Medication-immunized germ spreads silently around the world

The recently discovered Candida auris fungus has been found in several countries; can cause death in 90 days

NEW YORK – Last May, an elderly man entered Mount Sinai Hospital in Brooklyn for abdominal surgery. Blood tests revealed that he was infected with a newly discovered, deadly and mysterious germ. Doctors immediately isolated him in an intensive care unit.

The germ, a mushroom called
Candida aurisit attacks people whose immune systems are weakened and spread silently around the world. Over the last five years, he has ravaged a neonatal unit in Venezuela, wreaked havoc on a hospital in Spain, forced the closure of the intensive care unit of a prestigious dispensary in Britain and has taken root in India, Pakistan and South Africa.

And recently
Candida auris He has also reached New York, Illinois and New Jersey, forcing the US Centers for Disease Control and Prevention (CDC) to add to his list of germs considered a "threat" urgent ".

The old man admitted to Mount Sinai in Brooklyn died after 90 days of hospitalization, but the
Candida auris He survived. Analyzes showed that his room was completely invaded by the germ, to the point that the hospital had to use special cleaning equipment and even replace some of the ceiling and floor tiles to eradicate it.

"Everything was positive: the walls, the bed, the doors, the curtains, the telephones, the toilets, the pipes, the valves," says Dr. Scott Lorin, director of the hospital. "The mattress, the barrels of the bed, the containers, the blinds, the ceiling and all that was in the room were tested positive".

The
Candida auris It is so difficult to eradicate because it is immune to most antifungal drugs, making it a new example of the most difficult health threats to detect: the resurgence of drug-resistant infections.

Decades ago, public health experts warned that the abuse of antibiotics reduced the effectiveness of drugs that prolonged our life expectancy because of their ability to cure bacterial infections formerly threatening. But recently, there has also been an explosion of resistant fungi, adding a new and terrifying dimension to a phenomenon that undermines the pillars of modern medicine.

"It's a very serious problem, because to treat these patients, we depend on antifungals," says Matthew Fisher, Professor of Mushroom Epidemiology at Imperial College London, co-author of Antifungals. a recent scientific report on the rise of resistant fungi.

In short, fungi, like bacteria, develop defenses that immunize them against modern drugs.

Antibiotics and fungicides are essential for fighting infections, but antibiotics are also widely used to prevent disease in farm animals and fungicides are also used to prevent plants from rotting. Some scientists have discovered evidence that the widespread increase in the use of fungicides in crops stimulates the emergence of drug-resistant fungi that affect humans.

And although the problem is worsening, public opinion almost ignores it, in part because the very existence of resistant infections is usually hidden in secrecy.

Hospitals and local governments are reluctant to reveal infectious outbreaks of bacteria and fungi for fear of being seen as a source of disease. Even the CDC, under the terms of the agreement with US states, are not allowed to make public the exact name and location of the hospitals where the outbreaks are recorded. In many cases state governments refuse to publicly share this information and simply recognize the existence of such cases.

During this time, germs are widespread: from hand to hand hospital staff and equipment, in the transport of meat and vegetables of the countryside, in travelers crossing borders, in imports and exports and in patients . they enter and leave hospitals.

Example

The
Candida auris This is only one of dozens of fungi and dangerous bacteria that have already developed resistance. However, and like the rest, it remains virtually unknown to the public.

There are other known strains of
Candida -one of the most common causes of nosocomial infections -which has not developed significant drug resistance, but more than 90% of infections
Candida auris they are resistant to at least one drug and 30% are resistant to two or more drugs, according to the CDC.

Lynn Sosa, Deputy Chief of Epidemiology for the State of Connecticut, said that at present, the
Candida auris it is "the" main threat among resistant infections. "It's virtually unbeatable and very difficult to identify," said the manager.

Nearly half of patients who contract
Candida auris they die within 90 days, according to the CDC. However, world experts have not been able to detect where he was coming from.

"It's the monster in the black lagoon," said Dr. Tom Chiller, head of the CDC's fungal diseases department, who leads a detective initiative around the world to find appropriate treatment and stop the spread of the disease. mushroom. it exploded. "

Where does it come from?

While the CDC is trying to limit the progress of the
Candida auris, its researchers are trying to deconstruct a troubling question: what part of the world does it come from?

The first time doctors discovered the fungus was in the ear of a woman in Japan in 2009 (
Auris in Latin means ear). At that time, it seemed innocuous, the cousin of one of the many fungal infections easy to cure.

Three years later, the unusual result of a laboratory badysis of Dr. Jacques Meis, a microbiologist from Nijmegen, The Netherlands, badyzed the bloodstream infections of 18 patients from four Indian hospitals. Very soon and in a few months, new channels of
C. auris they began to appear in different parts of the world.

The CDC researchers theorized that the
C. auris he was born in Asia and spread all over the planet. But when the agency compared the complete genome of the samples of
C. auris India, Pakistan, Venezuela, South Africa and Japan discovered that it did not originate in one place and that there was not a single strain of
C. auris. In one way or another, it took almost an almost simultaneous jump, and it seemed to be spreading and now, it is drug-resistant, which is really disconcerting, "says Dr. Snigdha Vallabhaneni, a key member of the CDC research team.

There are different theories about what could have happened to the
Candida auris. Meis, a Dutch researcher, believes that the fungus has become resistant to drugs due to the intensive use of fungicides in crops.

Meis is interested in resistant fungi when he hears about the case of a 63-year-old Dutch patient who died in 2005 from a fungus known as
Aspergillus, which has been shown to be resistant to a leading antifungal agent called itraconazole. The drug is essentially a copy of the azole-based pesticides used to spray crops around the world and accounts for over one-third of total fungicide sales.

Dr. Chiller, of the CDC, has the theory that the
C. auris it may have been reinforced by the intensive use of fungicides. He thinks the mushroom has been around for thousands of years, hidden in the nooks and crannies of the world, without being a particularly aggressive pest. But when azole fungicides began to decimate the most common fungi, the
C. auris He has found a chance to gain ground because of his ability to resist fungicides in a world where less resistant fungi are attacked.

The origin of
Candida auris This remains a mystery, but for now, it's less important than slowing down its progress.