The number of Candida auris infections is said to have doubled in the United States between 2020 and 2021. It is a potentially deadly yeast (fungus), resistant to most drugs. Should we fear it in France? What are its symptoms?
[Mis à jour le 22 mars 2023 à 15h54] Cases of life-threatening Candida auris fungal infections almost doubled in the United States, between 2020 and 2021, announced on March 20, 2023 the Centers for Disease Control and Prevention of the United States in the Annals of Internal Medicine. THE candida auris is a microorganism of the genus Candida belonging to the category of yeasts. This germ is increasingly found as a pathogen responsible for many fungal infections (caused by mushrooms therefore) nosocomial, that is to say contracted during a stay in a healthcare establishment. It would attack hospitalized patients, those undergoing surgery or intravenous treatment. Problem: the Candida auris is resistant to most antifungal drugs available on the market. This fungus attacks in particular people with weakened immune systems as infants, the elderly, or people with certain illnesses such as multiple sclerosis or diabetes. In the United States, health authorities consider this germ to be “a very urgent public health threat“. Should we fear its proliferation in France?
What is Candida auris fungus?
THE candida auris East a fungus of the genus Candida which develops in the form of a yeast. This species can cause candidiasis in men and in particular cause infections:
- blood (candidaemia),
- bile,
- wounds (surgical, “severe burns”),
- ear (otitis),
- urinary tract,
- skin (abscesses associated with the insertion of catheters),
- heart muscle,
- liver,
- meninges (meningitis),
- bones.
Is Candida auris present in France?
In Franceat the last balance sheet of the High Council of Public Health (updated July 2019), 6 cases (4 confirmed cases and 2 probable) would have been identified mainly colonizations. “This yeast can persist for several months in the environment and in colonized or infected people, which promotes transmission in hospital settings.“, can we read on the notice. So, Candida auris has already been observed in France. Nevertheless, France has not experienced any epidemic situations to date, unlike other countries such as the United Kingdom, Spain and the United States. Note that Candida auris was first described in 2009 in Japan in a sample taken from a patient’s ear canal. Hence the name “Candidas auris” which means “candidiasis of the ear” in Latin. Since then, this yeast has been identified in several countries spread over the 5 continents, in particular the United Kingdom, Spain, United States and India which have experienced major epidemics, reports the high council of public health.
How to recognize Candida auris?
The usual laboratory methods do not always make it possible to accurately recognize Candida auris, “so much so that it is often misidentified“, specifies the National Institute of Public Health of Quebec in theone of his publications (January 2018). The gene sequence, slightly different from other strains, its resistance to different classes of antifungals and its ability to grow at 42°C – but not at 45°C like other Candida – are three elements that allow biologists to recognize the Candida auris.
THE candida auris is transmitted in healthcare settings by causing outbreaks. Transmission takes place:
- by direct contact from one infected person to another,
- by indirect contact via the environment and contaminated healthcare equipment.
This germ can affect any age group, but particularly adults with risk factors (people who had surgery less than 3 months ago, immunocompromised, diabetics, with chronic renal failure, HIV-infected, carriers of a catheter, an endotracheal tube or catheter, taking steroids, elderly…). Newborns are particularly affected.
What are the symptoms of a Candida auris infection?
The symptoms of a Candida auris infection are:
- a moderate to intense fever,
- body aches,
- severe fatigue.
These symptoms may seem ordinary and benign, but are particularly dangerous for people at risk such as patients with weakened immune systems, infants and the elderly.
Who are the people at risk?
People who are very ill, who wear invasive medical devices, or who stay frequently or for a long time in healthcare facilities are at increased risk of contracting Candida auris.
What causes Candida auris?
Candida auris is a mysterious germ, still little known by biologists. But where does Candida auris come from? “This fungus, resistant to drugs would have developed thanks to intensive use of fungicides in cropswhich can be found on potatoes, beans, wheat, tomatoes, onions…“, said Dr Rhodes, an infectious disease specialist who worked on the epidemic in London. However, this possibility must be verified. Another hypothesis: Candida auris would be the direct consequence”overuse of antibiotics by hospitalsthus contributing to the resurgence of drug-resistant fungi“, add other researchers quoted in the New York Times. A study published in July 2019 in the scientific journal mBio looked at the origins of Candida auris. It seems that this fungus developed because of the global warming. Indeed, the majority of fungi normally develop in temperate air, but do not resist the heat of the human body. However, Candida auris seems to adapt very well to higher temperatures. This pathogen would then be able to get out of histhermal restriction“an area that is too hot, which prevents most fungi from growing in our bodies, explains Dr. Arturo Casadevall, the study’s lead author.
What is the treatment for a Candida auris infection?
THE candida auris is very often resistant to antifungals (Fluconazole, Voriconazole, Amphotericin B, etc.) commonly used in the treatment of Candida infections, which considerably reduces the treatment capacities and the survival of infected people. In other words, this “super-mushroom” is capable of developing defenses to survive treatment. At the moment, extremely few medical options exist. Only prevention and control measures can reduce its proliferation: screening of close contacts in the event of a new case, reinforced hand hygiene, isolation (room only) of an infected patient, etc.
Sources:
– Increasing Threat of Spread of Antimicrobial-resistant Fungus in Healthcare Facilities, CDC, March 20, 2023
– Management measures for patients infected or colonized by Candida auris, High Council for Public Health, July 2019