A concerning fungus among us

NICK EICHER, HOST: Coming up next on The World and Everything in It: A new threat in American health facilities.

From mushrooms to yeast, fungus is everywhere and generally nothing to worry about. But a fungus in the yeast family that’s now spreading across the U.S. is causing concern among health officials.

MARY REICHARD, HOST: Back in June, the Wall Street Journal reported what’s causing that concern: infections from Candida auris. The CDC says that it’s “a serious health threat in part because the fungus is resistant to many antifungal drugs.”

So, how bad is it? WORLD’s Mary Muncy has the story

MARY MUNCY, REPORTER: Hospitals across the U.S. are learning how to screen for the multi-drug resistant fungus Candida auris, or C. auris.

ALABAMA REGIONAL CENTER WEBINAR: There are key things that we can do to stop the spread.

CDC WEBINAR: Today’s webinar is going to delve into the basics of what we call colonization screening.

JEMS: So who is at risk for contracting this infection?

C. auris was first identified in Japan in 2009. That particular strain, or clade, was mostly found in people’s ears—hence “auris.” Since then, clades have been identified in at least 30 countries.

This is Meghan Lyman, a medical officer in the CDC’s mycotic diseases branch.

MEGHAN LYMAN: And those were likely introduced from other countries, you know, likely through patients who were colonized and came here. But it's interesting that they all seem to kind of arise at the same time in different parts of the world and then get introduced around the same time here in the U.S.

The first cases weren’t found in the U.S. until 2016. Now, there are three main areas where C. auris is found: the Northeast, the Midwest, and the Southwest coast.

Earlier this year, the CDC reported over two thousand clinical cases of C. auris infections in 2022. That seems like a small number in a country of almost 350 million, but because the fungus is often resistant to standard treatments and is invisible to the naked eye, it is a growing concern.

For the most part, C. auris stays on someone’s skin—outside their body those people are considered colonized, not infected, and don’t have symptoms. They likely won’t even know they have it.

LYMAN: We find that like five to ten percent of colonized individuals will develop invasive infections.

C. auris can infect anyone, but it mostly affects people recovering from a procedure that addresses a severe or dangerous condition. For example, a patient who is on a ventilator or has another invasive medical device.

Infection symptoms can range from fever, chills, and sweats, to low blood pressure—the common signs of any type of infection.

LYMAN: There are no specific signs and symptoms for Candida auris. It's similar to other bacteria and fungi, and really depends on the body site that's infected.

This particular fungus is resistant to what Lyman calls the “first line” antifungals.

So what makes C. auris dangerous is not diagnosing it early and prescribing the right antifungal.

Lyman says a few rare cases have been resistant to all three major classes of antifungals.

She says there hasn’t been much study into whether antifungals will also decolonize someone. So while antifungals may kill an infection, the fungus may still be on a patient’s skin, putting them at a high risk of reinfection.

LYMAN: So right now, our only method is for them to not become colonized. So doing as much as we can to prevent that and ultimately prevent them or anyone else they could spread it to from developing an infection is the ultimate goal, but the speed that it spreads makes that really challenging.

If someone is infected, officials put the mortality rate anywhere from 30 to 60 percent.

The wide range is because it’s typically not affecting healthy people, so it’s hard to tell what caused a patient’s death. Was it really the fungus? Or was it actually the medical condition that made them vulnerable in the first place? Or some combination of the two?

Another pressing question is why the fungus is spreading now.

Lyman thinks the spread in healthcare facilities has to do with infection control and the quick identification of cases.

LYMAN: The timing of this increase, and, you know, some findings from our public health investigations, also make us think that the spread of C. auris may have worsened due to the strain on, you know, health care and public health systems during the COVID pandemic just because there were you know staffing shortages, increased patient burden and severity, changes in patient movement patterns and you know, a focus on COVID so perhaps worse infection control for non-covid reasons.

C. auris likes hot, salty environments—like human skin and then sheds onto other things to spread. So, one of the best ways to prevent the spread is to clean surfaces with a bleach-based cleaner.

LYMAN: It's tough, because you know, you can't see it. And so doing thorough cleaning is—can be really challenging, but it's really, really important to prevent the spread.

As of December 2022, 29 states had told the CDC that they detected C. auris.

Dr. Ihsan Azzam is the chief medical officer for the state of Nevada.

IHSAN AZZAM: I would say really, that Candida auris is everywhere in healthcare facilities. And it's either unreported or undetected, because it is there. And it's really difficult to get rid of.

Nevada has reported the highest number of clinical cases. Azzam says that if you’re looking for it, you’ll find it.

AZZAM: It is not a bad thing that our facilities were able to detect it. And we are following it, and actually taking precautions I hope I can say, to eliminate it. But I don’t think we can. Just hopefully we can reduce the spread and control it.

So if controlling the spread of this fungus is the best we can hope for right now, is it something we should be worried about?

For healthy people with no immune system concerns or invasive surgeries on the horizon, the answer is no. But for those with family members who may be at risk, C. auris could enter the bloodstream or internal organs and cause an infection. For them, a C. auris infection could lead to medical complications or even death.

So the best things to do are be aware of where in the country the fungus is spreading, get tested if it’s near you, and take some extra precautions like gloves and gowns. And, as always, wash your hands.

Reporting for WORLD, I’m Mary Muncy.

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