US Cases of Drug-Resistant Fungal Infection - CDC

CDC identifies first US cases of drug-resistant fungal infection
http://www.cnn.com/2016/11/04/health/drug-resistant-c-auris-found-in-us/

I heard on the radio that several of these patients died because the doctors did not recognize the disease and didn't properly diagnose it.

As someone with psoriasis/eczema, I'm susceptible to fungal infections and this does concern me.

What do you think?

http://www.cdc.gov/fungal/diseases/candidiasis/candida-auris.html
"C. auris is difficult to identify with standard laboratory methods and can be misidentified in labs without specific technology. CDC encourages all U.S. laboratory staff who identify C. auris strains to notify their state or local public health authorities and CDC at candidaauris@cdc.gov."

It appears that the CDC has been pushing for stricter standards "In 2013, CDC issued a http://www.cdc.gov/drugresistance/threat-report-2013/index.html describing antibiotic resistance threats in the United States that needed prompt action, including Candida infections." I think it's part of a larger problem involving globalization in general and global environmental change. One of the members of my subgroup in the American Geophysical Union's Global Environmental Focus Group is an epidemiologist and when we meet we plot changes on a huge wall map, sit back with our glasses of wine and say, "Oh, s***." when things seem to be converging. In the cases of diseases, we clearly need to be more vigilant than in the past.

Superbugs arise from over prescribing/overuse of antibiotics and antibiotic abuse. It is not always the failure of a medical professional to identify or recognize a pathogen, (while dangerous for a given patient), that is the real problem. Some other issues:

1. Iatrogenic infections - On a routine visit, I am exposed to pathogens in a medical facility that have been in and around antibiotics in patients and survived. Maybe bugs are resident in air conditioning ducts, as a simple-minded example. I pick up something from exam equipment that lay in the open for a few minutes. Voila.

2. I take antibiotics, but don't follow directions. A patient compliance failure. Like stopping antibiotics early. I build my very own personal supply of resistant bugs this way. Example: Tuberculosis patient is on drugs with unpleasant side effects for long periods. So, the patient gets p*** off, stops the meds early. Then TB symptoms return. The patient now has to use another possibly more unpleasant drug because the TB bacteria have become resistant to the previous drug. Wash, rinse, repeat - and patient now has is own supply of TB superbugs. Which he can now freely donate to friends and neighbors.

3. Taking antibiotics when there is no good reason to do so. Example: taking antibiotics meant to control bacterial infections for a virus infection. Many third world countries have very powerful antibiotics available from street vendors. Physicians are often few and far between. Example: Every time I get sick with a cold or the flu, I buy Amoxicillin or whatever from a vendor. I am creating the same situation for myself as in #2 above.

Candida auris has a high fatality rate and may present a significant public health problem. This new strain is multidrug resistant.

http://jmmcr.microbiologyresearch.org/content/journal/jmmcr/10.1099/jmmcr.0.T00018

What about the fact that this is a fungal infection makes the approach of medical professionals different than if it were a drug resistant bacteria or virus?

Hercuflea said:

What about the fact that this is a fungal infection makes the approach of medical professionals different than if it were a drug resistant bacteria or virus?

I'm not sure what you're asking. There are antibacterial, anti fungal and anti viral drugs. There are far more choices among antibacterial drugs than among the other two. However drug resistance is a big problem for antibacterial and increasingly for anti fungal drugs. For C auris specifically, it's hard to diagnose. In my previous post, the failure of a standard fungal infection test is described in the link.

It's back! Or it never went away.

Superbug Fungus Candida Auris Explained As CDC Warns of U.S. Cases: 'Global Health Threat'
https://www.msn.com/en-us/health/medical/superbug-fungus-candida-auris-explained-as-cdc-warns-of-us-cases-global-health-threat/ar-AAMtpQ4

Researchers have discovered transmission of a type of drug-resistant fungal infection in Dallas, Texas and Washington, D.C. for the first time in the U.S.

The CDC states it is concerned about C. auris because of its drug resistance, plus the fact that it is difficult to identify without specific technology and because it causes outbreaks in healthcare settings.

I read yesterday that the 3 cases are resistant to three standard treatments.

Most C. auris isolates in the U.S.—around 85 percent—are resistant to the class of antifungal drug called azoles. Around 33 percent are resistant to the antifungal drug amphotericin B, and around 1 percent are resistant to echinocandins.

As such, echinocandin resistance in C. auris is concerning, but this is what has occurred in five U.S. cases reported by the Antibiotic Resistance Laboratory Network between January and April 2021. Three of the cases were in D.C., and two in Texas.

The CDC outlined the cases in its Morbidity and Mortality Weekly Report published July 23. The report's authors wrote that the cases "provide the first evidence suggesting that pan- or echinocandin-resistant C. auris strains might have been transmitted in U.S. health care settings."

Astronuc said:

It's back! Or it never went away.

Superbug Fungus Candida Auris Explained As CDC Warns of U.S. Cases: 'Global Health Threat'
https://www.msn.com/en-us/health/medical/superbug-fungus-candida-auris-explained-as-cdc-warns-of-us-cases-global-health-threat/ar-AAMtpQ4I read yesterday that the 3 cases are resistant to three standard treatments.

That's great. We have had MRSA and C Diff for a while now, just coming out of a virus pandemic (UK that is...give it a week see where we are) however, fungus...
Nice to know!

pinball1970 said:

That's great. We have had MRSA and C Diff for a while now, just coming out of a virus pandemic (UK that is...give it a week see where we are) however, fungus...

Don't forget meliodosis
https://www.physicsforums.com/threa...-bacterium-burkholderia-pseudomallei.1004729/

C. diff nearly killed my mother some years back. She was initially misdiagnosed, then a doctor who was familiar with C. diff and knew how to treat it took over her case. We waited overnight to see if she would survive, and fortunately, she recovered. If not for that one doctor, my mother would have died.

Astronuc said:

Superbug Fungus Candida Auris

Several weeks ago, I listened to a discussion on the adaptation of Candida Auris to increasing temperatures. Apparently, the fungus has been adapting to warmer temperatures approaching that of the human body, while simultaneously, the typical or nominal human body temperature has decreased/declined over time from ~98.6°F to about ~97.5°F in some parts of the world. The trends mean that people have become more susceptible to Candida Auris infections, and apparently, there are thousands of microbes in the environment that are similarly adapting to a warmer temperatures.

I believe it was a rebroadcast of RadioLab
September 4, 2020 - https://www.wnycstudios.org/podcasts/radiolab/articles/fungus-amungus

There is a paper commonly cited by various media organizations.
https://journals.asm.org/doi/10.1128/mbio.01397-19

https://hub.jhu.edu/2019/07/25/global-warming-fungus-humans/

A more recent program
https://www.keranews.org/health-wel...lthcare-facilities-but-not-the-general-public

CDC's mycotic diseases group looking at fungal infections.
https://www.cdc.gov/fungal/index.html
https://www.cdc.gov/fungal/candida-auris/c-auris-drug-resistant.html

By an odd coincidence, Facebook says I started a conversation 10 years ago today about a fungal disease. Kind of a sad story.


ps. Please note that those dates are not 'typos', and it did in fact take me 8 years to respond to her comment.

Outbreak of rare, fungal superbug reported at Oregon hospital
Connor Radnovich, Salem Statesman Journal

SALEM, Ore. —Two patients at an Oregon hospital contracted a dangerous fungal infection during an "outbreak" of Candida auris, a type of yeast rare to the United States, the Oregon Health Authority reported Tuesday.

A case — the first ever found in Oregon — was detected at Salem Health Dec. 11 and confirmed Dec. 17 in an individual who had "recent international health care exposures."

Two already-hospitalized patients then came down with the infection on Dec. 23 and Dec. 27.

https://news.yahoo.com/outbreak-rare-fungal-superbug-reported-121451470.html

The NY City area has had more than 300 cases, Chicago (Illinois) nearly 150 cases, and NJ has reported 132 cases. I thought Candida auris had been reported in the Pacific NW, either Oregon or Washington.

Astronuc said:

https://news.yahoo.com/outbreak-rare-fungal-superbug-reported-121451470.html

The NY City area has had more than 300 cases, Chicago (Illinois) nearly 150 cases, and NJ has reported 132 cases. I thought Candida auris had been reported in the Pacific NW, either Oregon or Washington.

Awesome, when the virus starts to wane a yeast is ready to step in...

More of a hospital born disease though like MRSA, C diff?

There is also a role for Candida (such as Candida albicans) in dental caries: https://pubmed.ncbi.nlm.nih.gov/32905885/

Pierce County man believed to be first in state infected with potentially deadly fungus​

https://www.yahoo.com/news/pierce-county-man-believed-first-194944869.html

A potentially deadly fungus – still considered an emerging disease – has now appeared in Western Washington. The first case of Candida auris showed up last week in a patient in Pierce County, launching a public health investigation.

The Tacoma-Pierce County Health Department (TPCHD) said the man was diagnosed with the fungus on July 13. The case was only discovered after he had been at Saint Joseph Medical Center for about six weeks and moved to another hospital that required screening for the fungus.

The TPCHD said the man infected was at Saint Joe’s for about six weeks. The fungus was only detected when he was transferring to Kindred Hospital in Seattle, a long-term acute care facility.

“Kindred Hospitals Seattle – First Hill has a standard of care to screen every patient on admission for colonization or infection of C. Auris, and Kindred Hospitals has been a leader in promoting screening on admission,” said a spokesperson for Kindred Hospital.

The Seattle and King County public health department announced Tuesday it identified three confirmed cases of Candida auris infection last week, after an initial case was confirmed on January 10.

https://www.msn.com/en-us/health/ot...gal-infection-here-s-what-to-know/ar-BB1hD4zS

2,377. That’s how many Candida auris infections were reported in the U.S. in 2022—the year with the most up-to-date data—according to the CDC. Some 5,754 other people were found to have Candida auris somewhere on their body that same year, though they weren’t sick or had an active infection.

Some background - looks like there needs to be an effective detection/test method - for people and separately for places

Candida auris was first identified in Japan in 2009, where it was spotted in a patient’s ear secretion. The U.S. first began tracking infections in 2016, and it was discovered that cases dated back to 2013 in the country. Cases have since grown every year and have been reported in 36 states as of 2022, with the most drastic increase occurring during the Covid pandemic between 2020 and 2021, where the U.S. saw a 94% increase, according to CDC data. Around 95% of cases occurred in five states between 2013 and 2020: New York (41%), Illinois (26%), New Jersey (14%), California (8%) and Florida (7%). Around 90% of Candida auris strains are resistant to at least one antifungal, while 30% are resistant to at least two. Part of the reason the infection spreads so quickly is because it’s often misdiagnosed as a different fungus and not treated properly, and spreads easily through healthcare facilities.

Much like staphlococcus and streptococcus, once Candida gets in the blood stream, it's a very serious matter. A common pathway seems to be entry through lungs or open wound.

Candida auris can cause severe infection and hospitalization in some patients. It’s particularly deadly in healthcare patients with serious medical issues, as one in three people with an invasive Candida auris infection—which affects places like the heart, brain and blood—die. The fungus can cause infection in different parts of the body like an open wound or the lungs, the CDC reports, though bloodstream infection is the most common. There’s not a specific set of symptoms, as it has similar symptoms to other fungal infections. Symptoms of fungal infections include fever, chills, soreness, rashes, low blood pressure, muscle aches, shortness of breath, a cough, joint pain, pain while eating, fatigue, headache or discolored, brittle nails.