Doctors in Brazil report a rapid rise of drug-resistant Candida auris (C. auris), a potentially fatal fungal infection, in a hospital where patients with COVID-19 are treated.
Cases of drug-resistant C. auris have been increasing in the United States during the COVID-19 pandemic.
The Centers for Disease Control and Prevention (CDC) report that outbreaks may be related to changes in infection control practices, including limited availability of gloves and gowns, or reuse of these items.
Brazil has reported its first cases of a potentially fatal fungal infection called Candida auris (C. auris) that is becoming increasingly resistant to antifungal drugs.
The country had been on high alert for the emerging infection since 2016, when the first outbreak in the Americas was reported in Venezuela.
Outbreaks soon followed in Colombia, Panama, Chile, and the U.S., but there were no cases in Brazil until December 2020, shortly after a
Researchers led by Arnaldo Colombo, M.D., Ph.D., head of the Special Mycology Laboratory at the Federal University of São Paulo, analyzed samples from the first two cases. Both occurred in the COVID-19 intensive care unit of a hospital in Salvador, northeast Brazil.
The hospital has reported nine further cases of infection or asymptomatic colonization by the fungus.
In March 2021, Dr. Colombo and his colleagues reported in the Journal of Fungi that the fungus remained highly susceptible to antifungal drugs.
However, since then, they have detected a steep increase in the resistance of C. auris to fluconazole and a class of antifungal drugs called echinocandins in samples from the hospital.
“In the case of C. auris present in samples recently isolated in Salvador, for example, the dose has to be four to five times larger than the dose used to inactivate the isolate cultured in December 2020,” says Dr. Colombo.
No other cases have been reported in Brazil, but Dr. Colombo believes there are grounds for concern.
“The species quickly becomes resistant to multiple drugs and isn’t very sensitive to the disinfectants used by hospitals and clinics,” he says.
“As a result, it’s able to persist in hospitals, where it colonizes health workers and ends up infecting patients with severe COVID-19 and other long-stay critical patients.”
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The CDC reports that C. auris can cause infections of the bloodstream, wounds, and the ear.
It estimates that 30–60% of people with C. auris infections die, though many of these patients also had other life threatening illnesses.
Dr. Colombo’s paper stated that superinfection by C. auris in critically ill patients with COVID-19 is estimated to have a 30-day mortality rate of above 50%.
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However, since the start of the pandemic, outbreaks have been occurring in the COVID-19 units of hospitals.
“During the COVID-19 pandemic, there has been an increase in C. auris cases, particularly in some areas of the United States that had not previously had many cases,” said Dr. Meghan Marie Lyman from the CDC’s
“C. auris and COVID-19 often affect a similar patient population, particularly those in long-term care facilities,” she told Medical News Today.
The pandemic provided ideal conditions for fungal infections such as C. auris and mucormycosis in India to spread in hospitals.
The steroid dexamethasone that doctors use to treat severely ill patients suppresses immunity to other infections. In addition, broad-spectrum antibiotics kill bacteria that live in the gut and on the skin that usually compete with fungi for living space.
Catheters can allow C. auris to invade the bloodstream and urinary tract. There is also evidence that the virus damages the mucous lining of the intestine, which provides the fungus another entry point to the bloodstream.
Dr. Lyman said outbreaks may be related to changes in infection control practices during the pandemic, including limited availability of gloves and gowns, or reuse of these items, and changes in cleaning and disinfection practices.
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“There’s also been new C. auris cases without links to known cases or healthcare abroad identified recently in multiple states, suggesting an increase in undetected transmission,” said Dr. Lyman.
She added that routine screening for C. auris colonization in patients at healthcare facilities has been limited because resources have been diverted to respond to COVID-19.
Since 2009 when C. auris was first identified in Japan, infections have been reported in more than 30 countries.
However, because specialized laboratory equipment is needed to distinguish the species from other Candida infections, C. auris is likely to be more widespread.
Most infections remain susceptible to echinocandins, but some strains of the fungus have developed resistance to all three main classes of antifungal drug.
“Reports of echinocandin- or pan-resistance C. auris cases in the United States are increasing, which is concerning because antifungal treatment options for these highly resistant infections are extremely limited,” said Dr. Lyman.
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Candida auris: What you need to know
Candida auris is a type of fungus. It is one of the few Candida strains that can affect humans, and infections can be severe or fatal.
Some strains of Candida auris (C. auris) have developed resistance to multiple treatments, making them a significant health threat. Outbreaks of resistant strains tend to occur most often in hospitals and other care facilities.
The symptoms of a C. auris infection are not always easy to identify, and a lab test is the only guaranteed way to diagnose the issue.
C. auris is one of a few types of Candida fungus that transmits to humans.
Researchers discovered C. auris in Japan in 2009 when they isolated it from an infected ear canal. The name auris comes from the Latin word for ear. However, this name is a bit misleading because the infection can occur in many places in the body.
Since then, researchers in many countries, including the United States, have identified the fungi.
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Those who have weakened immune systems, either due to an underlying condition or medical treatments, are also more likely to contract C. auris. People undergoing the following procedures or treatments may also be at higher risk. Risks include:
- using a lot of antibiotics
- breathing tubes
- catheters in the bladder or a vein
- feeding tubes
Additionally, the authors of a 2017 review noted that the majority of people who have invasive C. auris received broad-spectrum antimicrobial agents before contracting the infection.
This does not mean that antimicrobial agents cause the infection, but that they may wipe out other competing microbes in the body and allow C. auris to take hold.
Otherwise healthy people do not usually get C. auris infections.
Doctors often find the symptoms of a C. auris infection challenging to identify because they usually occur in people who are already ill.
Symptoms of the infection can vary according to where C. auris is in the body. It can develop in a variety of places, including in an open wound, the bloodstream, or the ear.
The only guaranteed way to diagnose C. auris is through a specific lab test that can identify the fungus.
Early diagnosis is vital. C. auris infections that spread throughout the body or to the bloodstream can cause severe symptoms and can be life threatening.
Typically, C. auris spreads in hospitals and other care facilities through contact with contaminated surfaces or equipment.
However, it can also spread from person to person. People with Candida may shed the fungus through their skin cells. To limit the spread of C. auris, cleaning, hygiene, and sanitation are crucial.
However, ongoing research continues to investigate exactly how and why C. auris spreads.
While C. auris infections are serious, most are treatable. Typically, treatment begins with antifungal drugs called echinocandins.
However, some strains of C. auris have become resistant to one or even all classes of antifungal drugs designed to eliminate them. This makes treatment more difficult.
Strains that become resistant to treatment may lead to more severe infections. In these cases, doctors generally recommend a combination of antifungal drugs at very high doses to eliminate the infection.
Doctors will need to discuss all options and their possible outcomes with the patient beforehand.
C. auris infections have appeared in 30 different countries, including the U.S. The
While other infectious germs may cause outbreaks that start in one area of the world and spread from there, C. auris is different.
In 2019, researchers noted that cases of C. auris appeared around the same time on three different continents, and each strain had a different genetic code.
Experts are unsure why the infections seemed to appear at the same time. Some theories indicate that environmental factors such as climate change may have played a role. They also think that the fungi, in general, may have developed an immunity to the drugs designed to treat them.
It is important to note that C. auris does not usually impact people who do not have any health problems. Traveling to other countries or being in contact with a loved one who has C. auris should not increase the risk for an otherwise healthy person.
However, it is still essential to practice good hygiene to prevent spreading the infection to other vulnerable people.
Diagnosing C. auris infections requires specific lab equipment and tests. Many facilities do not have access to these tools, which may make misdiagnosis more likely and increase the risk of the infection spreading.
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While there are risks of Candida outbreaks in care facilities, there are many ways these care facilities can work to prevent the spread of C. auris.
Safe practices to help prevent spread and outbreak include:
- screening patients to identify risk and colonization
- limiting the number of people who work with patients who have C. auris
- keeping patients in single rooms or apart from other patients who do not have the infections
- practicing regular hand washing
- using hospital-grade disinfectants
- communicating with other care facilities the patient attends to follow up on the person’s status
Candida auris is a type of fungus that can transmit to humans.
The infections typically occur in people who have compromised immune systems, are taking strong antibiotics, or those who go to the hospital or other care facilities regularly or for extended periods. Healthy people are not likely to contract the infection.
C. auris infections can be severe and even life threatening, making treatment and prevention essential.
Care facilities must work quickly to screen and test patients for C. auris to begin treatment. Following CDC guidelines also helps reduce the risk of an outbreak.
Fonte: MNT
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