Drug resistant mushroom pops up worldwide and worries health researchers – National

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In April 2015, a patient hospitalized in London, UK, tested positive for a potentially fatal fungus – Candida auris.

In less than a week, the patient who had a bed had it too. A month later, two other people caught him. When hospital employees tested the intensive care unit, they discovered that C. auris was growing on the floor, radiators, window sills, monitors, and keyboards, depending on the location. a newspaper article on the epidemic.

Despite thorough cleaning and infection control measures, 50 people were colonized by the fungus within 16 months. Fortunately, no one has died.

In other hospitals, C. auris was transmitted from patient to patient by temperature probes, blood pressure cuffs, and contaminated computer keyboards. Disturbingly, not only was it in the environment, but in many cases it was difficult to treat – C. auris is often resistant to antifungal medications.

Of the 140 patients infected during the first 10 months of a recent epidemic in Spain, 41 developed invasive blood infections. Even with treatment, 17 people died, according to a newspaper article.

C. auris has also appeared in Canada, said Amrita Bharat, a research scientist at the National Microbiology Laboratory, which is managed by the Public Health Agency of Canada. Since 2012, there have been 19 cases – much less than the 617 cases seen in the United States as of March 29, 2019, according to a recent update from the Centers for Disease Control and Prevention.

"Until now, we have managed to contain our cases and we have yet to see any of the major hospitalization epidemics that other countries have experienced," Bharat said. She attributes this to infection detection and control measures implemented in Canadian hospitals and to mushroom awareness.

But not all mushrooms are so scary.

The microbiome

We are all covered with mushrooms. "There are probably hundreds of species on us at all times," said Julianne Kus, Clinical Microbiologist and Clinical Lead for the Public Health Ontario Reference Laboratory in Mycology.

Some of them are "transient," she says, simply crossing them as we inspire them in our environment or put them on our skin.

Some of them make us their home.

"They are part of our natural microbiome. They coexist with other organisms like bacteria. They are on our skins, they are on our mucous membranes, they are in our digestive tract. "

According to a study published in Nature, different fungi colonize different parts of the body. Aspergillus seems to like our forearms. Saccharomyces loves our nostrils. And everything seems to please our feet – our heels, our toenails and the space between our toes are home to a garden full of mushrooms. A family of mushrooms, Malassezia, seems to live on most of our skin.

Although they constitute a much lower proportion of organisms living inside of us and than bacteria, scientists believe that they could be important and strive to determine exactly what mushrooms prepare.

"We realize now that they are actually very important to health as well as disease," said Natalie Knox, chief of the computer biology department of the bioinformatics section of the Public Health Agency of Canada.

"So, like bacteria, there are good mushrooms, then bad mushrooms. And then, there are some that are apparently not harmful to humans, but that can cause illness or infection if the opportunity arises. "

Taking antibiotics, for example, kills both the bacteria that hurts us and the other benign bacteria that lives in us, Kus said. "And when these bacteria are gone, there will be some sort of hole, and the fungi or yeast can fill that void when there are more bacteria out there."

In some women, this can lead to an overgrowth of Candida fungi in the vagina, otherwise known as yeast infection. "And this often happens after antibiotic therapy because all your healthy bacteria that normally live in you are no longer there and that the balance has been totally upset," Kus said.

Patients with weakened immune systems are also prone to fungal infections, she said. "We have an increasing number of immunocompromised people in our population."

This is partly due to the progress of medicine. "The treatment of cancer, organ transplants, helping people with chronic inflammatory diseases such as rheumatoid arthritis – treatments for these diseases weaken their immune systems."

WATCH: Is the microbiome the key to good health?

This means that these people are not able to fight fungi as before, she said.

This is one of the reasons why researchers are so concerned about drug-resistant fungi.

Drug resistance

Another is that we simply do not have as many drugs. There are only three major families of antifungal drugs and, according to a review paper published in Science in 2018, some samples of Candida auris have been shown to be resistant to all three.

While all Canadian cases, up to now, were still sensitive to a family of medications, Bharat said, "I think that with only three classes of antifungals, any resistance we see is concern. "

"We do not have as many drugs with which to play as against bacteria," Kus said.

"So even a little resistance to antifungal medications is a big problem for people with fungal diseases."

"We are now witnessing an unprecedented increase in antifungal resistance worldwide," wrote the authors of the 2018 Science article. They suggested that antifungal resistance came from two main sources: all drugs Antifungals increasingly used in hospitals, especially in immunocompromised patients to prevent fungal infections, and the increased use of antifungals in agriculture.

"On the agricultural side, there is a group of antifungal agents called azoles. The chemical structure of these antifungals used on crops is very very similar to the one we use medically, "Kus said.

WATCH: Scientists trigger alarm against drug-resistant bacteria

Aspergillis fumigatis, another fungus that can infect humans, develops resistance to azoles – more than a quarter of Aspergillis infections in the Netherlands are resistant to azoles, according to the newspaper, and drugs fail more in addition as first-line treatments.

According to Kus, until we have new antifungal medications, it is important to advocate for the judicious use of antifungals in health care – perhaps also in agriculture, she thinks.

"These are opportunistic pathogens. They take advantage of the situation when it comes. "

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