The Centers for Disease Control and Prevention (CDC) is alerting U.S. healthcare facilities about a superbug on the rise nationwide that presents a serious global health threat.
Emerging Fungus, Serious Global Health Threat
Karen DiDonato • April 12, 2019
What is it?
Candida auris (also known as C. auris) is a type of drug-resistant yeast causing severe illness in hospitalized patients in several countries including the United States. It can cause invasive infections, including bloodstream and wound infections.
What is its history?
C. auris was first detected in 2009 in Japan and has been reported in over 20 countries including the United States. Most C. auris cases in the U.S. have been detected in the New York City area, New Jersey, and the Chicago area. There have been 587 confirmed cases in the States (as of April 11, 2019).
The CDC is calling it a global health threat because multiple cases of C. auris have been reported from Australia, Canada, China, Colombia, France, Germany, India, Israel, Japan, Kenya, Kuwait, Oman, Pakistan, Panama, Russia, Saudi Arabia, Singapore, South Africa, South Korea, Spain, the United Kingdom, and the United States.
The earliest known strain of C. auris dates to 1996 in South Korea.
Why is it dangerous?
CDC is concerned about C. auris as a global health threat for the following three reasons:
- It is often multi-drug resistant, which means it can’t be treated with multiple antifungal drugs typically used to treat Candida infections.
- It is difficult to identify without specific laboratory technology, and misidentification could cause a patient to be treated incorrectly.
- Because it has caused outbreaks in healthcare settings, quick identification is a must so healthcare facilities can take special precautions to stop its spread.
The fungus can cause various infections including bloodstream infection, wound infections, and ear infections (“auris” is the Latin word for ear).
What are the symptoms?
The most common symptoms are fever and chills that don’t improve after antibiotic treatment for a suspected bacterial infection. In some cases symptoms may not be noticeable because patients are often already sick with other medical conditions.
Who is at risk?
At the highest risk are patients who have been hospitalized for a long time; have a central venous catheter, or other lines or tubes entering their body; or have previously received antibiotics or antifungal medications.
How does C. auris spread?
C. auris is spread through contact with affected patients or contaminated environmental surfaces or equipment. To help prevent the spread of the infection, the CDC suggests following proper hand hygiene and infection control measures.
Are C. auris infections treatable?
Most C. auris infections are treatable with antifungal drugs called echinocandins; however, some C. auris infections have been resistant to all three main classes of antifungal medications.
More than one-third of patients with serious cases of the blood infection died.
Information for Laboratorians
C. auris can be misidentified unless specialized laboratory technology is used. Misidentification could lead to a patient getting the wrong treatment, which could expose more patients to the fungus. It is important to know how to identify this organism.
How to identify C. auris (taken from https://www.cdc.gov/fungal/candida-auris/recommendations.html)
“Diagnostic devices based on matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) can differentiate C. auris from other Candida species, but not all the reference databases included in MALDI-TOF devices allow for detection. Currently, accurate identification of C. auris can be performed using the Bruker Biotyper brand MALDI-TOF using the updated Bruker FDA-approved MALDI Biotyper CA System library (Version Claim 4) or their “research use only” libraries (Versions 2014  and more recent) and VITEK (MALDI-TOF) MS RUO (with Saramis Ver 4.14 database and Saccharomycetaceae update). VITEK 2 with software version 8.01 should also be able to accurately detect C. auris, though misidentifications of strains from certain clades have been reported and all Candida duobushaemulonii should be forwarded for further identification (see the identification algorithm Cdc-pdf[PDF – 9 pages]).
Supplemental MALDI-TOF databases that include additional C. auris strains from all four of the phylogenetic clades may enable users to overcome identification challenges by providing consistently higher MALDI identification scores. MicrobeNet is one example of a free online MALDI database of rare and unusual pathogens that is curated by CDC experts. MicrobeNet users will have access to CDC C. auris MALDI spectral libraries as well as Bruker’s most up-to-date database (all free with your MicrobeNet login).
Molecular methods based on sequencing the D1-D2 region of the 28s rDNA or the Internal Transcribed Region (ITS) of rDNA also can identify C. auris.”
If you or your coworkers identify C. auris, the CDC would like you to notify your state or local public health authorities and CDC at firstname.lastname@example.org.
For more information about this global health threat, including information specific to laboratorians, visit the CDC’s website on C.auris by clicking here.