Candida Auris A Drug Resistant Fungal Menace

Candida is a common fungus (yeast or mold) which frequently grows on human skin and in the digestive, urinary, and reproductive tracts. Candida species in the gut produce allergens, alcohols and toxins which can have adverse health effects.

In some people, especially those with immunocompromised immune systems such as those with cancer, HIV, severe malnutrition, premature babies, or those on immunosuppressive drugs, Candida can develop into a severe, invasive and life-threatening infection. In the USA, invasive Candida infections cause about 46,000 serious invasive infections and 15,000 deaths annually.

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1 A number of species of Candida infect humans- the most common one being Candida albicans, with other common species being Candida glabrata, parapsilosis, tropicalis, and kruesi. Recently, Candida auris has emerged as a very virulent form of Candida with a high death rate. Candida auris is hard to identify by traditional methods. Candida auris is especially dangerous since it is resistant to most common fungal drugs from the 3 main classes: 1) amphotericin B, 2) azoles such as fluconazole, 3) echinocandins such as Caspofungin.

A case report of the first seven cases in the USA between 2013 and 2016 was made. All cases were treated with strong antifungal drugs including echinocandins, but four patients still died 2. Another study reported a death rate of 59% for 54 cases of invasive Candida auris in India, Pakistan, South Africa and Venezuela

3 . Antibiotic resistance was very high in this series, with 93% Candida auris isolates being resistant to fluconazole, 35% to amphotericin B, and 7% to echinocandins. Forty-one percent of the Candida auris strains were resistant to 2 different antifungal drugs and 4% were resistant to all 3 classes 3. In is likely that Candida auris infections will increase worldwide. Prompt diagnosis and treatment with multiple fungal drugs of Candida auris is essential to control the epidemic.

References / Sources

1. CDC. Antibiotic Resistant Threats. 2013.

2. Vallabhaneni S, Kallen A, Tsay S, et al. Investigation of the First Seven Reported Cases of Candida auris, a Globally Emerging Invasive, Multidrug-Resistant Fungus-United States, May 2013-August 2016. Am J Transplant 2017;17(1):296-99. 3.Lockhart SR, Etienne KA, Vallabhaneni S, et al. Simultaneous Emergence of Multidrug-Resistant Candida auris on 3 Continents Confirmed by Whole-Genome Sequencing and Epidemiological Analyses. Clin Infect Dis 2017;64(2):134-40.

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