Candida auris is spreading at an alarming rate in Nevada and other state hospitals in the US. The fungal outbreak has been compared with the HBO series The Last of Us. Many viewers wonder if it could be “twice removed from reality.” But this zombie-ant fungus – Cordyceps – infecting humans in the post-apocalyptic thriller is not the same as the fungus C auris (Candida auris).
Candida auris is an airborne fungus that mostly breeds in healthcare facilities and nursing homes. “This fungus colonises on the skin or on any inanimate surface in the room that the skin comes in contact with and mutates at a rapid rate. The fungus can remain active for up to 72 hours. This makes it highly contagious,” says Dr Veereswara Raju SK, intensivist and palliative care specialist, Athulya Senior Care, Chennai. He adds that this capacity of the fungus to stay alive on surfaces such as tables, chairs and bedsheets among others could be the reason for the sudden rise in the cases.
Centers for Disease Control and Prevention (CDC), reported, as on 14 February 2023, that more than half of the states in the United States are combating the C Auris outbreak including New York, California, Florida, Nevada and Illinois. It is also present in Mexico.
Candida auris: a fungal attack in hospitals
As seen in the USA, most of the cases are seen in hospitals of those who are ICU-bound and on antibiotics usage and already immunocompromised. “The largest breeding space of C auris is the intensive care units (ICUs),” confirms Dr Rajesh Mohan Shetty, critical care specialist, Manipal Hospital, Whitefield, Bengaluru. He adds that C auris is a fungal attack that can affect those with a weaker immune system, including:
- Persons with comorbidities.
- Immunocompromised persons such as those affected by cancer, diabetes, those with HIV infection and those who have undergone organ transplants.
- Those frequently or continuously living in nursing homes or healthcare facilities.
- Those on invasive medical devices such as catheters or undergoing dialysis or organ transplant.
A 2022 study published in Infection & Chemotherapy by The Korean Society of Infectious Diseases also added those who have recently used antibiotics for any bacterial infections are most susceptible. Dr Shetty explains, antibiotics can destroy some of the gut bacteria and weaken the immune system which further increases the chances of fungal attacks.
C auris fungal infection symptoms
“Fever, chill and shivering are the early signs for Candida auris. It takes one to two weeks for the fungus to infect the body,” says Dr Subrata Das, senior consultant, internal medicine and diabetology, Sakra World Hospital, Bengaluru. The challenge is that the symptoms are similar to flu or other hospital acquired infections which can delay the diagnosis.
Dr Das further specifies, “Those who are immunocompromised and/or who are hospitalised are highly likely to be on anti-bacterial medications for other health complications. Despite being on antibiotics, if they develop the above symptoms, they should immediately be tested for this fungal infection.”
Spread of infection
Dr Shetty explains that fungus attacks the skin, blood stream, urinary tract and brain. The parasitic fungus, Cordyceps, in The Last of Us, is seen attacking and transforming humans into zombies. In real life, fungus Candida auris does not hijack the entire human body. But he adds that if not treated in time, it can lead to complications such as sepsis, urinary tract infection, meningitis depending on the organ the fungus attacks.
C auris diagnosis
Experts recommend various methods of diagnosis for Candida auris.
“Fungal culture from blood or urine is the most reliable testing method and it takes 12-24 hours for the fungal identification,” says Dr Shetty.
“C auris, most often colonises in the groin, armpits, urine, hip creases, external ear canals or wounds. Hence, a swab test [especially targeting the armpit, groin, hip creases] helps identify the infection. Another test for checking the presence of fungal infections is a fungal smear or KOH prep test. It is a potassium hydroxide skin lesion exam which assesses fungi through scraping the skin,” points out Dr Das.
In this regard, the CDC warns, “Cultures tests should be processed within a bio safety level 2 lab, a high-security level lab for testing highly infectious agents.”
Any test for Candida auris must adopt safety protocols to prevent further spread. Use of personal protection equipment (PPE), disinfectants, gloves, lab coats and strong hand hygiene is mandatory for decontamination during testing.”
Treatment
Understanding the changes in global health outbreaks, WHO proposed the need for a better global response for fungal pathogens in October 2022. Early diagnosis can prevent further complications. Echinocandins, a class of anti-fungal drug, should be given at early stages, say experts.
Treatments for fungal infections are longer than bacterial infection treatment and vary from three weeks to three months, says Dr Shetty. He explains that antifungal treatment is followed by repeated blood culture tests. Even after the tests report indicates negative, the antifungal treatment must continue for at least 15 days based on doctor’s supervision to ensure no relapse.”
Prevention
Experts recommend that quarantining each individual in a single room and limiting human contact with these individuals can help contain the infection.
“WHO has clearly explained the hand hygiene and infection prevention and control practices. The failure to follow these by the medical personnels can breed infections,” points out Dr Raju.
Dr Rajesh Shetty recommends wearing masks always, hand washing with soap and water, alcohol-based hand cleansers before and after contact with every hospital inmate, regular baths and wearing clean clothes.
Takeaways
- The fungus is airborne and affects those with weak immune system.
- It can colonise on the skin and also on the beddings, clothes, tables, chairs and other objects that come in contact with the infected person.
- Hand-hygiene and quarantining the affected, help contain the infection.
- The duration of antifungal treatment can vary from three weeks to three months.
- Do repeated blood culture until the test is negative.
