Interim Physicians Blog

Dr. Ken's Corner: deadly superbug comes out of the shadows

Posted by Ken Teufel M.D. on May 14, 2019 11:27:44 AM

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The dramatic increase in Candida auris infections has received little publicity...until now. According to the CDC, nearly half of those who become infected with this nasty fungus die within 90 days. Upon gaining access to a patient's blood-stream, C. auris defies conventional treatment. Ninety percent of the time it's found to be resistant to at least one of the three commonly used anti-fungal medications and 30 percent of the time it's resistant to two or more of the drugs.

There have been 587 cases of C. auris in the United States, says the CDC. To date, it's been reported in 12 states, the greatest concentration being in New York, New Jersey and Illinois. Fifty percent of residents in some Chicago nursing homes tested positive for the presence of C. auris. Its spread has become so much of a concern that the CDC has now placed C. auris on its list of germs classified as an "urgent threat."

A series of articles in the New York Times (April 2019) reports that the spread of C. auris has been shrouded in secrecy and "hospitals and local governments are reluctant to disclose outbreaks for fear of being seen as infection hubs." In an agreement with state health departments, the CDC "is not allowed to make public the location or name of hospitals involved in outbreaks." Eradicating the germ is a major dilemma: "Some hospitals have had to bring in special cleaning equipment and even rip out floor and ceiling tiles to get rid of it." Dr. Tom Chiller, head of the CDC's fungal branch, calls C. auris "a creature from the black lagoon. It bubbled up and now it's everywhere." Dr. Chiller "is spearheading a global detective effort to find treatments and stop the spread."

The symptoms of C. auris infection are nonspecific: fever, fatigue, and generalized aching. The populations at risk of infection are the elderly and anyone with a compromised immune system, including patients undergoing chemotherapy. Healthy individuals are unlikely to become infected; its main threat is to hospitalized patients and those in long-term facilities. Health care workers are advised to take the usual precautions to prevent spreading the infection — good hand-washing between patients and thorough cleaning of stethoscopes and other instruments.

Although C. auris is a global problem, it has not yet been called an epidemic. Where it came from remains a mystery.  The CDC's Dr. Chiller theorizes that C. auris has been around for thousands of years, "a not particularly aggressive bug" until recently. He and other experts agree that the widespread use of pesticides on food crops has probably caused an otherwise easy-to-treat pathogen to change into a germ highly resistant to anti-fungal drugs — a growing threat that can no longer be kept a secret.

Ken Teufel, M.D.