Since the pandemic, incidences of the harmful fungus Candida auris have dramatically increased.
On March 20, the Centers for Disease Control and Prevention released a warning regarding the fungus. Officials and experts issued a warning about Candida auris, which can be multidrug resistant, challenging to diagnose in a lab, and has been linked to outbreaks in medical facilities including hospitals and nursing homes. The Los Angeles County Department of Public Health has reported 2,377 clinical cases and 5,754 screening cases with a mortality rate of 30% to 60% in the past 12 months in the United States. However, a lot of the fatalities were in persons who had the fungus in their circulation, were immunocompromised, and typically had previous illnesses that made it difficult for them to fight off the infection.
According to Michael Yeaman, chief of molecular medicine at the Harbor-UCLA Medical Center and professor at the David Geffen School of Medicine, once the fungus enters the bloodstream, it can spread to other organs and disrupt the immune system.
According to Ashraf Ibrahim, a professor at the David Geffen School of Medicine and member of the infectious disease faculty at the Harbor-UCLA Medical Center, sepsis, the body’s extreme reaction to infection, which disrupts the blood vessel barrier and allows liquid from the blood vessels to enter the tissue and potentially causes organ failure, can result if the infection is not controlled. According to Zachary Rubin, MD, chief of the Healthcare Outreach Unit at the LA County Department of Public Health, once sepsis develops, there is no cure.
There are five distinct varieties of Candida auris, which are found all over the world and have different reactions to antifungal medications. For instance, the third type, which is less resistant to antifungal medications, predominates in LA, according to Rubin. Because of the global nature of travel, various strains of Candida auris have migrated to the United States over time, he added.
The U.S. has seen incidences of Candida auris, with the first cases of the disease in California being breakouts in senior facilities in Orange County in 2019, according to Ibrahim.
According to Rubin, the COVID-19 pandemic diverted focus from Candida auris. Many of the methods used to prevent infectious diseases before the Candida auris pandemic were less effective after the focus of infectious disease prevention measures moved to COVID-19 containment.
The number of persons who have been colonized by the fungus has doubled in the past year, according to Scott Filler, a professor at the David Geffen School of Medicine and the chief of infectious diseases at the Harbor-UCLA Medical Center.
According to the CDC, when a person has Candida auris colonization, the fungus is present on their body but they are not affected and do not show signs of illness. Only after Candida auris has entered a person’s bloodstream can it cause infection.
According to Filler, individuals are frequently colonized by Candida auris by close contact with both living and non-living things, and it can survive on non-living things for several weeks. Using catheters or other devices that come into contact with the bloodstream, for example, can allow an infection to enter the bloodstream and infect people who are older or immunocompromised.
According to Rubin, the CDC has not yet discovered an effective way to decolonize those who have been infected with Candida auris. However, he continued, only 5-10% of LA County residents who have Candida auris colonizations contract the infection.
Why is it so challenging to control and cure Candida auris?
A: According to Ibrahim, Candida auris is one of very few fungi that are multidrug resistant.
When medications are injected into Candida auris, some parts of its genome mutate, allowing the fungus to evolve and develop drug resistance, according to Yeaman. Based on its known resistance to medications previously used for therapy, he continued, the fungus can probably work to resist new drugs it hasn’t encountered before.
According to Ibrahim, Candida auris can be resistant to all of the drug classes used to treat fungi, making it challenging to treat a patient who has the illness.
“The likelihood that you will develop resistance to any new drug coming down the pipeline is extremely high when you have an organism that can show its resistance to several classes of drugs,” Ibrahim said.
“The likelihood that you will have resistance to any new drug coming into the pipeline is extremely high,” Ibrahim said. “When you have an organism that can show its resistance to several classes of drugs.” “(A drug) can stop working against the infection at any time.”
In addition to being challenging to treat, Filler added that Candida auris outbreaks are also challenging to control due to their rapid spread. For instance, even if a space was cleaned after being occupied by an infected person, an immunocompromised person can contract Candida auris. The fungus, he continued, is resistant to several of the soaps used to clean hospitals.
What treatments or prevention actions are available for Candida auris?
A: Hand washing and cleaning areas where Candida auris is known to exist are among the primary methods of infection control for this organism. Additionally, Rubin noted, there are more focused safeguards including contact protection measures like donning medical gowns.
Ibrahim claimed that in order to treat Candida auris in humans, researchers must create new medications.
Because fungi are eukaryotes and share features with mammalian cells, they have proven to be particularly difficult to treat, according to Ibrahim. “You really have to find the sweet spot where you have a drug that is not only nontoxic to mammalian cells but also really highly effective against them.”
Ibrahim noted that because Candida auris is a relatively recent danger, there is a dearth of financing for research into the illness, which has resulted in the approval of few antifungal medications to treat the condition. He continued, “New medications must be created that the fungus has not yet developed resistance to, and antifungal medications must still be used in order to treat Candida auris effectively.”
Yeaman continued, “Microbes will find a way to resist something, so maybe one of our strategies needs to be to stay just one step ahead.”
Depending on the type of Candida auris they have, Rubin said, people with the infection can still be treated with antifungal medications. He explained that, for instance, the antifungal medication most frequently used to treat yeast infections, or Candida infections, can be used to treat infections in LA.
The doctor has to transition to an older medicine class that might not be as effective and might have adverse effects whenever the fungus develops resistance to one drug class, according to Yeaman.
In-development medications that can be given intravenously or orally are showing promise in the treatment of Candida auris, according to Filler.
He continued by saying that a team at the Harbor-UCLA Medical Center’s Lundquist Institute is working on a vaccine that will lessen the severity of illness in people who have Candida auris infection. The creation of the vaccine involves Filler, Ibrahim, and Yeaman. If the vaccine yields positive results, Ibrahim added, it will be given to persons who have a high risk of colonizing and contracting the fungus, such as frequent visitors to nursing homes and ICU patients.
As the aging population increases and more people enter the population, it is crucial that medicines to prevent and lower infection levels are created.