Candida auris (C. auris) is a fungus species that has emerged as a serious threat to global health. The fungus grows as yeast and was first reported in 2009. It is amongst the few Candida genus species that cause candidiasis infection in human beings. The infection typically spreads at hospitals in patients with impaired immune systems.

Candida auris can cause severe invasive infections which affect the bloodstream, internal organs, and the central nervous system. The superbug has currently attracted increased global attention due to its resistance to several commonly used medications and antifungal drugs. Patients with central venous catheter in a big vein, or those in ICU for a prolonged period, or those who have used antifungal drugs or antibiotics in the past are more prone to developing Candida auris infections. The yeast is prone to get misidentified as other species of Candida and hence treatment of infection by the superbug is often difficult and complicated.

Because of all the above factors healthcare facilities all over the world have been asked by the government and health agencies to be on the alert for Candida auris infections in patients.

 Origin of ‘Candida auris’ name

In Latin, auris means war. The superbug can however also affect other different areas of the body and can cause invasive infections and wound/injury infections.

The fungus was first described in Japan in 2009. When strain collections of Candida were reviewed retrospectively, it was found that the earliest known C. auris strain dated back to 1996 in S. Korea.

The CDC of the United States has categorized the fungus to be an emerging germ due to the high infection rate in several countries since the time the superbug was first identified.

Risk to different types of infections caused by Candida auris

Candida auris has caused infections of the ear, wounds, and the bloodstream. The bug was also isolated from samples of urine and respiratory matter. It is however unknown whether the fungus causes bladder or lung infections.

There is very limited information with regards to risk factors for infections by C. auris. It is postulated that they are similar to risk factors for other kinds of Candida fungus infections. Some of these risk factors are diabetes, recent surgery, and use of antifungal drugs and broad-spectrum antibiotics, etc. The highest risk is to those who have had prolonged stays at nursing homes and hospitals and have had feeding or breathing tubes, or central venous catheters, or other kinds of tubes or lines that are inserted into the body. People of all age groups have been found to have C. auris infections, including the elderly and preterm infants.

The infection typically spreads in hospitals or other healthcare facilities via exposure to contaminated equipment or environmental objects or surfaces, or from one patient to another person. Research is still ongoing with regards to spread of the illness.

It is recommended that any person who thinks that he/she has any kind of fungal infection, or other kinds of infection, should immediately seek medical attention and get tested for Candida auris infection.

Why the widespread concern over C. auris infections?

Healthcare workers and agencies are concerned about Candida auris due to the below listed reasons:

• The fungus is multi-drug resistant, which means that it does not respond to several antifungal medications that are usually used for treatment of Candida infections.
• The fungus has caused outbreaks in hospitals and other healthcare facilities. Quick identification of Candida auris infection in patients can help stop its transmission and spread. Rapid diagnosis is therefore of vital importance.
• Normal laboratory methods of detection are usually not useful in identification of the fungus. Laboratories without specific equipment or technology may misidentify C. auris infections, which in turn can lead to incorrect treatment and management.

Identification for Candida Auris

Candida auris infections are also diagnosed like other kinds of Candida fungus infections, i.e., via fungal culture of a sample of blood or other bodily fluids. It is however very difficult to recognize C. auris as compared to cultures of other kinds of Candida. It is possible for lab technicians to confuse C. auris with other kinds of yeasts, especially Candida haemulonii.

Specialized lab tests and methods are required for accurate identification of the yeast.

Treatment of Candida auris infection

Most cases of Candida auris infections can be treated with echinocandins, a class of antifungal medications. Some infections have however been resistant to treatment via all the 3 major classes of antifungal drugs. This makes treatment more complex and difficult. In such cases, doctors may prescribe high dosage of multiple classes of antifungal drugs to treat C. auris infection.

It is best to seek treatment from an experienced doctor who specializes in treatment of fungal infections.

Invasive infections by any type of Candida can result in death of the patient. It is however unknown whether C. auris infection patients have a greater risk of death than those with other Candida infections. As per limited data gathered from limited patient numbers, the fatality rate for C. auris infections falls between 30 to 60 percent. It may however be noted that many of the patients also had other severe diseases which elevated their risk of fatality.

Candida auris infections around the world

Infections of C. auris has been reported in varied countries around the world, including the United States, Canada, India, Colombia, Kuwait, Germany, Kenya, Norway, Japan, Israel, Spain, Pakistan, South Korea, the UK, South Africa, and Venezuela.

Genome sequencing offers comprehensive DNA fingerprints of varied organisms. Genome sequencing of specimens collected from different countries in southern and eastern regions of Asia, South America, and southern part of Africa showed that isolates in each region were similar to each other, but were comparative different in different regions. These dissimilarities mean that the yeast emerged on its own in different regions of the world at about the same time.

Traveling to countries with document cases of Candida auris infections is not likely to increase the risk towards the illness. C. auris infections have mainly been diagnosed in hospitalized patients.