Candida auris: All about the world’s toughest fungus

Candida auris is a fungus that, due to its multi-resistance, has been increasingly highlighted from the health point of view, in addition to being difficult to identify, it also makes it difficult to fight infections, it is one of the most resistant in the world.

Therefore, Candida is often called a super fungus because of its multiple resistance. Candida was first isolated from a sample of ear discharge from a Japanese patient in 2009 .

In 2016, it was determined that the occurrence of this fungus should be reported, as the treatment and control of this infection is difficult. Recently, in 2020, Brazil discovered the first case of candida auris .

This shows healthcare professionals that more measures need to be taken to identify, prevent and control this fungal infection . This is all due to its degree of danger, because treatment is difficult.

What is Candida auris?

Candida is a fungus that grows like yeast and was discovered ten years ago. The expert explained: “We don’t know its origin, but it was first described in 2009 when it was discovered in the ear canal of a patient in South Korea before being isolated.

A few years later, it appeared in Japan and began to explode in India, South Africa, Venezuela, Colombia, the United States, the United Kingdom and Spain. The name of the microorganism is similar to Candida albicans, which is one of the main causes of candidiasis.

This is because they belong to the same genus ( candida ), but the species are very different. Candida albicans is a common disease that affects the skin, nails and genitals and is easy to treat.

Infectious disease specialist Arnaldo Colombo, professor Unifesp and a specialist in fungal contamination explained to BBC Brazil that candida auris infection is drug resistant and can be fatal.

According to infectious disease specialists, it is possible to be colonized by the Candida auris fungus on the skin or mucous membranes without really serious problems. But if the fungus gets to contaminate the blood, it is in real danger.

The infected must undergo invasive procedures and the immune system is compromised. Patients who have been hospitalized for a long time in an intensive care unit or who have previously used antibiotics are also considered to be at risk of contamination.

Candida auris symptoms:

People who have been hospitalized for a long time and have compromised immune systems are more often infected with candida auris , which is conducive to the presence of the fungus in the blood, leading to some symptoms such as:

  • very high fever;
  • Some dizziness;
  • Much Fatigue;
  • Increases heart rate;
  • Some vomiting symptoms.

This fungus was originally identified in the ear, but it can also be related to urinary and respiratory infections and can be confused with other microorganisms.

However, it is unclear whether the focus of candida infection could actually be the lungs or urinary system, or if the fungus is produced in these systems due to infections elsewhere in the body.

This is a very resistant fungus:

An assistant professor in the Department of Medicine, Medicine and Immunobiology said that different fungal variants  began to appear on four continents at the same time.

This simultaneous occurrence is unprecedented. What worries us most is that all variants show strong drug resistance. The specialist explained that this is a result of the evolution of fungi .

The epidemiologist explained that Candida auris underwent specialized treatment. It was born when a large number of antimicrobial substances and many antifungals were used.

Under this environment of selective pressure, species changed and became more resilient. The process is very similar to the emergence of antibiotic-resistant bacteria. Antifungal agents kill almost all fungi .

But some can survive, the fungi that have mutations that make them resistant to poisons. They reproduce and their offspring inherit the genes that made them resistant. Therefore, drug resistance is increasing.

How is the diagnosis made?

As the available identification methods are not very specific for the identification of this bacterium, it is difficult to diagnose Candida auris infection . It is important to carry out a more specific identification.

Mainly like MALDI-TOF, to identify bacteria or make differences. Tag to discard. It is difficult to identify other yeasts if the laboratory does not have MALDI-TOF equipment.

In addition, this fungus can be isolated from various biological materials, such as blood, wound secretions, respiratory secretions and urine, therefore, it is important for the laboratory to perform more specific tests in the identification of samples belonging to the genus Candida .

It is also important to perform an antifungal drug test while performing an identification test. The test aims to identify which antibacterial drugs the tested fungus is sensitive or resistant to, so that it is possible to know which treatment is most effective.

Which people have a higher risk of infection?

If the person is hospitalized for a long time, has already used antifungal drugs, has a central venous catheter or other medical equipment in the body, the risk of this fungal infection is greater, as candida auris has the ability to adhere to medical equipment.

Making the treatment change Make it difficult and promote its spread. Prolonged or indiscriminate use of antibiotics can also promote this superfungal infection.

Because excess antibiotics can eliminate bacteria that can resist entry into the body and prevent infection . Therefore, the more antibiotics used, the greater the risk of this fungal superinfection, especially when the patient is in a hospital environment. [1]

What kind of illness can this cause?

Candida auris usually causes bloodstream infections, but it can also infect the respiratory system, central nervous system, internal organs, and skin. These infections are usually very serious.

Invasive fungal infection by Clostridium spp is estimated to have caused 30% to 60% of patient deaths worldwide. It is usually resistant to common medications, making infections difficult to treat.

In addition, Candida auris is often confused with other infections, leading to inadequate treatment. This means that the patient may be longer or more severe.

Candida auris can survive in a hospital environment, so cleanliness is essential for control. Discovery of the fungus is a serious problem for patients and hospitals because control can be difficult.

Should you worry about getting an infection?

You are unlikely to be infected with Candida auris . However, if you stay in a hospital or nursing home for a long time, your risk is higher. In addition, patients admitted to the intensive care unit are more susceptible.

If you’ve taken too many antibiotics, the risk of infection is also higher, because this medication also destroys beneficial bacteria, thus preventing candida auris from entering .

As the map shows, so far Brazil has not confirmed cases of infection . However, as the fungus is difficult to identify, this does not mean that it has not yet entered the country.

Why is Candida auris so dangerous?

The danger of candida is related to its resistance to antifungals. Unlike more common infections, so-called superfungi are resistant to most drugs used to fight fungal infections .

According to an expert, Candida auris is resistant to these three types of antifungals, and it is difficult to resist because it is a fungus that acts like a bacterium.

Also, unlike other family members, the super fungus shows signs of direct person-to-person transmission and can survive on the surface for a long time, meaning it can be found with worrying frequency.

Why is Candida auris drug resistant?

Among the majority of candida auris found in patients, resistance to common antifungals (such as fluconazole) has been established. This means that these drugs cannot fight candida auris .

Therefore, less common fungicides have been used to treat these infections, but beetles have also developed resistance to them.

DNA analysis showed that the candida auris antifungal resistance gene is very similar to the candida albicans antifungal resistance gene. This indicates that these genes were passed from one species to another.

What can you do to reduce the number of infections?

A better understanding of who is most likely to get candida auris is the first step in reducing the number of cases. Healthcare professionals need to understand that patients with long-term hospitals, nursing homes or weak immune systems are at high risk.

Not all hospitals recognize it in the same way. Sometimes the fungus is confused with other fungal infections such as common thrush, leading to improper treatment. Improved diagnosis will help identify patients earlier.

Which means providing the right treatment to prevent the infection  from spreading to other patients. C. auris is highly resistant and can survive on the surface for a long time. Using the most common detergents and disinfectants will not eliminate it.

Therefore, it is important to use detergents suitable for hospital disposal, especially in the event of an epidemic.

Risk factors for candida auris infection:

Data on risk factors for candida auris infection are limited. Some known risk factors include:

  • Diabetes;
  • Recent surgeries;
  • Use of broad-spectrum antibiotics or antifungal drugs;
  • The latest use of intravenous lines;
  • Recent use of a breathing tube or feeding tube;
  • nursing homes;
  • Temperature increase;
  • Often feels uncomfortable after inserting an intravenous line (drip) or catheter.

So far, gender choice has not been found and can affect any age group. Traveling to countries that have reported cases is not believed to increase the risk of contracting this infection . However, hospitalization in these countries may increase this risk.

How does climate change influence the number of infections?

A recent published study suggests that candida auris infection may become so common because the species is forced to live in higher temperatures due to climate change.

Most fungi prefer lower temperatures in the soil. However, as the global temperature rises, fungi are forced to adapt to higher temperatures.

This can promote the development of fungi in the human body at high temperatures of 36°C and 37°C. Be very attentive to these various factors.

What does Anvisa say about candida auris?

Despite the suspicion, the National Health Surveillance Administration pointed out that the exact mode of transmission of candida auris has not been determined , but “preliminary evidence indicates that the organism can be transmitted in the medical environment through contact with surfaces or equipment.

In addition, case records of superfungal outbreaks show that superfungi can seriously contaminate rooms of accommodated or infected patients, and direct transmission of medical items and equipment will pose great risks to patients.

In 2017, Anvisa issued a risk statement reporting an outbreak in Latin America and described the fungus as a potential threat to global health. According to the agency, the first outbreak was detected in Maracaibo in 2013. Of the 18 patients affected, 13 were babies.

Despite not having been diagnosed in Brazil, experts say that with globalization and the fact that the fungus survives for a long time on the surface, the risk of the disease spreading throughout Brazil is high.

But according to doctors, the biggest concern is not the global epidemic, but a possible Staphylococcus aureus infection in patients who are already sick.

Treatment for Candida auris:

As this fungus has shown resistance to antifungal drugs commonly used to treat candida infections , it is also called superfungi and is very difficult to treat.

Therefore, the physician determines the treatment plan based on the severity of the infection  and the patient’s immune system, and may guide the use of echinococcal antifungals or the combination of several antifungals in high doses.

It is important to recognize and treat candida infections as  soon as possible to prevent the fungus from spreading into the bloodstream and causing generalized infections, which are often fatal.

How to prevent candida auris:

Candida aureus infection must be avoided, and this microbial contamination mainly occurs in hospitals because of prolonged contact with fungal -containing surfaces or medical devices (especially catheters).

Therefore, as a method to prevent the spread and spread of this fungus, it is important to wash hands before and after contact with patients and to disinfect hospital surfaces and medical equipment.

In addition, it is important for people diagnosed with candida infection to remain isolated as this will prevent infection by others in a healthy environment and with a weaker immune system.

Therefore, it is important that the hospital has an effective infection control system and encourages the adoption of infection prevention measures related to patients, medical staff and hospital visitors.

As well as protocols for identifying and monitoring laboratory infection by Candida auris . Therefore, it is very important to learn how to prevent nosocomial infections, which are the main cause of contamination. [two]

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