What You Need to Know About Emerging Fungal Infections

A fungal infection that can cause severe illness and death in vulnerable people, Candida auris, is raising alarm across the country. Cases are on the rise and the fungus is increasingly resistant to common anti-fungal medications. Here’s what you need to know.

What Is Candida auris?

Candida auris, or C. auris, is a newer species of yeast found mostly in health care settings. The infections typically affect patients who are very ill, who spend significant time in hospitals or nursing homes, and who have weakened immune systems.

The yeast was first identified in Japan in 2009, and the first U.S. cases were detected several years later. Nationwide, infections for C. auris rose from 476 in 2019 to 1,471 in 2021. The CDC issued a warning in March about the rise in cases, which are increasingly resistant to echinocandins, the anti-fungal medications for C. auris infections.

“In general, C. auris is not a threat to healthy people,” the CDC said in a media release. “People who are very sick, have invasive medical devices, or have long or frequent stays in healthcare facilities are at increased risk for acquiring C. auris.”

How It Spreads

C. auris can spread through contact with contaminated surfaces and equipment or through contact with an infected person. The yeast can survive for weeks on the skin or on surfaces in health-care settings.

“What’s different about Candida auris is that it can survive on skin and surfaces for up to two weeks, allowing the spread from person to person in healthcare settings and nursing homes,” says Mahmoud Ghannoum, PhD, Director of the Center for Medical Mycology at University Hospitals Cleveland Medical Center and Professor of Dermatology and Pathology at Case Western Reserve University School of Medicine.

Detection and Symptoms

Identifying C. auris is challenging because it can be misidentified as other types of fungi without specialized laboratory testing:

• Symptoms may not be noticeable because infected people often are already sick with another serious condition.
• Symptoms of infection depend on the part of the body affected. C. auris can cause many different types of infection, such as bloodstream infection, wound infection and ear infection. The pathogen also has been found in respiratory and urine samples.
• Because symptoms can vary greatly, a laboratory test is needed to determine whether a person has a C. auris infection.

How to Prevent Spread

C. auris infections carry a high mortality rate for vulnerable people. More than one in three patients with invasive infections affecting the blood, heart or brain will die.

Prevention measures include: good hand hygiene practices by health care staff and visitors; proper environmental disinfection; isolating infected patients; and use of personal protective gear by staff and caregivers.

Facilities should also clean rooms of infected patients with specialized products designed to kill the fungus.

Treatments

While some strains are treatment resistant, most C. auris infections are treatable with anti-fungal drugs called echinocandins. For infections that are resistant, multiple anti-fungal medications at high doses may be needed.

Dr. Ghannoum and researchers from University Hospitals and Case Western Reserve University School of Medicine are working on drug therapy to combat the infections. The research team received a $3 million grant from the National Institutes of Health.

“We hope to develop new antifungal compounds that will lead to clinical drugs through the research supported by this grant,” says Dr. Ghannoum.