In late March 2023, the U.S. Centers for Disease Control and Prevention highlighted the threat posed by a rapidly spreading fungus called Candida auris that is causing infections and deaths among hospital patients across the country. The unexpected rise of this recently discovered pathogen is part of a larger trend of increasing fungal infections in the U.S.
Arif R. Sarwari is a physician and professor of infectious diseases at West Virginia University. Amid rising concerns among doctors and public health officials, Sarwari helped explain what Candida auris is, how it is spreading and how worried people in the U.S. should be.
Candida auris is a recently identified, single-cell fungus that can infect humans and is moderately resistant to existing antifungal drugs. You might be familiar with superficial fungal infections – like athlete’s foot or vaginal yeast infections – which are quite common and don’t pose significant risks to most people. In contrast, Candida auris and other related fungi can cause infections within a person’s body and are much more dangerous.
Candida auris is a type of yeast that was first identified in 2009 and is one of a number of species in the candida family that can infect people. In the past, most invasive candida infections were caused by Candida albicans. Recently, though, infections with species of candida that are much more resistant to drugs than Candida albicans – like Candida auris – have shot up, with a nearly fivefold increase since 2019.
For the most part, healthy people do not have to worry about invasive candida infections. There are two groups of people who are most at risk for dangerous candida infections: first are patients in intensive care units who also have central intravenous catheters and are receiving broad spectrum antibiotics. Patients with weak immune systems, such as cancer patients on chemotherapy or patients with human immunodeficiency virus, are also at high risk of candida infection.
Nearly all people have candida fungi growing in their guts and on their skin as part of their microbiome. When a person is healthy, candida numbers are low, but the fungi can proliferate rapidly and overcome a person’s immune system when a patient is sick and on antibiotics.
If candida cells on a person’s skin contaminate an intravenous line, the fungus can get into a patient’s bloodstream and cause often deadly bloodstream infections. Candida species are the fourth most-common cause of hospital associated bloodstream infections.
There are three classes of antifungal drugs that can be used to fight invasive candida infections. Candida albicans is susceptible to all three and easier to treat than Candida auris, which is moderately resistant to all three classes of antifungals.
The CDC estimates that in the U.S., around 25,000 patients get candida bloodstream infections every year.
Candida bloodstream infections are best understood as a tale of two eras. In the past, they were almost always caused by drug-susceptible Candida albicans that arose endogenously from a patient’s own microbiome. There was no concern about infections spreading to other patients.
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