Amidst growing concerns about other drug-resistant diseases spreading throughout the world, in the US, a fungal disease, Candida auris, is a particular worry in some healthcare circles. Capable of causing serious infections and even fatalities, the growing potential for a Candida auris epidemic demands understanding, continued surveillance, and appropriate preparations.
What is Candida auris?
Candida auris is a fungus in the yeast family. First identified in 2009 in Tokyo, it has since then become a global issue, with cases found in over 20 countries worldwide. The first cases in Europe appeared in 2016, with the first US cases following later in the same year. There is some evidence to suggest that different strains of C. auris exist in different parts of the world, with some significant genetic diversity between them. A total of 30 countries have reported cases of Candida auris.
Why is Candida auris a medical concern?
From a public health standpoint, the rapid spread of Candida auris is a serious concern due to the difficulties in positive identification and treatment. Due to its similarity to members of the same family of fungi, C. auris is often misidentified by many commonly used laboratory tests, including VITEK 2 YST, API 20C, BD Phoenix yeast identification system, and MicroScan. This is especially easy to do in mixed cultures, which are a relatively common occurrence when testing patient samples.
In addition to the problems of identification and potential misidentification, Candida auris is also resistant to many common treatments for fungal infection. The multi-drug resistance shown by C. auris introduces another layer of complication in controlling its spread. While consultation with a specialist is recommended, treatment of C. auris in individual patients often involves administering multiple classes of antifungal drugs at high doses.
Candida auris is dangerous as it can cause a number of health problems. A C. auris infection may result in invasive candidiasis, which can cause issues ranging from chills and fever to vaginal/genital infections, rash, invasive gastrointestinal infections, blood infections, and neurological issues. While research is ongoing and the overall sample size is small, death may occur in 30-60% of all cases where C. auris develops into a bloodstream infection. Immune-compromised patients, the elderly, and those living in cramped or unsanitary conditions are especially vulnerable.
Controlling the Spread of Candida auris
In a clinical setting, controlling the spread of Candida auris relies on rapid and accurate identification of the infection followed by strict adherence to proper infection control measures, which–per the CDC–include the following:
- Adherence to hand hygiene
- Appropriate use of Transmission-Based Precautions based on setting
- Cleaning and disinfecting the patient care environment (daily and terminal cleaning) and reusable equipment with recommended products, including a focus on shared mobile equipment (e.g., glucometers, blood pressure cuffs)
- Screening contacts of newly identified case patients to identify C. auris colonization
- Laboratory surveillance of clinical specimens to detect additional cases
Family members of patients should listen carefully to the guidance and protocols given by healthcare providers, and follow them strictly. C. auris spreads easily under the right circumstances, and limiting contact is a critical part of controlling it.
Individual Precautions for Candida auris
While there’s quite a bit of information regarding the spread, treatment, and control of Candida auris for hospitals and healthcare professionals, what can we as individuals do to protect ourselves from the disease? There’s some good news–while C. auris is a growing concern at the time of this writing, many public health entities are taking aggressive steps to stop its spread, and it is not found in most hospitals yet. Following basic precautions–handwashing and hand hygiene, following proper protocol when visiting hospitals and other medical facilities, and limiting contact with potential sources of infection, can reduce the spread.
However, we must emphasize that this is an evolving situation and that Candida auris is spreading rapidly. Staying informed is the best single precaution right now.