WASHINGTON – A rapid rise in reports from around the world of a deadly fungal infection is sounding alarm bells about the dangers of drug resistant diseases.

First discovered in Japan in 2009, Candida auris is a type of yeast that can cause severe illness and spreads easily in healthcare facilities. Cases proliferated during the Covid-19 pandemic.

Widespread infections in the United States led the Centres for Disease Control and Prevention (CDC) to label it an “urgent threat”.

More recently, scientists in China called for closer monitoring of the potentially fatal fungus after a study found that almost all of the cases recorded there in 2023 exhibited resistance to drugs.

1. How prevalent is it?

First reported in the US in 2016, C. auris started to spread rapidly during the Covid-19 pandemic.

According to the CDC, in 2022 there were 2,377 American clinical cases, in which a patient presents with symptoms, and an additional 5,754 screening cases, in which an asymptomatic individual tests positive.

In the latest outbreak, four people tested positive for the diseases in Washington, the first ever report there.

A study led by researchers at Shanghai’s Fudan University and Tongji University found that there were 182 outbreaks of C. auris in China in 2023.

That is a marked increase from previous years, when the numbers ranged from eight to 26.

According to the study, almost all of the strains tested in China were resistant to the anti-fungal drug fluconazole, and a small percentage could not be treated with two other fungicides, caspofungin or amphotericin B.

The increase in cases could be due to enhanced efforts to detect the fungus.

Similar surges have been seen in some European countries, alongside outbreaks in India and South Africa.

2. How do you contract Candida auris?

C. auris is spread through contact with contaminated surfaces or by person-to-person transmission.

Most cases have been reported in healthcare settings such as hospitals and nursing homes, according to the CDC.

People with severe underlying medical conditions and those that spend a significant period in intensive care units are the most at risk.  

3. What are the symptoms of Candida auris?

The most common symptoms are fever, low blood pressure and chills and sweats that do not go away after treatment with antibiotics. But in many cases, there are no symptoms.

People can be “colonised” with C. auris, meaning they carry it on somewhere in their body, such as on their skin, rectum or mouth.

The risk of infection increases if invasive medical devices are used, such as breathing tubes, feeding tubes or catheters.

Carriers can also spread the fungus onto other people; if it enters the bloodstream or through open wounds, a severe infection may result.

Firm diagnosis requires sending a blood sample or sample from an infection site to a specialised lab to definitively confirm the fungus is present.

In the recent outbreak in China, most of the cases were identified in Eastern provinces, where health facilities are more advanced.

Due to the difficulties in diagnosis, scientists are concerned that the true number of infections across China could be much higher. 

4. Can it kill you? 

Yes, although it is not clear just how deadly it is.

The CDC put the mortality rate at 30 per cent to 60 per cent, based on information from a limited number of patients.

But the organisation said many of the victims also had other serious illnesses that may have increased the risk of death.

5. How is C. auris treated? 

Most fungal infections are treated with drugs known as echinocandins.

The CDC recommends three for C. auris: anidulafungin, caspofungin and micafungin. (Merck KGaA’s Cancidas and Pfizer’s Eraxis are among the brand names.)

While the CDC said echinocandins have worked on most strains found in the US, it warned that “this organism appears to develop resistance quickly”.

It called for careful monitoring, warning that patients with invasive infections generally remain colonised with C. auris “for long periods, and perhaps indefinitely”.

6. Why are fungal diseases becoming more common?

The World Health Organisation said we are seeing a rise in fungal infections due to global warming and the increase of international travel and trade.

In 2022, in a bid to boost research attention, the international health body released its first-ever list of the fungi that pose the greatest threat to public health, a list that included C. auris.

To tackle the rising threat, the Biomedical Advanced Research and Development Authority, a US government agency, announced in 2022 that it would begin funding private-sector companies to develop new antifungals. 

7.  What can be done to stop the spread? 

In healthcare settings, the CDC recommends using alcohol-based hand sanitisers and regularly cleaning the patient care area and shared medical equipment with hospital-grade disinfectants to stop the spread of C. auris. BLOOMBERG