This drug resistant fungus is spreading

Today, ten years after its discovery, cases have been reported in more than 30 countries worldwide, including the United States, Australia, India, Germany, Israel, Venezuela and South Africa. , according to the US Center for Disease Control. Prevention.

But the way we got there is a mystery: while the mushroom seems to have appeared relatively recently, its genetics reveal distinct groups that have separated on different continents.

"We really can not explain that … unless it goes back thousands of years," said Dr. Tom Chiller, chief of the Division of Mycotic Diseases at the CDC.

But when scientists looked for old samples of C. auris – knowing that previous tests might have misidentified it or did not detect it – it was hard to find it anywhere .

"It's a bit of a paradox, really," said Dr. David Eyre, a physician specializing in infectious diseases based at Oxford University. "Why did he suddenly come to cause a problem at a similar time in different parts of the world?"

Could this have to do with our use of antibiotics and antifungals? Changes in the health environment? Or maybe it's another evolutionary change, the experts ask.

"We have about 5 to 6 million different species of fungi, only a few hundred people cause human diseases," Chiller explained. "So, there is a ton of potential for more things to emerge.

"Why did this Candida emerge?"

A mushroom that acts "like a bacterium"

For Chiller, the emergence of C. auris highlights the danger of antimicrobial resistance: the appearance of "superbugs" that threaten to render powerless many of our proven drugs. But there is something different about this mushroom.

"It's a yeast that acts like a bacterium," he said.

Other Candida species already travel with us – on our skin, in our guts – and they do not tend to cause infections unless there is an imbalance. This can happen, for example, when antibiotics eliminate good bacteria with bad ones, leaving room for Candida to develop.

When this happens in the mouth, we usually talk about lily of the valley. In the bad, it is a yeast infection. But it is not known that most Candida are pbaded on to health care facilities, like C. auris.

According to the CDC, C. auris can travel to health care facilities by focusing on surfaces and medical equipment, or spreading directly from one person to another.

In a study published in October, Eyre and his colleagues discovered 70 cases of C. auris in Oxford University Hospitals over a period of about two and a half years, from February 2015 to August 2017. All except a handful had been admitted to his neuroscience unit.

Until public health authorities issue warnings on the fungus and doctors start looking for it actively, "we did not know that Candida auris was such a big problem," Eyre said.

But it would take several months before they can contain the problem. They used protective equipment, changed the way they cleaned, reduced bedside equipment and taken other measures to stop the spread.

"But despite that, we continued to see new cases," Eyre said.

Finally, they found the culprit: a probe to monitor the temperature of patients. The doctors stopped using the probes, but the mushroom remains lingered.

"Even by removing the main culprit, he was still able to stay a few more months before we could get rid of him completely."

Eyre said that it was successful: only a few patients had contracted an invasive fungal infection, no deaths were directly related to this disease and they did not have had trouble since. But he warns that it may not be as simple for other places, especially those that deal with types of C. auris that are more resistant than they have.

Mushroom samples sent to the CDC are often resistant to one or two essential antifungal drugs, the agency says. And he can develop resistance to each other during the treatment of a patient.

"When it becomes resistant, it remains resistant," Chiller said, although other microbes may lose their resistance when these drugs are no longer used to combat it.

"We have seen it become resistant to the three clbades of antifungals, making it a superbug, which makes it really impossible to treat because there is no drug that kills it. "

Consume drugs responsibly

In the United States, according to the CDC, 587 confirmed clinical cases were reported in 12 states as of February 28. More than 1,000 additional patients were infected with the fungus through targeted screening in seven of these states.

Most clinical cases have been discovered in New York, Illinois and New Jersey – 309, 144 and 104 confirmed cases, respectively.

Chiller said that C. auris is "another difficult organism to treat in a population of patients who already have a lot of trouble treating … the sickest patients."

The patients Dr. Susan Bleasdale saw in Illinois, for example, are chronically ill people who contracted the fungus in long-term care facilities, where they receive a number of other medical treatments. Fortunately, most of the cases she's seen have always been treated with common antifungals, but she added that the appearance of C. auris shows why we need to use drugs such as antibiotics and antibiotics. antifungals in a responsible way.

"It's not about using less antibiotics – it's about using the right antibiotic for the right diagnosis and for the right duration," Bleasdale said. Director of Infection Control and Antimicrobial Management at the Hospital and Clinics of the University of Illinois.

In the United States, drug-resistant bacterial infections affect 2 million people a year, leaving at least 23,000 people dead, the CDC says. In addition, one estimate is that drug – resistant infections could kill 10 million people a year in the world by 2050, up from 700,000 today.

"We live in a world covered with antibiotics," said Chiller. "We really have to think about how we use these drugs."