Thirteen cases of fungal infection by Candida auris have been identified in the United States since 2013, according to an article published online November 5 in Morbidity and Mortality Weekly Report (MMWR). C auris infections are potentially lethal.
The infection was first identified in 2009 in the external ear-canal discharge from a Japanese patient. Seven cases occurred in the United States from May 2013 to August 2016; the remaining six US cases that emerged since then are still under investigation.
The first seven cases were identified in New York, Illinois, Maryland, and New Jersey. All affected patients had serious underlying medical conditions, such as hematologic malignancies, respiratory failure, or paraplegia, and had been hospitalized for a median of 18 days at the time of isolation of the fungus. Four patients died, although it is not certain whether the deaths were the result of C auris infection or the patients’ comorbid conditions.
Two of the seven patients had been treated in the same hospital or long-term care facility and had nearly identical fungal strains, suggesting that C auris can be transmitted in nosocomial settings, although such transmission in the United States has not been documented. Disturbingly, five isolates were misidentified as C haemulonii. One case occurred in a patient recently transferred from a hospital in the Middle East.
In addition, 71% of the C auris strains showed some drug resistance; some of the strains were resistant to all three classes of antifungal drugs.
Six of seven cases were found through review of hospital and reference laboratory records. The US isolates are related to isolates from South America and South Asia.
“We need to act now to better understand, contain, and stop the spread of this drug-resistant fungus,” said Tom Frieden, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), in a news release. “This is an emerging threat, and we need to protect vulnerable patients and others.”
To that end, the CDC stresses the importance of accurate identification of the pathogen by US laboratories and implementation by healthcare facilities of recommended infection control practices. “Local and state health departments and CDC should be notified of possible cases of C auris and of isolates of C haemulonii and Candida spp that cannot be identified after routine testing,” the MMWR article states.
According to the MMWR report, with first author Snigdha Vallabhaneni, MD, of the CDC’s Mycotic Diseases Branch, C auris-related blood infections and other infections have been identified in several countries, including Colombia, India, Israel, Kenya, Kuwait, Pakistan, South Africa, South Korea, Venezuela, and the United Kingdom.
In June 2016, the CDC issued a clinical alert concerning this emerging pathogen. It asked laboratories to report all cases and submit patient samples to state and local health departments and the CDC.
The CDC is collaborating with its domestic and international partners on C auris epidemiologic studies and on studies to determine risk factors for infection and mechanisms of transmission. It will evaluate current infection control guidelines and, if necessary, make additional recommendations.