In 2016, hospitals in the state of New York discovered an uncommon and dangerous fungal infection that had never previously been reported in the United States. Rapidly mobilizing to examine historical specimens, research institutions determined the fungus had been present in the country since at least 2013. Since then, New York City has become the epicenter of Candida auris infections. And until 2021, according to data analyzed by The Associated Press from the Centers for Disease Control and Prevention (CDC), the state documented the highest number of confirmed cases in the country, despite the disease’s spread to other regions.
Candida auris is an emerging global hazard to public health that can cause severe illness, such as bloodstream, wound, and respiratory infections. According to the CDC, a small cohort of patients in the United States had a mortality rate of 30% to 60%, and many of these patients had other underlying conditions. Candida auris poses a heightened risk in healthcare settings for patients with preexisting severe medical conditions. The most cases were reported in Nevada and California in 2012, but the fungus was clinically identified in patients in 29 states. The state of New York remains a significant hotspot.
Climate change is a prominent explanation for the sudden spread of Candida auris, which was not discovered in humans until 2009. Due to the fact that humans and other mammals have higher body temperatures than most fungal pathogens can tolerate, they have been historically protected from the majority of infections. However, rising temperatures can enable fungi to develop a tolerance for warming environments, and as a result, humans may eventually lose their resistance. According to some researchers, this is already occurring with Candida auris.
The pathogen emerged spontaneously on three continents, Venezuela, India, and South Africa, fourteen years ago. Arturo Casadevall, a microbiologist, immunologist, and professor at Johns Hopkins University who specializes in fungal diseases, remarked that this was perplexing due to the vastly diverse climates in these regions. “Our temperature provides tremendous protection against environmental microorganisms. “However, if the world continues to warm and fungi begin to adapt to higher temperatures, some will reach what I call the temperature barrier,” Casadevall said, referring to how the mild body temperatures of mammals historically protected them.
According to Meghan Marie Lyman, a medical epidemiologist for the CDC’s mycotic diseases branch, the initial cases of Candida auris were linked to international travelers who had entered the United States. Currently, the vast majority of cases are acquired locally, typically spreading between patients in clinical settings. Last year, 2,377 confirmed clinical cases were diagnosed in the United States, an increase of over 1,200% since 2017. However, Candida auris is becoming a worldwide concern. According to a survey conducted last year, the number of cases in Europe virtually doubled between 2020 and 2021. “Both the number of cases and their geographic distribution have increased,” Lyman stated. While screenings and surveillance have improved, the skyrocketing case numbers indicate a real increase, she noted.
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CDC Sounds Alarm on Candida auris: Rapid Response Needed
In March, the CDC issued a press release highlighting the gravity of the situation, citing the pathogen’s resistance to conventional antifungal treatments and the alarming rate of its spread. Public health agencies are predominantly concentrated on strategies to mitigate transmission in healthcare settings as soon as possible. “It’s a kind of active fire they’re trying to put out,” Lyman stated. Candida auris, according to Dr. Luis Ostrosky, a professor of infectious diseases at McGovern Medical School at UTHealth Houston, is “kind of our nightmare scenario.”
“It’s a potentially multidrug-resistant pathogen that can spread rapidly in healthcare settings,” he said. We have never encountered such a pathogen in the domain of fungal infections. It is nearly always resistant to the most common class of antifungal drugs, and is sometimes also resistant to a second class of antifungal drugs used predominantly to treat severe catheter-related fungal infections in hospitals.
“I’ve had to sit down with a family and tell them that there is no treatment available for their loved one’s infection,” Ostrosky said. Ostrotsky has treated approximately ten patients with the fungal infection, but has provided consultations for many more. He reported observing the disease spread throughout a complete ICU in two weeks. Theoretical explanations for the emergence of Candida auris are being investigated and discussed by researchers, academics, and public health organizations. Climate change, according to Ostrosky, is the most frequently acknowledged theory.
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Unveiling the Fungus Within: Candida auris and Its Mysterious Origins
It’s conceivable, according to Lyman of the CDC, that the fungus has always been among the microorganisms that inhabit the human body. However, because it wasn’t causing infection, no one investigated it until it began causing health problems. She added that there are reports of the fungus in the natural environment, including sediment and wetlands, but sampling of the environment has been limited, and it is uncertain whether these discoveries are the result of human activity.
“There are also many concerns regarding the increased contact with humans and the intrusion of humans into nature, as well as the environmental changes and the use of fungi in agriculture,” she said. These factors may have enabled Candida auris to migrate to a new environment or expand its niche.
Researchers assert that the fungus poses a significant hazard to human health, regardless of its origins. Immunocompromised hospital patients are at greatest risk, but so are residents of long-term care facilities and nursing homes, which typically have less access to diagnostics and infection control specialists.
Not only is Candida auris difficult to treat, but it is also difficult to diagnose. It is extremely uncommon, and many clinicians are unaware of its existence.
There are numerous potential causes for the common infection symptoms sepsis, fever, and low blood pressure. The fungus is identified through a blood test. Blood is placed in a nutrient-rich medium to enable infectious organisms to proliferate and become easier to detect.
Ostrosky, however, remarks that this overlooks roughly half the cases. “Our gold standard is a little bit better than flipping a coin,” he said, adding that there is a newer technology that enhances bloodstream detection, but it’s costly and not widely used in hospitals.
In addition to the rise in incidence, popular culture has aided raise awareness of fungal infections. “The Last of Us,” a popular HBO series, is a drama about the survivors of a fungal pandemic. A fungal infection that can turn humans into zombies is a work of fiction, but confronting climate change, which is altering the types of diseases that pose a significant threat to human health, is a challenge in the real world.
“I believe the best way to consider how global warming is putting selection pressure on microbes is to consider how many more extremely hot days we are experiencing,” said Johns Hopkins’ Casadevall. “Each day at (100 degrees Fahrenheit or 37.7 degrees Celsius) is a selection event for all affected microbes, and the more days of high temperatures that are experienced, the greater the likelihood that some microbes will adapt and survive.”
Ostrosky of UTHealth Houston stated, “We’ve been flying under the radar for decades in mycology because fungal infections were uncommon in the past.”
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Source: CBS News
