H5N1

Essential reading on Candida auris

Via Controversies in Hospital Infection Prevention, Dr. Dan Diekema writes: Essential reading on Candida auris. Click or tap through to read the whole post and use the links. Excerpt:

During my intern rotation on the University of Virginia bone marrow transplant unit, I convinced myself that a Candida krusei epidemic was brewing. One of my patients was infected, and the bug was (and is inherently) resistant to fluconazole, a drug that had only recently been introduced (yes, I’m old—the year was 1990). This never really came to pass—despite 30 years of widespread fluconazole use, C. krusei still accounts for < 5% of invasive candidiasis, and outbreaks are rare.  

Now, a Candida species that wasn’t even described a decade ago is emerging as a major problem in ICUs around the world. The Candida auris story is fascinating, puzzling, and concerning. For reasons nobody understands, the species emerged (or began to recognized) almost simultaneously on three different continents. 

Although risk factors for invasive C. auris are similar to those for other causes of invasive candidiasis (ICU stay, antibiotic exposure, device use), it also features high rates of antifungal resistance, persistence on environmental surfaces, resistance to commonly used disinfectants, frequent transmission in ICU environments, and has thus caused several large, difficult-to-control outbreaks.

Rapid genome sequencing for outbreak analysis of the emerging human fungal pathogen Candida auris

Via bioRxiv: Rapid genome sequencing for outbreak analysis of the emerging human fungal pathogen Candida auris. The abstract:

Background: 

Candida auris was first described in 2009, and has since caused nosocomial outbreaks, invasive infections and fungaemia across 11 countries in five continents. An outbreak of C. auris occurred in a specialised cardiothoracic London hospital between April 2015 and November 2016, which to date has been the largest outbreak reported worldwide, involving a total of 72 patients. 

Methods: 

To understand the epidemiology of C. auris infection within this hospital, we sequenced the genomes of outbreak isolates using Oxford Nanopore Technologies and Illumina in order to type antifungal resistance alleles and to explore the outbreak within its local and global context. 

Findings: 

Phylogenomic analysis placed the UK outbreak in the India/Pakistan clade, demonstrating an Asian origin. The outbreak showed similar diversity to that of the entire clade and limited local spatiotemporal clustering was observed. One isolate displayed resistance to both echinocandins and 5-flucytosine; the former was associated with a serine to tyrosine amino acid substitution in the gene FKS1, and the latter was associated with a phenylalanine to isoleucine substitution in the gene FUR1. These mutations are novel for this pathogen. 

Interpretation: 

Multiple differential episodic selection of antifungal resistant genotypes has occurred within a genetically heterogenous population across this outbreak, creating a resilient pathogen and making it difficult to define local-scale patterns of transmission as well as implementing outbreak control measures.

Rare fungus found in 200 patients in 55 UK hospitals

Via Reuters: Rare fungus found in 200 patients in 55 UK hospitals. Excerpt:

A rare fungus that can cause drug-resistant infections has been found in around 200 patients in more than 55 hospitals across Britain, health officials said on Tuesday.  

Around a quarter of the cases of Candida auris have caused infections with symptoms, Public Health England (PHE) said, including in 27 patients who developed blood stream infections.

The fungus, also known as C. auris and first identified in Japan eight years ago, is rare and low-risk, but has a propensity to spread between hospital patients.  

"Most cases detected have not shown symptoms or developed an infection as a result of the fungus," said Colin Brown, a microbiologist with PHE's national infection service.  

He said health service staff were working with PHE experts to limit the fungus's spread. 

First isolated from the ear of a patient in Japan in 2009, C. auris has since been linked with bloodstream and wound infections, and with ear infections known as otitis, in at least eight other countries including South Africa, Kuwait, India and Venezuela. 

The first case of infection in Britain was in 2013.

CDC chief fears a deadly superbug's spread

Via STAT: CDC chief fears a deadly superbug's spread. Excerpt:

ATLANTA — Public health officials have a lot on their plate now: Outbreaks of measles and flu, soaring deaths from opioid overdoses, funding cuts. But for Dr. Anne Schuchat, acting director of the Centers for Disease Control and Prevention, one of the scariest threats is a deadly fungus. 

The lethal fungus, known as Candida auris, has killed at least 61 people in the United States in recent years, mostly in New York, New Jersey, and Illinois. And Schuchat fears it could spread. 

The superbug poses a “catastrophic threat” to the public, Schuchat told STAT in a recent interview.  

Identified eight years ago in Japan, C. auris has spread around the world. It can infect wounds, infiltrate the bloodstream, and take root in the urinary tract, and it’s resistant to many antifungal drugs. Health officials have warned US clinicians to watch for the fungus in hospitals. Patients who have undergone recent surgery, used central venous catheters, or been hospitalized for lengthy periods, as well as those with diabetes, are particularly at risk. The fatality rate appears to be unusually high: About 60 percent of those who get infected with C. auris have died, the CDC said. 

“Eradication of Candida auris from hospitals is very difficult and in some cases has led to closing hospital wards,” Mahmoud Ghannoum, director of the Center for Medical Mycology at Case Western Reserve University School of Medicine, said upon releasing a study last month.

New medical worry: A deadly fungal infection that resists treatment

Via NPR's Goats and Soda blog: New Medical Worry: A Deadly Fungal Infection That Resists Treatment.

You've probably heard of antibiotic resistance — germs that can resist the drugs designed to wipe them out. 

Now there's a new kind of resistance to worry about — fungal infections that are resistant to treatment.  

The fungal infection in question is Candida auris, which can cause infections in the mouth, genitals, ears, wounds or, worst of all, the bloodstream. While other species of Candida can lead to the same kinds of infections, Candida auris is getting worldwide attention because, according to a study in the February 2017 journal Emerging Infectious Diseases, some cases have proved to be resistant to all three classes of drugs available to treat fungal infections. The first reported case was in Japan in 2009 but it has now been found on five continents.

Fungi like yeast and mold develop resistance to the antifungal medications used to treat them in the same way bacteria develop resistance to antibiotics: Drugs kill most germs, but some resistant germs are left to grow and multiply. Misuse of antibiotics and antifungal drugs promotes the spread of these resistant germs.  

The problem with antibiotic resistance is well-known and widespread. But resistance to all available antifungal drugs "is something we haven't seen previously," says Dr. Cornelius J. Clancy, chief of infectious diseases at the VA Pittsburgh Health Care System. 

All species of Candida can trigger a potentially life-threatening infection, says Dr. Riina Rautemaa-Richardson, researcher at Wythenshawe Hospital in Manchester, England, and an author of the study. The danger occurs when the fungal infection enters the bloodstream, leading to sepsis — the body's overwhelming response to an infection, which can slow blood flow, damage organs and sometimes cause death. It appears that C. auris puts people at greater risk of sepsis than other species of Candida, says Richardson.