A mysterious deadly infection is loose around our planet and is shrouded in a cloak of secrecy and the drug-resistant germ called Candida auris is on the rise and has become a very serious health threat around the globe, leading the federal Centers for Disease Control and Prevention to add it to a list of germs deemed “urgent threats.”
The New York Times reports, in late 2015, Dr Johanna Rhodes, an infectious disease expert at Imperial College London, got a panicked call from the Royal Brompton Hospital, a British medical centre outside London.
C. auris had taken root there months earlier, and the hospital couldn’t clear it.
‘We have no idea where it’s coming from. We’ve never heard of it. It’s just spread like wildfire,’” Dr Rhodes said she was told.
She agreed to help the hospital identify the fungus’s genetic profile and clean it from rooms.
Under her direction, hospital workers used a special device to spray aerosolized hydrogen peroxide around a room used for a patient with C. auris, the theory being that the vapour would scour each nook and cranny.
They left the device going for a week.
Then they put a “settle plate” in the middle of the room with a gel at the bottom that would serve as a place for any surviving microbes to grow, Dr Rhodes said.
Only one organism grew back. C. auris. It was spreading, but word of it was not.
The hospital, a speciality lung and heart centre that draws wealthy patients from the Middle East and around Europe, alerted the British government and told infected patients, but made no public announcement.
“There was no need to put out a news release during the outbreak,” said Oliver Wilkinson, a spokesman for the hospital.
Dr Silke Schelenz, Royal Brompton’s infectious disease specialist, found the lack of urgency from the government and hospital in the early stages of the outbreak “very, very frustrating.”
“They obviously didn’t want to lose reputation,” Dr Schelenz said.
“It hasn't impacted our surgical outcomes.”
By the end of June 2016, a scientific paper reported “an ongoing outbreak of 50 C. auris cases” at Royal Brompton, and the hospital took an extraordinary step: It shut down its I.C.U. for 11 days, moving intensive care patients to another floor, again with no announcement.
Days later the hospital finally acknowledged to a newspaper that it had a problem.
A headline in The Daily Telegraph warned, “Intensive Care Unit Closed After Deadly New Superbug Emerges in the U.K.”
(Later research said there were eventually 72 total cases, though some patients were only carriers and were not infected by the fungus.)
Yet the issue remained little known internationally, while an even bigger outbreak had begun in Valencia, Spain, at the 992-bed Hospital Universitari i Politècnic La Fe.
There, unbeknown to the public or unaffected patients, 372 people were colonized — meaning they had the germ on their body but were not sick with it — and 85 developed bloodstream infections.
A paper in the journal Mycoses reported that 41 per cent of the infected patients died within 30 days. A statement from the hospital said it was not necessarily C. auris that killed them.
“It is very difficult to discern whether patients die from the pathogen or with it since they are patients with many underlying diseases and in very serious general condition,” the statement said.
As with Royal Brompton, the hospital in Spain did not make any public announcement. It still has not.
Coming to America In the United States
587 cases of people having contracted C. auris have been reported in the US, concentrated with 309 in New York, 104 in New Jersey and 144 in Illinois, according to the C.D.C.
The symptoms — fever, aches and fatigue — are seemingly ordinary, but when a person gets infected, particularly someone already unhealthy, such commonplace symptoms can be fatal.
Reports and more information can be found here at the Mycotic Diseases Branch at the Centers for Disease Control and Prevention (CDC). As part of the CDC Expert Commentary Series on Medscape, I would like to tell you about Candida auris, a novel yeast that is behaving in unexpected and concerning ways, causing severe disease in countries across the globe, including the United States. Today we'll share how you can protect your patients from this potentially deadly infection, the history of this unusual bug, and how the United States is working with global partners to combat its spread.
Several features set C auris apart from other Candida species and make it a particular concern:
- C auris can spread between patients in healthcare facilities and cause outbreaks. In this way, it appears to behave much like some multidrug-resistant bacteria (eg, methicillin-resistant Staphylococcus aureus or Acinetobacter). Using contact precautions to prevent transmission may sound strange for Candida, but for C auris, they are a key part of the control strategy.
- C auris can colonize a patient's skin for months or longer. It can be readily detected by culturing swabs of a colonized patient's axilla, groin, or other body sites. In light of this, use of contact precautions, as well as strict attention to hand hygiene, are critical elements in controlling spread. CDC is also working with partners to better understand the role of topical agents to prevent spread by reducing colonization.
- This hardy yeast can live on surfaces for a month or more, and preliminary testing suggests that quaternary ammonium compounds commonly used for healthcare disinfection may not be sufficiently effective against C auris. Until further testing is available, CDC recommends that healthcare facilities meticulously perform daily and terminal cleaning of rooms of patients who were infected or colonized with C auris with an EPA-registered disinfectant that is effective against Clostridium difficile spores.
- C auris is quickly becoming more common. In some international healthcare facilities, it has gone from an unknown pathogen to a cause of 40% of invasive Candida infections within a few years. We need to act now to prevent this from happening in the United States.
- C auris is often multidrug resistant. Some strains have been resistant to all three major antifungal classes, including echinocandins, the first-line treatment for Candida infections.
- C auris has reportedly never been isolated from the natural environment, and it does not seem to have been a common colonizer of humans before 2009. More research is needed to understand where in the environment C auris lives and why it began affecting humans only recently.
CDC's website has the most up-to-date guidance on identifying, treating, and controlling the spread of C auris.
Thanks once again to Dr Carol Rosin
Thanks once again to Dr Carol Rosin
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