This drug-resistant super fungus has sent scientists in 30 countries into a funk

A relatively new fungus has scientists scratching their heads in 30 countries, including India. Called Candida auris (C. auris), it has become a red flag for the medical community. Why? C. auris is drug-resistant, it can survive almost anywhere - even on sterilized medical equipment - and it is increasingly causing infections in patients in the Intensive Care Unit (ICU). Normally Candida, a species of fungus, causes the most superficial skin infections and can be treated with over-the-counter drugs. C. auris, by contrast, does not respond well to antifungal drugs - not only is C. auris resistant to most medicines, it is actually more likely to affect patients who are given antifungal drugs to prevent common Candida infections. [caption id=“attachment_5564691” align=“alignleft” width=“380”]  Representational image. Getty images[/caption] First isolated in japan in 2009, C. auris was originally thought to cause ear infections. Since then, scientists have discovered that it is more invasive - and deadly. In India, the first cases of C. auris infection came to light in 2011. According to the US-based Centres of Disease Control and Prevention (CDC), there’s a higher chance of C. auris infection in patients in a hospital set-up, and among those fitted with a central venous catheter and other devices which go inside the body. CDC data also show that patients who have received antibacterial or antifungal drugs are at the highest risk of C. auris infection than those who have not. The CDC says that 30-60% of patients infected with C. auris infection die, however, most had a prior serious illness with a compromised immune system. Though the exact mechanism of how C. auris causes infection is not known, research studies in India have also linked C. auris infection to a longer stay in the ICU. In ‘Candida auris candidaemia in Indian ICUs: analysis of risk factors’, published in The Journal of Antimicrobial Chemotherapy, researchers led by S.M. Rudramurthy found that C. auris was responsible for 5.3% of all Candida infections in ICU patients. They also established that those who spent more time in the ICU were more likely to be infected with C. auris. The study looked at data from 27 hospitals in North India. “What makes C. auris even more dangerous is that it can grow in all kinds of places - dry areas, moist places, plastic surfaces, and sterilized areas and equipment,” said Dr Archana Nirula, medical officer, myUpchar.com. Seeing the alarming increase in C. auris infection in Indian hospitals, the Indian Council of Medical Research released an advisory for healthcare providers in 2017. The advisory cautions healthcare providers that C. auris can grow in unfavourable environments. It is thermo-tolerant, salt-tolerant, and resistant to antifungal drugs like azoles and polyenes. It can even form a biofilm on the sterilized polymers used in medical equipment. The ICMR advisory also notes that it’s easy to misidentify C. auris as infection by another Candida fungus. In ‘Multidrug-resistant endemic clonal strain of Candida auris in India’, published in 2013 in the peer-reviewed journal European Journal of Clinical Microbiology and Infectious Diseases, researchers Anuradha Chowdhary et al explained that the C. auris collected from India, Korea and Japan were all different. Not only did they have different phenotype (what they look like), even their genotype (what’s inside) was different - this is highly unusual and makes treatment even harder. It’s an understatement to say that C. auris is quirky. Even as scientists are throwing all their weight behind research to find a cure, doctors are banking on good old hygiene and echinocandins - an antifungal drug that seems to work in select cases of C. auris infection. ICMR has even recommended that doctors schedule any interventional procedures for C. auris-infected patients at the end of the day - C. auris can survive sterilization and the infection can spread to other patients through medical equipment. Points to note:

• Candida auris is a drug-resistant fungus that can grow anywhere, irrespective of temperature.
• Cases of C.auris infection have mainly been observed in patients who’ve been hospitalized for a long time.
• Globally, C. auris infection has been associated with high rates of morbidity as well as mortality.
• For now, echinocandins are the only antifungal treatment that works - and should be the first line of treatment.
• Little is known about how this fungus causes infection. All suspected cases of infection should be carefully isolated from the general population and antifungal susceptibility testing should be made mandatory to prevent invasive infections.
• Collaborating with public health officers, clinical laboratories and hospital infection prevention and control can ensure optimum management and control of infections.

Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health. To know more on this topic, please visit   https://www.myupchar.com/en/disease/candidal-infection