Days after print publication, Bill Knight’s syndicated newspaper column, which moves twice a week, will appear here. The most recent will appear at the top. (Columns before Sep. 11, 2017, are archived at http://billknightcolumn.blogspot.com/).

Wednesday, July 5, 2023

The dangerous ‘fungus among us’ has spread in recent years

A drug-resistant fungus called Candida auris has been spreading through hospitals and nursing homes, the U.S. Centers for Disease Control and Prevention said last month

 

The Community Word addressed the rise of the fungus in September 2019, reporting that dozens of species of Candida exist – including about 20 strains of C. auris, according to Dr. John Farrell, who last month said, “C. auris is fairly widespread. It is now prevalent throughout Illinois.

 

“Like many other emerging pathogens before that arrive on the scene and gradually become endemic (for instance, West Nile) C. auris has become much more common since 2019. 

 

“The organism does not represent much of a threat to healthy individuals,” he adds, “– it is a yeast and we encounter yeast routinely in everyday life. But it does continue to represent a hazard to vulnerable people (for example, patients with immuno-compromising conditions such as cancer, AIDS, or who rely on medications to prevent organ rejection following transplantation or treatments for autoimmune conditions).”

 

The fungus can be harmless on the skin, but if it gets inside the body and enters the bloodstream, it can be fatal. In fact, the CDC says that almost half die within 90 days – although most of those cases are people with underlying conditions or are using devices such as catheters, central lines or ventilators.

 

Detected in Japan in 2009, C. auris has probably existed in some form for thousands of years, said Dr. Tom Chiller of Global Action for Fungal Infections, formerly with the CDC.

 

First reported in the U.S. in 2016, clinical cases of C. auris have exploded since.

 

As Farrell explained, C. auris is a yeast, but one with has three troubling characteristics, according to the National Institutes of Health: It’s often misidentified; its antifungal resistance makes it challenging to treat; and unlike other Candida species, it can survive on surfaces for weeks, and even for months on skin, allowing further transmission.

 

Spreading easily from person to person, C. auris therefore is difficult to prevent or eliminate.

However, “C. auris has not evolved into a multidrug resistant pathogen,” Farrell says. “It remains susceptible to most of the antifungal drugs at our disposal and treatment is effective when patients are capable of mounting an immune response. However, it IS resistant to standard disinfection measures and typically becomes a very tenacious resident of environmental surfaces and the skin flora [microorganisms on the skin] of patients.”

 

Indeed, C. auris moves within medical facilities by remaining on equipment or other surfaces, spreading by direct contact or even by the routine flaking of skin cells. Symptoms of Candida infections include fever and chills that persist despite antibiotic treatment for what’s suspected as a bacterial infection. The CDC says C. auris can be on the body without symptoms showing, making identification challenging before appropriate treatment can begin.

 

Almost four years ago, Farrell saw parallels between the reach of C. auris and the 2009-2019 pandemic of swine flu, the H1N1 respiratory disease that caused between 150,000 and 575,000 excess deaths, according to a study by the CDC and the World Health Organization.

 

“We were lucky more didn’t die [then],” Farrell said. “Farms where a lot of antibiotics and pesticides were used, keeping livestock well and weeds out of the fields meant a mixture [of factors], especially at pig farms. Pigs are the perfect vessel. From the same ecosystem [came] runoff and waste, which flowed into streams, and we got novel mutations: a new flu… a superbug.”

 

The emergence of C. auris also is similar to the appearance of Carbapenem-Resistant Enterobacteriaceae (CRE) [a group of gut-dwelling bacteria that no longer responds to many antibiotics],” Farrell said. “CRE suddenly showed up in London in an intensive-care unit that had to be shut down, then in Brooklyn, where it couldn’t be eradicated even after the outbreak was controlled.”

 

Today, science has developed new knowledge about the fungus, but no real “breakthrough.”

 

Research has “all just confirmed our initial impressions that it is extremely resilient and resistant to eradication from the environment.”

 

Also, there are no new treatments, Farrell says, “but the standard antifungal treatments are effective.

 

“The rub is balancing risk and benefits,” he continued. “It may require a more toxic medicine and a patient who’s going to need it may be fragile.”

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