A Mysterious Infection, Spanning the Globe in a Climate of Secrecy
The rise of Candida auris embodies a serious and growing public health threat: drug-resistant germs.
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The germ, a fungus called Candida auris, preys on people with weakened immune systems, and it is quietly spreading across the globe. Over the last five years, it has hit a neonatal unit in Venezuela, swept through a hospital in Spain, forced a prestigious British medical center to shut down its intensive care unit, and taken root in India, Pakistan and South Africa.
Recently C. auris reached New York, New Jersey and Illinois, leading the federal Centers for Disease Control and Prevention to add it to a list of germs deemed “urgent threats.”
The man at Mount Sinai died after 90 days in the hospital, but C. auris did not. Tests showed it was everywhere in his room, so invasive that the hospital needed special cleaning equipment and had to rip out some of the ceiling and floor tiles to eradicate it.
“Everything was positive — the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump,” said Dr. Scott Lorin, the hospital’s president. “The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive.”
C. auris is so tenacious, in part, because it is impervious to major antifungal medications, making it a new example of one of the world’s most intractable health threats: the rise of drug-resistant infections.
“It’s an enormous problem,” said Matthew Fisher, a professor of fungal epidemiology at Imperial College London, who was a co-author of a recent scientific review on the rise of resistant fungi. “We depend on being able to treat those patients with antifungals.”
Simply put, fungi, just like bacteria, are evolving defenses to survive modern medicines.
Yet even as world health leaders have pleaded for more restraint in prescribing antimicrobial drugs to combat bacteria and fungi — convening the United Nations General Assembly in 2016 to manage an emerging crisis — gluttonous overuse of them in hospitals, clinics and farming has continued.
Resistant germs are often called “superbugs,” but this is simplistic because they don’t typically kill everyone. Instead, they are most lethal to people with immature or compromised immune systems, including newborns and the elderly, smokers, diabetics and people with autoimmune disorders who take steroids that suppress the body’s defenses.
Scientists say that unless more effective new medicines are developed and unnecessary use of antimicrobial drugs is sharply curbed, risk will spread to healthier populations. A study the British government funded projects that if policies are not put in place to slow the rise of drug resistance, 10 million people could die worldwide of all such infections in 2050, eclipsing the eight million expected to die that year from cancer.
Antibiotics and antifungals are both essential to combat infections in people, but antibiotics are also used widely to prevent disease in farm animals, and antifungals are also applied to prevent agricultural plants from rotting. Some scientists cite evidence that rampant use of fungicides on crops is contributing to the surge in drug-resistant fungi infecting humans.
Yet as the problem grows, it is little understood by the public — in part because the very existence of resistant infections is often cloaked in secrecy.
With bacteria and fungi alike, hospitals and local governments are reluctant to disclose outbreaks for fear of being seen as infection hubs. Even the C.D.C., under its agreement with states, is not allowed to make public the location or name of hospitals involved in outbreaks. State governments have in many cases declined to publicly share information beyond acknowledging that they have had cases.
All the while, the germs are easily spread — carried on hands and equipment inside hospitals; ferried on meat and manure-fertilized vegetables from farms; transported across borders by travelers and on exports and imports; and transferred by patients from nursing home to hospital and back.
C. auris, which infected the man at Mount Sinai, is one of dozens of dangerous bacteria and fungi that have developed resistance.
Dr. Lynn Sosa, Connecticut’s deputy state epidemiologist, said she now saw C. auris as “the top” threat among resistant infections. “It’s pretty much unbeatable and difficult to identify,” she said.
Nearly half of patients who contract C. auris die within 90 days, according to the C.D.C. Yet the world’s experts have not nailed down where it came from in the first place.
“It is a creature from the black lagoon,” said Dr. Tom Chiller, who heads the fungal branch at the C.D.C., which is spearheading a global detective effort to find treatments and stop the spread. “It bubbled up and now it is everywhere.”
Candida Auris
A deadly, drug-resistant fungus is infecting patients in hospitals and nursing homes around the world. The fungus seems to have emerged in several locations at once, not from a single source.
COUNTRIES WITH
Multiple cases of
Candida auris
infection
One reported case
CANADA
UNITED
STATES
UNITED STATES
The country has had at least 587 Candida auris infections since 2013.
PANAMA
VENEZUELA
COLOMBIA
CENTRAL AND
SOUTH AMERICA
The first documented outbreak in the Americas was at a medical center in Venezuela from 2012–13.
EUROPE
The first large outbreak in Europe involved 72 cases in a London hospital in 2015–16.
BRITAIN
GERMANY
FRANCE
SPAIN
ISRAEL
KUWAIT
SAUDI
ARABIA
OMAN
KENYA
SOUTH AFRICA
A genetically distinct strain of Candida auris in South Africa infected at least 451 patients from 2012–16.
SOUTH
AFRICA
INDIA AND PAKISTAN
The two countries have some of the highest case counts in the world.
RUSSIA
JAPAN
CHINA
PAKISTAN
SOUTH
KOREA
INDIA
SINGAPORE
JAPAN
Candida auris was discovered in 2009 in the infected ear of a 70-year-old Japanese woman.
AUSTRALIA
‘No need’ to tell the public
In late 2015, Dr. Johanna Rhodes, an infectious disease expert at Imperial College London, got a panicked call from the Royal Brompton Hospital, a British medical center in London. C. auris had taken root there months earlier, and the hospital couldn’t clear it.
“‘We have no idea where it’s coming from. We’ve never heard of it. It’s just spread like wildfire,’” Dr. Rhodes said she was told. She agreed to help the hospital identify the fungus’s genetic profile and clean it from rooms.
Under her direction, hospital workers used a special device to spray aerosolized hydrogen peroxide around a room used for a patient with C. auris, the theory being that the vapor would scour each nook and cranny. They left the device going for a week. Then they put a “settle plate” in the middle of the room with a gel at the bottom that would serve as a place for any surviving microbes to grow, Dr. Rhodes said.
Only one organism grew back. C. auris.
It was spreading, but word of it was not. The hospital, a specialty lung and heart center that draws wealthy patients from the Middle East and around Europe, alerted the British government and told infected patients, but made no public announcement.
“There was no need to put out a news release during the outbreak,” said Oliver Wilkinson, a spokesman for the hospital.
醫療警報：醫院正在向戶外空氣釋放致命的超級真菌，以死亡率為41％-88％的危險病原體“定居”於人口中
MEDICAL ALERT: Hospitals are releasing deadly superbug fungi into the open air, “colonizing” the population with dangerous pathogens that have a 41% – 88% fatality rate
https://autumnson-nwo.blogspot.com/2019/04/blog-post_97.html
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