Candida Auris: An Emerging Threat in Healthcare Settings

Candida auris it is a yeast, a fungus, that can infect humans and was first identified in 2009. It is a very rare infection, of recent appearance and about which little is known. Se is a fungus that is usually contracted in hospitals, which mainly affects patients with a depressed immune system due to any cause and that it is highly resistant to the vast majority of existing antifungal treatments. It is for all this that it is a potentially very serious health problem.

How the Candida Auris fungus appeared

The first case of Candida auris It was isolated in the ear canal - hence its name - from a 70-year-old Japanese patient admitted to a Tokyo hospital. Under the microscope, a fungus of the genus Candida was observed that grew despite the presence of micafungin, an antifungal. The first cases of infection caused by Candida auris were detected in South Korea in 2011. These cases had initially been attributed to other fungi and the diagnosis of Candida auris was not established until genomic sequencing was carried out. Two of the patients died as a result of the generalized infection produced by this fungus.

During the years 2009 and 2011, more cases were detected in India in patients from different healthcare settings: medical, surgical, oncological, pediatric and neonatal. Many of these patients had candidaemia, a severe generalized Candida infection, and several of them had died.

The fungus spread to other continents and in early 2016 a strain that was multi-drug resistant was isolated in Southeast Asian countries. In Europe, the first case that was isolated was in October 2016 in a hospital in the United Kingdom. At the end of 2017, cases had also been detected in Pakistan, South Africa, Kenya, Kuwait, Israel, Spain, Venezuela, Colombia, Panama, the United States and Canada.

In several of these countries the cases have occurred in patients admitted to the same hospital center. Candida auris has been isolated from the floors of infected patient rooms, on furniture, on computing devices, and on windows. This fungus, unlike others, can survive for weeks on contaminated surfaces.

What does it mean for health

It is a threat to health at a global level since its infection poses a risk to the life of the patient. Is a very aggressive fungus that affects various organs, especially in patients with a compromised by other diseases or treatments, patients admitted to the ICU, patients with or carriers of pathways for a long time or patients with metabolic diseases. It can cause generalized candidemia, that is, its passage into the blood can cause the fungus to reach various organs, such as the central nervous system, kidneys, liver, musculoskeletal system, spleen or eyes.

Symptoms of Candida auris infection

The symptoms of this infection are nonspecific, with fever, chills, fatigue and general malaise, and it does not improve with taking antibiotics. The mortality of Candida auris infection is quite high, 40-70%, given that it often takes time to make a laboratory diagnosis, the fungus is frequently resistant to various treatments and affected patients usually have an altered immunity of base.

Diagnosis

The diagnosis of Candida auris infection is made with the same laboratory techniques used to detect infections by other fungi of the genus Since the cause of the infection can often be attributed to other fungi, the suspicion of its presence must be confirmed with molecular techniques in a reference laboratory.

Treatment

The treatment of Candida auris can be complex, since several of the isolates are resistant to two or more families of antifungals, such as fluconazole, voriconazole, amphotericin B, and echinocandins. Treatment must take into account the patient's condition and the in vitro sensitivity of the fungus before starting a therapeutic regimen.

Prevention

Prevention of infection must be carried out through strict hygiene measures by healthcare personnel when handling patients. Likewise, it is essential that patients infected with Candida auris remain in isolation to avoid contagion to other patients. Environmental decontamination will be carried out by extreme cleaning with soap and water and subsequent use of chlorinated products from floors and surfaces, 3 times a day. It is important to clean the material, equipment and apparatus after use with the colonized or infected patient.

Candida auris infection does not pose a danger to the health of the vast majority of us, but it does for people at risk, for whom it does carry a potential life risk. The health authorities of all countries, coordinated by WHO, are working to face this new health challenge.

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