Candida auris: Mysterious fungus that infected Covid-19 patients at US hospital

A hospital in Florida reported nearly 40 cases of the mysterious, often deadly fungus Candida auris among patients who were being treated for the coronavirus disease (Covid-19) in July last year, a US government study has said. The hospital, which wasn’t named in the study, carried out an additional screening in the following month in which 35 more patients were identified as being Candida auris-positive.

According to the Centers for Disease Control and Prevention report, follow-up data was available for only 20 out of the 35 patients. Eight of these 20 people died. However, it was not clear whether the fungus was the main factor or not.

What is Candida auris?

C auris is a multidrug-resistant yeast that can cause invasive infection. Its ability to colonise patients asymptomatically and persist on surfaces has contributed to previous C auris outbreaks in health care settings, according to the Centers for Disease Control and Prevention.

C auris is associated with up to 40% in-hospital mortality and is usually caught inside healthcare settings, especially when people have feeding or breathing tubes, or catheters placed in large veins. It causes bloodstream, wound and ear infections and has also been found in urine and respiratory samples, but it's not clear if the fungus actually infects the lung or bladder.

Origin

The fungal disease was first identified in Japan in 2009 and has been a top priority for the Centers for Disease Control and Prevention in recent years because of its increasing global spread. Since the first C auris case was identified in Florida in 2017, aggressive measures have been implemented to limit spread, including contact tracing and screening upon detection of a new case. C auris has now been documented in more than 30 countries, with some 1,500 US cases reported to the CDC as of October 31, 2020.

What leads to Candida auris infection?

The Florida department of health and CDC together performed an investigation focused on infection prevention and control measures, finding numerous weaknesses. "Mobile computers and medical equipment were not always disinfected between uses, medical supplies (e.g., oxygen tubing and gauze) were stored in open bins," the CDC report said.

It added that hospital staff, possibly out of fear of the coronavirus, were wearing multiple layers of personal protective equipment (PPE), which is not recommended and in fact heightens the risk of microbe transmission. There were also instances of extended PPE use and re-use. The CDC says the fungus can spread in healthcare settings "through contact with contaminated environmental surfaces or equipment, or from person to person."

What did the Florida hospital do?

After Candida auris-positive cases were found, the hospital removed supplies from hallways, enhanced cleaning and disinfection practices, and improved practices around PPE use following which no new cases were detected on subsequent surveys.

"Outbreaks such as that described in this report highlight the importance of adhering to recommended infection control and PPE practices and continuing surveillance for novel pathogens like C auris," the report said.

(With AFP inputs)