Fungal disease spreads through UK hospitals – here's what you need to know about _Candida auris_

August 18, 2017 by Daniel Henk, The Conversation

At least 20 NHS Trust hospitals have been hit by a drug-resistant fungus, Candida auris. So far, 200 people have been contaminated or infected with the fungus, which can cause potentially deadly complications.

The fungus, which is able to live on the skin or inside the body, was first discovered in Japan in 2009. Since then it has been found in at least 15 countries, including the UK, where the first case was identified in 2013.

While many new diseases generate both dismissive "not another one" attitudes and "the end is nigh" hysteria, fungal diseases rarely cause much of a ripple in public health, compared to viruses or bacteria. But there are several reasons C. auris represents a significant concern for those trying to keep the UK population healthy.

The early indications are that many of the infections it causes are life threatening – and it has characteristics that raise serious concern over the short and long-term effectiveness of . Of the more than 200 cases in the UK since 2016, more than 10% have been systemic bloodstream infections, which are typically the most serious kind of fungal .

These systemic infections, known as candidemia or fungemia, are notoriously difficult to diagnose and treat. The persistent, localised and high-mortality cases that have made up the bulk of the reported infections across the world are probably hospital acquired.

Multidrug-resistant strain

Being acquired in the puts the most vulnerable patients right in the way of C. auris. Patients with and those requiring treatment for other diseases are the ones most likely to get C. auris infections.

Even more troubling, some strains of C. auris appear to have natural resistance to all three classes of antifungal drugs. There are limited antifungal options in the clinic, and a hospital transmissible multidrug-resistant strain is quite threatening. If C. auris is able to persist in hospitals, then drug-resistant strains may repeatedly emerge, and hospitals might become breeding grounds for the worst strains.

Unprecedented spread

Compared with many other fungi, the emergence of this pathogen is occurring at a surprising pace. C. auris was first documented after it was found in the ear of a patient in a hospital in Tokyo in 2009. However, recent global outbreaks, mostly since 2013, appear to stem from few a few places, suggesting that the fungus is either a rapidly spreading novel pathogen or is being driven by changes in clinical conditions. Although there is good evidence for the rapid spread of fungal diseases of animals and plants, there is virtually no precedence for a rapidly spreading fungal disease of humans.

Most fungal diseases of humans are environmentally acquired and their spread tracks events in the environment rather than the clinic. Although, the sudden emergence of fungal diseases associated with the global AIDS epidemic appeared very rapid, the fungi themselves were already present.

It remains to be determined what the driving factor is behind the rapid emergence of C. auris, but health agencies across the world are on the alert for new outbreaks and research is very active.

Finally, because it is a very recently discovered , we know very little about its abilities and vulnerabilities. Studies so far have found that C. auris may display traits associated with virulence similar to other fungi such as biofilm formation (forming sticky matrices on surfaces) and the production of protein-degrading enzymes – but, because scientists are only just beginning work with this fungus, there are a lot of unknowns.

It is not yet clear which, if any, specific traits enable C. auris to invade hosts, or if strains differ in virulence. Similarly, although the evidence supports C. auris being resistant to antifungals, the mechanisms of resistance remain unknown.

In the bigger picture, key questions remain. Where is C. auris from? Are the clinical strains different from outside the clinic? What is the route of transmission, if any, within and between hospitals? These unknowns make C. auris challenging for professionals and disconcerting for the public.

Explore further: First 13 cases of deadly fungal infection emerge in US

Related Stories

First 13 cases of deadly fungal infection emerge in US

November 4, 2016
Thirteen cases of a sometimes deadly and often drug-resistant fungal infection, Candida auris, have been reported in the United States for the first time, health officials said Friday.

First systematic study of deadly, antibiotic-resistant fungus reported

February 24, 2017
The deadly fungus, Candida auris, which has been found in hospitals, is resistant to entire classes of antimicrobial drugs, limiting treatment options for those infected. First reported in 2009, the fungus has been linked ...

Fungus causing fatal infections in hospitalized patients has unique growth patterns

August 17, 2016
The multidrug-resistant yeast Candida auris, which has caused fatal infections in some hospitalized patients, has at least two different growth patterns and some of its strains are as capable of causing disease as the most ...

Deadly superbug linked to four deaths in the US

November 8, 2016
A deadly new drug-resistant fungus has been linked to the deaths of four hospital patients in the U.S., according to a report released Friday from the Centers for Disease Control and Prevention.

New study targets lethal fungal infection

July 24, 2017
The development of new drugs to fight a common fungal pathogen which kills half a million people globally each year is a step closer thanks to a University of Queensland-led study.

Recommended for you

Flu infection study increases understanding of natural immunity

January 23, 2018
People with higher levels of antibodies against the stem portion of the influenza virus hemagglutinin (HA) protein have less viral shedding when they get the flu, but do not have fewer or less severe signs of illness, according ...

New long-acting approach for malaria therapy developed

January 22, 2018
A new study, published in Nature Communications, conducted by the University of Liverpool and the Johns Hopkins University School of Medicine highlights a new 'long acting' medicine for the prevention of malaria.

Virus shown to be likely cause of mystery polio-like illness

January 22, 2018
A major review by UNSW researchers has identified strong evidence that a virus called Enterovirus D68 is the cause of a mystery polio-like illness that has paralysed children in the US, Canada and Europe.

Creation of synthetic horsepox virus could lead to more effective smallpox vaccine

January 19, 2018
UAlberta researchers created a new synthetic virus that could lead to the development of a more effective vaccine against smallpox. The discovery demonstrates how techniques based on the use of synthetic DNA can be used to ...

Study ends debate over role of steroids in treating septic shock

January 19, 2018
The results from the largest ever study of septic shock could improve treatment for critically ill patients and save health systems worldwide hundreds of millions of dollars each year.

New approach could help curtail hospitalizations due to influenza infection

January 18, 2018
More than 700,000 Americans were hospitalized due to illnesses associated with the seasonal flu during the 2014-15 flu season, according to federal estimates. A radical new approach to vaccine development at UCLA may help ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.