(beraking latest news) – The death of a man positive for Candida auris and hospitalized in Milan rekindles the spotlight on the killer mushroom: what are the symptoms? How is it taken? How does the infection happen? What are the therapies? Candida auris, as Professor Matteo Bassetti explains, “is a drug-resistant microorganism, which has a very high mortality rate that can reach 50%, therefore one in two of those affected can risk their lives”.
“Candida auris is a fungus isolated for the first time in 2009 in Japan from the ear (in Latin “auris”) of a woman – reads the website – however the first known isolate dates back to 1996 retrospectively identified in a collection of Korean champions. The first European outbreaks date back to 2015 in France while in Italy the first case of invasive infection was identified in 2019 followed by an outbreak in the northern regions in the two-year period 2020-2021 “, reads EpiCentro, the epidemiology website of the Istituto Superiore of Healthcare..
“Candida auris has been isolated from a variety of body sites, including the skin (very common), the urogenital tract (common), and the respiratory tract (occasional), and more rarely causes invasive infections, such as candidaemia, pericarditis, urinary tract and pneumonia,” explains EpiCentro, warning that “Candida auris is an emerging type of Candida that poses a serious threat to global health for several reasons: it is often resistant to more antifungal drugs than those commonly used to treat Candida infections ( multidrug resistance); it is difficult to identify in laboratories that do not have specific technologies, resulting in inappropriate management; people can have Candida auris infections without knowing it and this colonization can last a long time; it can cause epidemic outbreaks in health care environments, even if the possible spread in the community is not excluded; it is highly infectious and infections are usually minor, however it can cause serious infections in immunocompromised individuals; presents a high lethality in the invasive forms; it has the ability to create biofilm which makes it not very susceptible to disinfectants and therefore particularly resistant on surfaces”.
Candida auris can be transmitted through contact with contaminated surfaces and/or medical devices or contact between colonized or infected people – reads the ISS epidemiology website – Patients are more at risk of contracting a Candida auris infection who: have pre-existing health problems; are hospitalized or in nursing homes; require invasive medical devices (e.g. bladder catheters, central venous catheters, tracheostomy tubes, etc.); have a weakened immune system. Additionally, patients colonized with C. auris undergoing surgical procedures may have an increased risk of surgical site infections, therefore skin preparation with an alcohol-based disinfectant agent is recommended unless contraindicated.
The symptom picture is varied. The signs and symptoms of Candida auris infection “vary according to the affected body site, however the symptoms may not be evident as patients who contract the infection are often already hospitalized and suffering from other pathologies that can hinder their diagnosis. The clinical pictures most frequently encountered in Candida auris infections are: infections of the bloodstream; intra-abdominal infections; wound infections; ear infections. Furthermore, Candida auris has been isolated from bile fluid, respiratory tract and urine, but it is not yet clear whether it can cause infections, lung and bladder.
“Like other Candida infections, C. auris infections are diagnosed by culture of blood or other body fluids. However, in laboratory tests C. auris can be confused with other Candida species (in particular Candida haemulonii), so special laboratory tests are required for correct identification. Diagnostic tools based on MALDI-TOF (Matrix Assisted Desorption Ionization – Time Of Flight) technology are able to distinguish C. auris from other Candida spp., but not all MALDI-TOF spectrometer reference databases include this species. When a particular resistance profile of Candida spp. auris species may be suspected, but should be confirmed by a reference laboratory. All C. auris strains from clinical isolation should be tested for susceptibility to antifungals to rule out therapy with drugs to which it is resistant”.
TREATMENT – Most C. auris infections “are treatable with a class of antifungals, the echinocandins. Some infections are particularly difficult to treat due to multi-resistance to various antifungal agents, including fluconazole (and other azoles), amphotericin B and echinocandins, EpiCentro explains. This involves therapy with more drugs and at higher doses. Even after treatment for invasive infections, patients generally remain colonized for long periods, therefore, all infection control measures should be followed during and after treatment of C. auris infection. In particular, patients who become colonized with C. auris are at risk of developing invasive infections at any time.”