A drug-resistant killer MUSHROOM. What could be the nightmare of any infectious disease specialist is already a (small) reality. The positive side is that we know it and we know how to prevent it, the negative one is that if it arrives in the blood of immunosuppressed people or in the hospital for serious diseases, mortality can go from 30 to 50% or more. We are talking about the Candida auris, a yeast related to the albicans variant which causes the common sexually transmitted candidiasis, able to develop ainfection opportunist with higher resistance to antifungals.
New outbreaks have also arisen due to overcrowding in hospitals linked to Covid. It happened in Japan, then in Bangladesh and now also in the United States, in two health facilities in Texas and in a long-term care center in Washington DC. Same problem also in Brazil, where an outbreak has spread to Salvador.
“The anti-Candida auris drug”
daniele banfi
The alert
The Centers for Disease Control and Prevention issued an alert bulletin, while in Italy last March the Ministry of Health sent an update on the infection to the highest authorities, underlining how “urgent and necessary it is to alert the clinical microbiology laboratories and all the health structures of the country in order to implement the diagnostic capabilities and the appropriate prevention and control measures for Candida auris, to avoid the spread of this highly infectious, persistent and lethal pathogen “.
“If I wanted to conjure up a nightmare scenario for a drug-resistant pathogen, this would be it,” he told the New York Times. Cornelius Clancy, Va Pittsburgh Health Care System infectious disease specialist – An untreatable fungal infection poses a serious threat to immunocompromised, transplant recipients and critically ill patients in intensive care. “
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In our country, no more than 20 cases have been registered so far but Candida auris has “the potential for a hospital epidemic”, explains the professor. Francesco De Rosa, Director of the Infectious Diseases Department of the City of Health of Turin. “Without making unnecessary alarms, we can define it as a fearful infection but in healthcare environments: this is because it manages to develop in immunosuppressed patients or those who follow long antibiotic or cortisone therapies, with serious manifestations of the disease often also due to the pathology for which one is in hospital “. And in this case, thehand hygiene and cleanliness with common disinfectants it may not be enough: Candida auris is covered with a biofilm which makes hydrogen peroxide as well as chlorhexidine less effective.
The therapies
There are three classes of antifungal used to treat invasive infections: azoles, polyenes and echinocandins. 90% of isolated cases are resistant to at least one of the three and more and more often they are found with more complex, incurable resistance profiles. Although resistance to azoles and polyenes is very common, 1% of infections are also resistant to echinocandins.
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Beware of humidity
The super fungus lurks everywhere, especially in humid environments. It can colonize bathrooms, beds, surfaces and is transmitted from human to human by proximity and contact. This is because “unlike others, it also proliferates at room temperature. It was first isolated in humans in the auricle of a Japanese patient in 2009 and since then we have seen how it can easily colonize and create bloodstream infections using entry ports such as wounds, skin lesions, mucous membranes and venous access. “.
How to identify it
A close collaboration with microbiology is the first weapon one has to identify it. “Next to each infectious disease specialist there is always a microbiologist and a microbiology laboratory. Our specialization has become sadly famous with Covid, but we have always worked in the shadows to fight infections, especially in healthcare environments – underlines De Rosa -. Here in Italy we have been monitoring hospital infections for 40 years, in the last twenty years the bar of attention has been raised in the rest of the world, this today allows us to know well about drug resistance and to be aware that ours is a complex job. , with a lot of scientific research. We need new molecules that can deal with these kinds of infections. We hospital doctors, on the other hand, must not let our guard down and continue with careful surveillance to identify the outbreaks early ”.
Infections in the hospital
Infections related to in-hospital care affect some 284,000 people every year in Italy alone, 10% of hospitalizations in pre-Covid times. And the number of dead fluctuates between 4500 and 7 thousand. According to Review on Antimicrobial Resistance, as of 2016, by 2050, bacterial infections will cause more deaths than cancer, which already causes 10 million deaths a year. This is if no new pathogens come out.
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