There Is A New Fungus Among Us: Candida Auris

Brenda F. Johnson, MSN

What Is Candida Auris?

The Auris part of the name for Candida Auris refers to the ear because this fungus is found in the ear. Although it is found in the ear, it is also detected in many other parts of the body such as the bloodstream and wound infections causing invasive and deadly infections according to the CDC. Any type of candida can kill but it is not yet determined whether Candida auris is more deadly than other strains.

The CDC does know that 60% of patients with C. auris pass away, however, they all have had serious other medical problems that contributed to their death. C. auris has been found in the bloodstream, ear infections, and wound infections. Even though it has been found in the bladder or lungs, the CDC is not sure if it caused the infections.

Because C. auris can easily be confused with other yeasts such as Candida haemulonii, or Saccharomyces cerevisiae, molecular methods are needed to test body fluids to detect it specifically.

Hospitals in several countries have reported hospitalized patients that have illnesses related to C. auris. There are many strains of C. auris including one that is resistant to all three major classes of antifungal drugs the CDC tells us. They also warn healthcare facilities that it is not easy to identify. As with other unusual and communicable disease, it needs to be reported to the CDC at [email protected].

Who Is At Risk For C. Auris?

Information collected on patients who have contracted C. auris reveals that they are hospitalized, and often have cancer or other serious illness. All of them have reduced immune systems and are less able to fight infections. Because of this, it is not clear that the fungus killed them, just that they had C. auris in their bodies.

One patient in Illinois, was a paraplegic who had an infected catheter. Even after treatment, he still remained infected. In other states such as New York, Maryland, and New Jersey have reported to the CDC four patient deaths. Again, it is ambiguous C. auris' role in the patients deaths due to the fact that the patients were already very sick: one had a brain tumor, one had respiratory failure, two had blood cancers. We can see that those with not a lot of reserve are attacked by C. auris.

Across the globe, healthcare facilities have disclosed that several patients have contracted C. auris through the bloodstream. These infections are challenging to treat because they don't respond to the usual antifungal medications.

Those that are in the most danger, according to the CDC, are ICU long term patients, or those with a central line. Also, those patients who have been previously treated with antibiotics and antifungal medications. Again we see that C. auris is no respecter of the ill, but attacks those most at risk.

Not only are the extremely sick susceptible to C. auris, all ages from elderly to preterm babies are all in the fungus' eyesight. The CDC is quick to say that more studies are needed to determine specific risk factors.

Stats for C. Auris In America and Elsewhere

The first case of C. auris was diagnosed in Japan in 2009, but an early strain was collected in the year 1996 in South Korea.

Countries who have cases of C. auris: South Korea, India, Pakistan, Canada, United States, Kuwait, South Africa, Japan, Venezuela, Colombia, Kenya, United Kingdom, and Israel.

It has been found that with genome sequencing, the strains in regions contain the same DNA fingerprint, differing from those in other regions. "These differences suggest that C. auris has emerged independently in multiple regions at roughly the same time," reports the CDC.

Dr. Tom Chiller who is head of the fungal disease area of the CDC is quoted as saying, "It appears that C. auris arrived in the United States only in the past few years."

Number of cases as of December 13, 2016

Illinois - 2 May 2016, July 2016
Maryland - 1 April 2016
New Jersey - 1 July 2015
New York - 15 May 2013, April 2016, Aug. 2016(3), Sept. 2016(2), Oct 2016(3),
Nov 2016(5)

Treatment/Tests Available To Treat and Identify C. Auris

C. auris is not easy to identify, and not all facilities have the equipment to do the tests. The two tests used to diagnose C. auris are;

Matrix - assisted laser desorption/ionization time - of - flight analysis
D1 - D2 region of the fungus' 28s ribosomal DNA

It is resistant to many drugs, but usually responds to at least one antifungal medication. There are three main concerns of the CDC regarding C. auris

Difficulty in identification, misidentification leads to wrong treatment.
Has caused outbreaks in healthcare settings, rapid identification is vital.
Often multidrug-resistant

"Isolates from the two Illinois patients were nearly identical and were most closely related to isolates from South America," CDC.

One patient's room was swabbed and C. auris was found on the mattress, bed rail, chair, window sill, and bedside table. Bleach did kill it, but the fact that it was all over the room is concerning.

Recommendations of the CDC

The need for action is now in order to stop the spread of C. auris and protect vulnerable patients. In the meantime, they recommend thorough cleaning of hospital rooms where the fungus is found. Also, giving the heads up to facilities that are receiving an infected patient. More study is need to track routes of contamination whether person to person or contaminated surfaces.

While working with health agencies, labs, and hospitals, they ask for preventative action by following the guidelines found at Interim Recommendations to report cases because five of the seven cases were found in the U.S.

Conclusion

While we as nurses have little power over what our healthcare facilities put into action, being aware and educated on new issues is very important. The next time a patient has a fungal infection resistant to the medications being given, question the source. Ask the doctor to consider C. auris. Awareness brings education and better treatment. Have any of you had patients diagnosed with C. auris? Please share with us!

References

CDC. "Candida auris." 13 Dec. 2016. Center for Disease Control and Prevention. 17 Dec. 2016. Web.

CDC. "Candida auris Questions and Answers." 4 Nov. 2016. Center for Disease Control and Prevention. 17 Nov. 2016. Web.

Fox, Maggie. "New Killer Fungus Found in U.S. Patients." 4 Nov. 2016. NBCNews. 17 Nov. 2016. Web.

Harris, Richard. "First Cases of New, Infectious Fungus Reported in U.S." 4 Nov. 2016. NPR. 17 Nov. 2016. Web.