Imminent outbreak of a deadly multidrug -resistant yeast infection-Candida auris

Emobileclinic Health News

The Centers for Disease Control and Prevention (CDC) as well as Public Health England (PHE) in the U.S and the U.K. respectively have issued alerts to hospitals and testing laboratories on the potential outbreak of deadly multidrug-resistant yeast, known as Candida Auris that is causing lethal, invasive infections in healthcare settings.  The disease first broke in 2009 in Japan, however, outbreaks of Candida auris infections have now occurred in nine countries on four continents.

Invasive infection – where the yeast enters the bloodstream – with any Candida species can be fatal. Based on information from a limited number of patients, the CDC notes that 60 percent of patients with candida auris infection have died. However, many of them had serious illnesses that, on their own, raised their risk of death.

The CDC identified three concerns about candida auris infections; firstly, it is often multidrug-resistant; secondly, it is difficult to identify; thirdly, it has caused outbreaks in hospital settings.

Candida auris enters the bloodstream and spread through the body, causing severe invasive infection. It often does not respond to commonly used antifungal drugs, making infections difficult to treat. The yeast can also cause wound infections and ear infections.

The breakout of the infection across the globe

The yeast infection was first identified in 2009 in Japan after being isolated from ear discharge of a patient. Since then, the infections that have entered the bloodstream have been reported from South Korea, South Africa, India, and Kuwait. It has also been identified in Colombia, Pakistan, the U.K., and Venezuela, although these are not detailed in any published reports, note the CDC.

Sporadic cases have been identified throughout England since 2013. One English hospital has identified more than 40 cases in its adult critical care unit.

Two other cases have also been identified in another English hospital, and investigations are under way to find if there are any other cases, says Dr. Berit Muller-Pebody, head of the antimicrobial resistance section at PHE.

So far, however, no multidrug-resistant strains of the infections have been found in the U.K.

Diagnosis still yet unclear

The infection can only be identified reliably with molecular analysis; conventional laboratory techniques can mistakenly confuse it with another related fungus.

Misidentification leads to the wrong treatment and raises the chance of the infection spreading to other patients.

Unlike candida albicans (the yeast that causes thrush infections in the genitals and mouth), candida. auris has also been found in urine and respiratory samples. However, it is not clear whether it causes infections in the lung or bladder.

Inadequate information are available on the risk factors for candida auris infections, but the CDC say evidence suggests these are much the same as for other types of candida infections, including recent surgery, diabetes, use of broad-spectrum antibiotics and antifungals, and use of central venous catheter (catheter in a large vein).

Patients who have been in intensive care for a long time appear to be particularly susceptible.

More work needed to understand C. auris

The CDC note it is unlikely that travel to the countries with known outbreaks of the infection will increase a person’s chance of becoming infected with the yeast, as infections have primarily affected patients who were already in the hospital for other reasons.

Most of these infections are treatable with a class of antifungals called echinocandins. However, in some cases, the yeast infections have been resistant to all three main classes of antifungals, making them more difficult to treat. In such cases, the infection is treated with high doses of several classes of antifungal drugs at the same time.

The authorities say more work is needed to understand how candida auris spreads, but early evidence suggests it could be via contact with surfaces or medical equipment, or from person to person.

However, certain infection control measures such as strict hand hygiene and wearing gowns and gloves are likely to prevent spread. Thorough environmental cleaning of hospital rooms could also help.

Other measures include screening of patients, isolation of those infected, and temporary closure of affected wards to enable thorough deep cleaning with an approved, fungus-targeting product.

 



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