Hospital Infection Nightmare: Fungus Candida auris

"Typically, we have never really been concerned about fungi or yeast spreading from person to person."
"It seems to be acting a little bit differently. We haven't really thought about fungi this way before."
"It highlights that we are still vulnerable to infectious disease. We will not be able to rely on antibiotics forever."
"Should [Canadians] be worried? In Canada we are doing a pretty good job so far in containing it. We haven't had the same experience as is happening in the States."
"I would say from the community level, I would not worry about it. But it is a good thing to talk about."
Dr.Julianne Kus, clinical microbiologist, Public Health Ontario

File photo

In Winnipeg, a resident who had been to India became a patient in a local hospital in 2017. That 64-year-old is now recognized as Canada's Patient Zero, the first individual to bring back a new threat steadily emerging across the globe, hitting hospitals everywhere and placing them on high alert. Having undergone dental surgery in India, the individual became infected with a drug-resistant bacteria called Candida auris, a fungal infection found in the person's ear after being drained and tested.

This is an infection resistant to multiple drugs, one able to spread from patient to patient. Candida auris is able to live on skin, walls, curtains, handles, cellphone; virtually any surface. It poses little risk to healthy patients, but can colonize the skin of patients with seemingly no deleterious impact. They, in turn can communicate the bacteria to others with suppressed immune systems, causing a serious infection that can enter their bloodstreams and can result in lethality.

It flourishes in some countries as a now-common infection, and there mortality rates for people with invasive Canadida auris are above 50 percent with limited treatment options, making it a viral and often-deadly threat difficult to eradicate. Hospitals in particular view its impact with alarm, since it is there that populations of patients with suppressed immune systems congregate; undergoing cancer treatment or transplants, as an example.

To complicate matters even further, Candida auris is difficult to identify, diagnose, treat and contain; it is particularly persistent. "I think it is something that all hospitals are worried about", remarked Dr. Kus at Public Health Ontario. Thus far, Canada has recognized 19 cases of Candida auris. A cluster of cases in British Columbia, and five others in southern Ontario, although none of the cases surfacing in Ontario was multi-drug resistant.

Candida auris was identified first in 2009 in Japan. Since then it has morphed into a global threat, behaving differently than other infectious threats; its ability to cling to synthetic surfaces to form a biofilm makes it particularly difficult to eradicate. While humans are normally colonized with various strains of Candida which can sometimes cause infections like vaginal yeast and athlete's foot, those strains are considered a nuisance, rather than serious infections.

Treatment for fungal infections is limited, posing yet another complication with Candida auris. Aside from which antifungal drugs can be harmful, and this being the case, they must be judiciously used to avoid harm. Advice to physicians from Public Health Ontario is that rooms of patients or residents colonized with C.auris must be cleaned and disinfected on a daily basis; even twice daily -- with medical equipment used only on that patient, none others.

Ultraviolet light holds out hope as a treatment to eradicate its presence, and evidence exists that hydrogen peroxide vapour together with ultraviolent light can be capable of reducing levels of environmental contamination with C.auris. It is as yet unknown whether this will ultimately reduce transmission rates.

Stephanie Spoor, second from the right, is pictured here with her family. The Chicago woman died in February after contracting a drug-resistant superbug in hospital. (Submitted by Jason Spoor-Harvey.)
Stephanie Spoor, 64, died in February after contracting the fungal superbug Candida auris at Chicago's Northwestern Memorial Hospital while awaiting a lung transplant. She had lived with lupus for years, but the infection killed her within weeks.