La Candida auris “is an ugly beast. It is increasing significantly all over the world, including Italy, and with Covid the growth has become impressive”. So Matteo Bassetti, director of the infectious diseases clinic of the San Martino polyclinic in Genoa, who adds: “We must raise the bar. It is essential to superviseavoiding making the mistakes of the past”.
Candida auris, what is it
Candida auris is a fungus (or yeast) first described in 2009, also called: Super Mushroomas it is incredibly resistant to the main categories of antifungal drugs, usually used to eradicate fungal infections or Fungo killer, as it is highly lethal (for now) in the most fragile patients. “Auris” derives from the Latin “ear”, a denomination attributed to having been isolated from the external ear canal of a 70-year-old female, admitted to a Japanese hospital. From the moment of her identification, doctors began to record new cases of Candida auris infection worldwidefrom the United States to Kenya, from India to Venezuela, from Australia to Europe.
How it is transmitted
The methods of transmission of C. auris known to date are:
• Contact with surfaceie contaminated medical devices;
• Interhuman contactfrom person to person.
Plus this leaven it has virulence factors and a tropism for surfaces that make it unique for its persistence in the environment and on the skinthus enhancing its transmission capacity.
How it manifests itself
The clinical manifestation of Candida auris infection depends on the site. Most frequently, the pathogen is responsible for:
• Infections of blood stream;
• Infections intra-abdominal;
• Infections of wounds;
• A plague.
Candida auris has also been isolated from bile fluid, respiratory tract and urine, however, it is not yet clear whether the pathogen can cause infections in the lungs, bladder or other districts.
What are the symptoms
Candida auris infections are accompanied by burning, difficulty swallowing, body aches, fever and fatigue. It should be noted that the skin and other body sites can be colonized even in the absence of signs and symptoms.
First case in Italy
After the alarm raised by the US CDC for the growing spread of infections from this fungus – which represents “an urgent threat” to its antibiotic resistance – the alert is also rising in Italy, where a first case was confirmed in Tuscany. “Like Sita, the Italian Society of Anti-infective Therapy – continues Bassetti – we have a surveillance system and a register of these infections”. What is worrying, explains the expert, is the fact that “the Candida auris is resistant to many tier one anti-fungal drugs.
High mortality
Infections can be very serious up to septicaemia and the mortality is quite high, from 30-40% up to 50%. The increase in infections is unfortunately the result of a easing of infection control measures during the COVID-19 pandemicwhen people thought more about protecting themselves from the virus and there was less attention to this microorganism, on which we really need to pay a lot of attention”. Multi-resistant infections are not caused only by bacteria – recalls the infectious disease specialist – but also from mushrooms. We must also do more at the Italian level on the issue of fighting resistant microorganisms, we still need to raise the bar further. I know that Minister Schillaci is very sensitive on this subject. We must all work together, the fight against drug-resistant microorganisms is the current and future challenge”.
The spread of the fungus in the USA
According to CDC data (Centers for Disease Control and Prevention), published in the Annals of Internal Medicine, in the pandemic years 2020-2021 infections increased significantly in US healthcare facilitiesi: in 2021, in particular, the cases resistant to the most recommended drug used for the treatment of Candida auris infections, the echinocandins, tripled. A worrying fact, the CDC highlight. Also this new family of antifungals is starting to be a blunt weapon. From 2016 to the end of 2021, when it was first reported, there were 3,270 clinical cases (in which infection is present) and 7,413 in which fungus is detected but no infection develops. Clinical cases have increased every year since 2016, with the greatest growth in the period 2020-2021. Nationwide, clinical cases rose from 476 in 2019 to 1,471 in 2021. Screening cases tripled from 2020 to 2021, for a total of 4,041. According to the CDC, this increase is also visible in 2022. For experts, the spread of Candida auris may have worsened due to the overload on healthcare systems during the Covid-19 pandemic.