The Centers for Disease Control and Prevention said Candida auris, a fungus discovered about 15 years ago in Japan, is expected to infect at least 2,377 people in the US in 2022, up from 53 in 2016. Its rapid spread in most states and more than 40 countries has prompted the CDC and the World Health Organization to label it as a growing threat to public health. The CDC states that Candida auris has a mortality rate of up to 60% and is especially risky for people who are older or have compromised immune systems.
An infectious disease specialist at the University of Alabama at Birmingham, Dr. Peter Pappas said, “To see a new species—and then less than 15 years later suddenly emerge as a global pathogen—it’s really remarkable.”
In a study published Monday in Annals of Internal Medicine, CDC researchers said the first documented Candida auris infection in the US occurred in 2013. The fungus has expanded its range from centers around New York City and Chicago to at least 28 states and Washington, DC, the study said.
“Looking at the number of cases was alarming,” said CDC epidemiologist and lead author of the paper, Dr. Meghan Lyman said.
The paper noted that most Candida auris transmission has occurred in health facilities that provide long-term care to very ill patients. Select Specialty Hospital-Northwest Detroit, a rehabilitation center for the seriously ill, temporarily stopped admitting patients last year after an outbreak of Candida auris. Buddy Hammerman, chief medical officer of Select Medical Holdings Corp., the operator of the hospital, said all health facilities need to be aware of the threat.
“Patients are being colonized with this organism, and it’s getting smarter than us,” Dr. Hammerman said.
Candida auris is a yeast of mysterious origin. It was identified in 2009 after it was discovered in the ear of a patient in Japan. Microbiologists have scoured genomic databases and the natural environment for clues into its origin and evolution. Outside of people, it has been found in only two sites: a remote archipelago in the Indian Ocean, a salt marsh and a sandy beach in the Andaman Islands.
Infectious disease experts said that Candida auris can live in the environment or animals for a long time before a change can spread to people. They said that rising global temperatures may have encouraged Candida auris to develop greater tolerance to heat, making it more efficient at infecting people whose body temperature has prolonged the invasive fungal disease. Acts as an effective barrier against The widespread use of insecticides and antifungals on crops may have allowed Candida auris to thrive by killing off microbial competitors, he said.
Lady Speck, MD, an associate professor of medicine at Washington University School of Medicine in St. Louis, said that common disinfectants, including bleach and alcohol, are not always effective against Candida auris, which can colonize a person’s skin. He said deep cleaning and special disinfectants that destroy the spores are needed to limit their spread.
“If someone is found to have Candida auris on their skin, you need to isolate them to prevent new people from colonizing,” Dr. Speck said.
Not everyone who encounters Candida auris becomes ill, but if it infects the bloodstream, wounds, or organs, the effects can be serious. The CDC states that the most common symptoms of Candida infection are fever and chills.
Fungal infections are estimated to kill at least 1.6 million people a year, according to Global Action for Fungal Infections, a research and fundraising non-profit organization.
There are only three classes of antifungal drugs commonly used for severe fungal disease, all of which can cause toxic side effects, Dr. Speck said. Dr. Speck said fungi are also developing resistance to these drugs. At least seven Candida auris infections were resistant to available antifungals in 2021, the CDC said, compared to the four years prior to 2020.
Scynexis Inc. and Pfizer Inc. are developing drugs that have been shown to be effective against Candida auris in clinical trials. Cidara Therapeutics Inc. said it has submitted its drug rezafungin to the Food and Drug Administration for approval to treat Candida infections, including Candida auris. The company said that rezafungin will be the first new drug to treat invasive Candida infections in the past decade.