Drug-immune mushroom secretly sweeps the world | New

Recently, C. auris reached New York, New Jersey and Illinois, which brought the Federal Centers for Disease Control and Prevention to add to a list of germs considered "threats" urgent. "

The man of Mount Sinai died after 90 days of hospitalization, but not C. auris. Tests have shown that it was everywhere in his room, so overwhelming that the hospital needed special cleaning equipment and had to rip some of the ceiling and floor tile for the first time. ;eradicate.

"Everything was positive: the walls, the bed, the doors, the curtains, the telephones, the sink, the whiteboard, the poles, the pump," said Dr. Scott Lorin, president of the hospital. "The mattress, the bed rails, the box holes, the blinds, the ceiling, everything in the room was positive."

C. auris is so persistent, in part, because it is insensitive to major antifungal medications, making it another example of one of the most insurmountable health threats in the world: the resurgence of drug-resistant infections .

For decades, public health experts have warned that overconsumption of antibiotics reduced the effectiveness of drugs that prolonged life by curing bacterial infections, which were often fatal. But recently, there has also been an explosion of resistant fungi, adding a frightening new dimension to a phenomenon that undermines one of the pillars of modern medicine.

"It's a huge problem," said Matthew Fisher, professor of fungal epidemiology at Imperial College London, co-author of a recent scientific study on the rise of resistant fungi. "We depend on being able to treat these patients with antifungals."

In simple terms, fungi, just like bacteria, develop defenses to survive modern drugs.

Yet, even though global health leaders have called for more restraint in the prescription of antimicrobial drugs to fight against bacteria and fungi, the UN General Assembly convened the UN General Assembly in 2016 to manage an emerging crisis.

Resistant germs are often called "superbugs", but this is simplistic because they usually do not kill everyone. They are quite deadly for people whose immune systems are immature or compromised, including newborns and the elderly, smokers, diabetics and people with autoimmune disorders who take steroids that inhibit the defenses of the body.

Scientists say that unless new, more effective drugs are developed and the unnecessary use of antimicrobials is greatly reduced, the risk will spread to healthier populations. A study by the UK government funded projects that, in the absence of a policy to slow drug resistance, 10 million people worldwide would have died from all these infections in 2050, eclipsing the 8 million that should die of cancer that year.

In the United States, 2 million people become infected each year and 23,000 die, according to official CDC estimates. This number was based on 2010 figures; More recent estimates from researchers at the University of Washington's School of Medicine report 162,000 deaths. The number of deaths from resistant infections worldwide is estimated at 700,000.

Antibiotics and antifungals are essential for fighting infections in humans, but antibiotics are also widely used to prevent disease in farm animals and antifungals are also used to prevent rotting of agricultural plants. Some scientists cite evidence that the widespread use of fungicides on crops contributes to the recrudescence of drug-resistant fungi that infect humans.

However, as the problem grows, the public misunderstands it – in part because the very existence of resistant infections is often hidden in secrecy.

With bacteria and fungi, hospitals and local governments are reluctant to disclose outbreaks for fear of being considered as outbreaks of infection. Even the CDC, 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 refused to publicly share information beyond simple case recognition.

During all this time, germs spread easily – carried by hands and equipment in hospitals; ferries on vegetables fertilized with meat and manure from farms; transported across borders by travelers and on exports and imports; and transferred by patients from the retirement home to the hospital.

C. auris, which infected the man of Mount Sinai, is one of dozens of dangerous bacteria and fungi that have developed resistance. Yet, like most of them, it is a threat virtually unknown to the public.

The other important strains of the Candida fungus – one of the most common causes of blood infections in hospitals – have not developed significant drug resistance, but more than 90% of C-infections auris are resistant to at least one drug and 30% are. resistant to two or more drugs, said the CDC.

Dr. Lynn Sosa, Connecticut's associate epidemiologist, said she now sees C. auris as the most serious threat among resistant infections. "It's pretty unbeatable and difficult to identify," she said.

According to the CDC, nearly half of patients who contract C. auris die within 90 days. Yet, the world experts have not specified where he came from.

"It's a creature of the black lagoon," said Dr. Tom Chiller, head of the fungal branch of the CDC, who leads a global detective effort to find treatments and stop the spread. "He's bubbling and now he's everywhere."

"No need" to tell the public

In late 2015, Dr. Johanna Rhodes, an infectious disease expert at Imperial College London, had a panicked call from the Royal Brompton Hospital, a British medical center located outside of London. C. auris had taken root there months earlier and the hospital could not clean it.

"We have no idea where it comes from. We have never heard of it. It's like lighting up a trail of powder, "said Rhodes. She agreed to help the hospital identify the genetic profile of the fungus and clean the rooms.

Under his leadership, hospital employees used a special device to spray aerosol hydrogen peroxide around a room used for a patient with C. auris, the theory being that the Steam would foam every corner. They left the camera for a week. Then they placed a "fixation plate" in the middle of the room with a bottom gel that would serve as a breeding ground for the surviving microbes, Rhodes said.

Only one organism has rejected. C. auris.

It spread, but nothing says it. The hospital, a specialized lung and heart center that attracts wealthy patients from the Middle East and Europe, alerted the British government and informed infected patients, but made no public announcements.

"It was not necessary to issue a press release during the outbreak," said Oliver Wilkinson, spokesman for the hospital.

This muffled panic is taking place in hospitals around the world. Individual institutions and national, state and local governments have been reluctant to announce epidemics of resistant infections, saying there is no point in scaring patients – or potential patients.

Dr. Silke Schelenz, infectious disease specialist at Royal Brompton, said the lack of urgency of the government and the hospital at the very beginning of the epidemic was "very, very frustrating".

"They obviously did not want to lose their reputation," said Schelenz. "It did not have an impact on our surgical results."

At the end of June 2016, a scientific article reported "an ongoing epidemic of 50 cases of C. auris" at Royal Brompton, and the hospital has reached an extraordinary milestone by closing its intensive care unit for 11 days, moving ICU patients to another floor. , again without announcement.

A few days later, the hospital finally admitted to a newspaper that he had a problem. In the Daily Telegraph, the Daily Telegraph warned, "The intensive care unit is closed after the appearance of a new deadly Superbug bacteria in the UK."

However, the problem remained little known at the international level, while an even more serious epidemic had begun in Valencia, Spain, at the university hospital of 992 political beds. There, without the knowledge of the public and unaffected patients, 372 people were colonized – which means they had the germ on their body but were not sick – and 85 developed blood infections. An article in the journal Mycoses reported that 41% of infected patients had died within 30 days.

A statement from the hospital indicates that it is not necessarily C. auris who killed them. "It is very difficult to determine if patients are dying from the pathogen because they are patients with many underlying diseases and the general condition is very serious," the statement said.

As with Royal Brompton, the Spanish Hospital has made no public announcement. He still has not.

An author of the article Mycoses, a hospital doctor, said in an email that the hospital did not want him to talk to reporters because he "worries about the public image of the hospital".

The secret irritates the advocates of patients' rights, saying that people have the right to know if there is an outbreak in order to decide whether or not they should go to the hospital, especially if it is about a non-urgent case, such as elective surgery.

"Why on earth are we talking about an epidemic almost a year and a half later – and we do not have it on the front page the next day?" Said Dr. Kevin Kavanagh, Kentucky physician and president of the Health Watch USA board of directors. , a non-profit patient advocacy group. "You would not tolerate that in a restaurant where there was food poisoning."

Health officials say the revelation of the outbreaks scares patients of a situation they can not do anything about, especially when the risks are unclear.

"It's hard enough with these organizations for health professionals to get along," said Dr. Anna Yaffee, a former CDC investigator who discussed outbreaks of resistant infections in Kentucky, where hospitals have not been publicly disclosed. "It's really impossible to get a message out to the public."

Officials in London alerted the CDC of the Royal Brompton outbreak during its appearance. And the CDC realized that the message had to be sent to American hospitals. On June 24, 2016, the CDC sent a national alert to hospitals and medical groups and created an email address, [email protected], to respond to inquiries. Dr. Snigdha Vallabhaneni, a key member of the fungal team, was waiting to receive a net – "maybe a message every month".

Instead, after a few weeks, his inbox exploded.

In the United States, 587 cases of people having contracted C. auris have been reported, concentrated with 309 in New York, 104 in New Jersey and 144 in Illinois, according to the CDC.

The symptoms – fever, body aches and fatigue – are apparently ordinary, but when a person is infected, especially someone already in poor health, such common symptoms can be fatal.

The first known case in the United States involved a woman who arrived on May 6, 2013 in a hospital in New York to receive care for respiratory failure. She was 61 years old and was from the United Arab Emirates. She died a week later after being tested positive for the fungus. At the time, the hospital had not thought much about it, but three years later, he referred the matter back to the CDC after reading the June 2016 agency's opinion.

This woman was probably not the first American patient with C. auris. She wore a different strain of the most common South Asian here. He killed a 56-year-old American woman who had traveled to India in March 2017 for scheduled abdominal surgery, contracted C. auris, and was flown to a Connecticut hospital that officials would not be identified. . She was later transferred to a Texas hospital where she died.

The germ is widespread in long-term care facilities. In Chicago, 50% of residents in some retirement homes tested positive, the CDC reported. The fungus can grow on intravenous lines and ventilators.

Workers who care for patients infected with C. auris are worried about their own safety. Dr. Matthew McCarthy, who treated several patients with C. auris at the Weill Cornell Medical Center in New York, described an unusual fear when treating a 30-year-old man.

"I found myself not wanting to touch the guy," he said. "I did not want to take it to the guy and carry it to someone else." He did his job and thoroughly examined the patient, but he said, "There was a feeling overwhelming to be terrified at the thought of accidentally taking him on a sock or tie or a dress. "

While the CDC is using it to limit the spread of drug resistant C. auris, its investigators are trying to answer the thorny question: where does it come from around the world?

The first time doctors met C. auris was in the ear of a woman in Japan in 2009 (auris is an ear in Latin). At the time, it seemed innocuous, cousin of common fungal infections and easy to treat.

Three years later, the result of his test was unusual in the laboratory of Dr. Jacques Meis, a microbiologist in Nijmegen, the Netherlands, who analyzed a blood infection in 18 patients in four Indian hospitals. Soon, new groups of C. auris appeared to emerge over the months in different parts of the world.

CDC researchers assumed that C. auris had started in Asia and had spread around the world. But when the agency compared the entire genome of auris samples from India and Pakistan, Venezuela, South Africa, and Japan, it found that its origin was not unique and that there was not a single strain of auris.

Sequencing of the genome showed that there were four distinct versions of the fungus, with differences so deep that they suggested that these strains had diverged thousands of years ago and had become pathogens resistant from harmless environmental strains at four different locations at the same time.

"In one way or another, he apparently jumped almost simultaneously, he seemed to be spreading and he resists drugs, which is really mind-boggling," said Vallabhaneni.

There are different theories about what happened with C. auris. The Dutch researcher Meis said he believed that drug-resistant fungi were growing thanks to the intensive use of fungicides on crops.

Meis was intrigued by resistant fungi when he heard about the case of a 63-year-old Dutch patient who died in 2005 from a fungus called Aspergillus. It has been shown to be resistant to first-line antifungal therapy called itraconazole. This medication is a virtual copy of the azole pesticides used to dust crops around the world and accounts for over one-third of all fungicide sales.

An article published in 2013 in PLoS Pathogens indicated that it did not seem to be a coincidence that drug-resistant Aspergillus appeared in the environment where azole fungicides were used. The fungus appeared in 12% of Dutch soil samples, for example, but also in 'flower beds, compost, leaves, plant seeds, soil samples from tea plantations, rice paddies, hospitals and air samples from hospitals ".

Last summer, Meis went to the CDC to share research and hypothesize that the same goes for C. auris, which is also found in the soil: Azoles have created an environment so hostile that fungi evolve and resistant strains survive.

This is similar to the concerns that resistant bacteria are developing because of the excessive use of antibiotics in livestock for health and growth promotion. Like antibiotics in farm animals, azoles are widely used on crops.

"On everything – potatoes, beans, wheat, all you can think of, tomatoes, onions," said Rhodes, the infectious disease specialist who worked on the London epidemic. "We are driving this with the use of antifungals on crops."

Chiller assumes that C. auris could have benefited from the intensive use of fungicides. His idea is that C. auris has existed for thousands of years, hidden in the crevices of the world, a little aggressive virus. But while azoles were starting to kill more common fungi, an opportunity has emerged for C. auris to penetrate the gap, a germ that can easily withstand fungicides that are now suitable for a world where less resistant fungi are able to survive. attacked.

The mystery of the emergence of C. auris has not been solved and its origin seems, for the moment, less important than its judgment.