughout a hospital without the right steps being taken to prevent it.
In Latin, auris means “ear.” And the yeast is so named because it was first discovered in material that had come from this part of a Japanese patient’s body, although this isn’t the only area that it can infect. The word Candida, meanwhile, also comes from the Latin, and it means “bright white” – even though C. auris appears gray when it’s cultured.
One of the chief causes for concern with C. auris is that it can often withstand antibiotics. Indeed, the drugs that doctors typically employ to clear up Candida infections often cannot fix it. And this is a growing problem for health professionals: apparently, more than 20,000 deaths occur each year in the United States as a result of such so-called “superbugs.”
It’s important to note, too, that this kind of resistance hasn’t been seen in other versions of Candida on the whole. However, when it comes to C. auris, as many as nine out of ten infections have proven resistant to one of the drugs used to treat it. And three out of ten times, more than one type of antibiotic has failed to work.
According to the U.K.’s Healthcare Infection Society, this issue of resistance to antibiotics has become very prominent. So much so, in fact, that a reported 700,000 people die annually from infections that cannot be treated with the drugs that we rely on. And this number may rise to as many as 10 million each year by 2050, the society says.
As Centers for Disease Control & Prevention (CDC) medical officer Alexander Kallen explained to StatNews in January 2017, some bugs are now evolving more quickly than scientists are able to keep up with. “We have relied for so long on just newer and newer antibiotics,” he said. “But obviously, the bugs can often [develop resistance] faster than we can make new ones.”
Indeed, Imperial College London fungi expert Matthew Fisher told The New York Times in April 2019 that drug resistance is now a huge issue. “It’s an enormous problem,” he admitted. “We depend on being able to treat those patients with antifungals.” But it may be this very dependency that’s caused the surge in resistant organisms.
While antifungals are crucial in fighting human infection, they’re much utilized in preventing rot in plants as well. And scientists now say there’s evidence that using antifungals to keep crops free of disease has contributed to the increase in the numbers of fungi that resist medicines in human beings. Furthermore, poor dosing levels or not applying medication for long enough may boost resistance, too.
On top of this, there’s a degree of evidence that antibacterial drugs working in the gut may create conditions that are good for Candida. Although it’s not possible to say for sure that lowering antibiotic intake will lessen fungal infections, the CDC is certain that proper use of medications is crucial in tackling the issue of resistance.
Given that Candida strains can live quite happily in the gut or on the skin, it’s no surprise that C. auris readily spreads. Equipment and surfaces can become contaminated, you see, and once a person has an infection, the yeast can move from them to other people. But precisely just how it spreads isn’t yet entirely clear.
However, while we may not know all the details of the how the germs spread, we nonetheless know that they do. C. auris can travel throughout hospitals on apparatus or people’s hands, for instance. Plus, once the germs are in one healthcare establishment, they can easily be transmitted to another. They can also be transported in meat or on produce that has been fertilized with infected manure. The yeast even crosses borders, in fact, hitching rides on travelers and goods.
What’s more, the spread of C. auris can be astonishing. After a patient who’d tested positive for the condition passed away following three months of treatment in The Mount Sinai Hospital, New York City, the fungus proved very hard to get rid of. Even specialized equipment wasn’t up for the task , in fact, and some parts of the room had to be torn out to get the job done.
Hospital chief Scott Lorin told The New York Times just how extensively the yeast had infested the room. He said, “Everything was positive – the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the pump.” And that wasn’t all, he explained, listing even more places that had subsequently tested positive for C. auris.
As we noted earlier, C. auris was first discovered in the ear canal of a Japanese patient. However, although the scientists who found it thought that they’d isolated a single new species, it may be that there are four separate strains of the yeast – and they’re all somewhat resistant to drugs.
When scientists investigated the fungus’ genome, you see, they determined that it comes in four types. And this quartet of variations are so different that they may have separated into strains in the distant past, each one becoming resistant to drugs. One of the researchers, Snigdha Vallabhaneni, told The New York Times, “Somehow, it made a jump almost seemingly simultaneously and seemed to spread. And it is drug resistant, which is really mind-boggling.”
Interestingly, Vallabhaneni’s boss, Tom Chiller, has a theory that C. auris may well have been around for milennia. For most of its history, though, it hasn’t been all that aggressive. But as powerful chemicals destroyed more common fungi, opportunity knocked for C. auris. And while antifungals slaughtered its competitors and created room for it, it thrived.
Whatever the exact origins of C. auris, though, since 2009 it has begun to pop up all over the globe. In 2011 it was spotted in South Korea. And now, more than 30 countries have reported infections. However, it’s also thought that the yeast may be present in other nations that just haven’t yet identified it.
There is some good news, though: it does at least seem that awareness of the problem is spreading. As we’ve heard, there are different strains of the fungus, and these are seen in different parts of the planet. And further comparisons between these known types have suggested that the one that’s found in the U.K. may be yet another separate strain of C. auris.
When C. auris first showed up in the U.K. in 2015, it caused panic. For example, London’s Royal Brompton Hospital phoned university expert Johanna Rhodes for help. And in an April 2019 interview with The New York Times, she recalled what the medical facility had told her: “We have no idea where it’s coming from. We’ve never heard of it. It’s just spread like wildfire.”
Meanwhile, in Valencia, Spain, C. auris broke out in a hospital that has 992 beds. Its effects were incredible, with more than 350 people contracting the condition while not becoming ill, and in excess of 80 coming down with infections. Worse was to follow, however, with more than four in ten of those infected passing away within a month.
Frighteningly, somewhere between three and six out of every ten people involved in outbreaks of C. auris have perished. The story is somewhat complicated, though, because a large number were patients who had already been sick. The CDC also says that it is not sure whether these infections are any more dangerous than those of other Candida species.
C. auris has led to infections of the bloodstream as well as of wounds and ears. Once in the blood, it can of course spread throughout the organs of the body. But while it has been found in specimens taken from the urine and respiratory matter, it’s still not certain that it actually infects the bladder or lungs.
Not everyone is at high risk of infection, however. Candida fungi can be found in people who are perfectly healthy, in fact, as a quite normal part of the gut, mouth or skin. Usually, growth of the yeasts is kept down by the immune system and other microbes fighting for space.
Consequently, C. auris infection most often occurs in people who are already sick, especially those who have lines that intrude into the body. Those with weak immune systems – often when that’s been caused by conditions such as HIV or diabetes – are most at risk, along with people who’ve just undergone operations.
Because it’s most often encountered in a medical setting, travel to places that have reported C. auris shouldn’t be too dangerous, according to the CTC. If you’re hospitalized, however, you may become prey to the superfungus. What’s more, a darker future could lie ahead if current trends continue, with the drug-resistant organism potentially running rampant.
Indeed, some experts think that even healthier people could come under threat from the superfungus and its ilk. Within a little more than three decades, more people may be dying of infections by drug-resistant organisms than of cancer. Scientists warn of the need for new drugs and of the importance of ceasing to overuse the ones that we already have.
Meanwhile, the superfungus has reached the United States. A woman from the United Arab Emirates entered a New York hospital in May of 2013, as she was having difficulty breathing. And although she came up positive for C. auris, the hospital apparently didn’t think that it was especially important until a 2016 CDC alert confirmed the danger of the yeast.
However, the yeast may have killed even before then in America, as the patient in question didn’t have the particular strain that prevails there. This version of the fungus was responsible for the demise of an American who’d gone to India in 2017. She’d undergone surgery there and had become infected. The patient was returned to the U.S. by plane but subsequently passed away from her condition in Texas.
Said woman was just one of nearly 600 people who’d been infected by C. auris in the U.S. by April 2019. More than half of those infections had occurred in New York, while New Jersey and Illinois had also seen more than 100 cases each. And it’s not just in hospitals, either; some Chicago nursing facilities are finding that half of their residents have contracted the superfungus as well.
It’s perhaps no wonder, then, that after warning medical professionals about the yeast, the CDC became swamped with emailed queries. It seems that even some of those who nurse the sick may be concerned about their own wellbeing. One doctor told The New York Times about the fear that he’d felt when treating an infected patient. “I found myself not wanting to touch the guy,” he admitted. “I didn’t want to take it from the guy and bring it to someone else.”
Perhaps this concern is partly fueled by how hard it is to detect the superfungus. It can only be diagnosed by examining the cultures of various bodily fluids. Even this test isn’t straightforward, though, since it’s hard to tell C. auris and C. haemulonii apart. And you can’t deduce whether somebody has the infection just from inspecting their physical condition.
Indeed, some people don’t exhibit symptoms at all, so they have no idea that they’re spreading the superfungus. The CDC says as many as 10 percent of people who underwent its superbug screen did in fact have a disease that was resistant to drugs and didn’t even know it.
Moreover, you also may not even know that you’ve been infected if you’re sick with something else. Symptoms such as chills and fever that persist are common, but they can of course have other causes, and only the lab can say for sure. But if you’re diagnosed with a superfungus infection, is there anything you can do about it?
In some cases, the strain of C. auris in question will turn out to be susceptible to a type of drug named an echinocandin. But some versions of the superfungus not only resist this medication but also the other two principal potential cures. And when this happens, the best hope is that large doses of a mixture of medicines will clear it up.
Given the difficulty of dealing with the superfungus, then, the CDC advises that even medical professionals should consult an expert when they come across it. Meanwhile, the CDC continues with its job to try to restrict the spread of the yeast. This isn’t easy because no one wants to admit that they have had an outbreak. And in some cases, states have allegedly even refused to share any information publicly beyond confirming that they’ve had cases.
Nonetheless, the CDC issues detailed guidelines for both medical staff and laboratories. Its aim is to make sure that labs can spot C. auris and that people keep their hands clean with sanitizer and soap after coming into contact with the infected. But knowledge about the superfungus remains limited.
Indeed, Tom Chiller, chief of the CDC’s fungal team, which is trying to halt the superfungus in its tracks, outlined to The New York Times the scale of the problem. He said, “It bubbled up, and now it is everywhere.” And Chiller didn’t hold back when describing the organism, either, adding, “It is a creature from the black lagoon.”