Candida auris may be a fungus. But there’s nothing fun about the C. auris outbreaks that have been happening in Texas and Washington, DC.
From January through April of 2021, Washington, DC, had 101 reported cases of C. auris and Texas had 22, according to Thursday’s edition of the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR).
That alone is bad news. If someone were to ask if you would like some C. auris on your Benedict Cumberbatch cummerbund, you’d have to say no to this creative collision. As I reported for Forbes back in 2019, the CDC has already dubbed C. auris a “global emerging threat.” It is highly transmissible, meaning that this yeast can be easily passed from one person to another or even from one object to a person. That’s helped C. auris spread through different healthcare facilities. So at the very “yeast,” it’s important to pay attention to C. auris, which can go from sitting on or “colonizing” your skin to invading your body. And this fungus can kill you, especially when your immune system is weakened.
That alone, of course, is bad. But in case you said after 2020, “there’s just not enough bad news,” see what’s now happening with C. auris. Of the 123 reported cases in Washington, DC, and Texas, five (three in DC and two in Texas) had C. auris that was pan-resistant. In this case, “pan-resistant” doesn’t mean can’t be hit by a frying pan. Instead, “pan-resistant” means can’t be treated by the three standard types of anti-fungal medications: echinocandin, azoles, and amphotericin B. That’s because “pan” can be a prefix meaning “all.”
Now an azole is not a different way of saying “butt exit” or calling a person a jerk. Rather, it’s a class of medications that includes fluconazole. Speaking of fluconazole, five of the cases in Texas were infected with C. auris that was resistant to two types of anti-fungal medications: echinocandins and fluconazole. That ain’t pan-resistant yet. But it’s getting scarily close to the pan.
You may initially think that five pan-resistant cases are not a big deal. But when something very rare goes to less rare, unless it’s a steak, there’s cause for concern. Even three pan-resistant C. auris cases in New York from August 2016 through June 2019 were enough to garner attention in a previous CDC MMWR. Contrast that with five such cases in the first four months of 2021.
Plus, the pan-resistant cases of 2019 have included patients who had never been exposed to echinocandin previously and visited the same health care facilities. In the past, it seemed like pan- and other echinocandin-resistant strains emerged in patients after they had recieved echinocandin. In other words, the treatment helped select for such mutations of the fungus. However, now for the first time in the U.S., it looks like pan- and echinocandin-resistant strains of C. auris have actually spread from patient-to-patient in a health care settings. That’s like finding out that a Terminator can walk for the first time. Not good.
As mentioned earlier, C. auris infections can be deadly, as 30% of the reported cases in Texas and Washington, DC, this year ended up in death. Now it’s not clear how much C. auris may have contributed to each of these deaths. But it probably didn’t help in any case.
It should be a a Candi-no duh to do more to stop the spread of Candida auris. A potentially deadly fungus spreading is not good unless you happen to be the fungus. A potentially deadly fungus that is resistant to all available anti-fungal medications and spreading would be even worse. More resources are needed to improve surveillance systems and infection control measures. There a need for more anti-fungal treatments to be developed as well. It’s still not clear how best to treat pan-resistant infections and whether combinations of existing anti-fungal treatments will suffice for now.
The spread of this species of Candi-doh, as Homer Simpson may say it, should be causing more concern and springing more people to action. But as we’ve seen with the Covid-19 coronavirus pandemic, people may have a habit of not paying more attention to a problem until it hits them in the face like a frying pan.