The CDC is warning Americans in nearly 20 states that they may be at risk of contracting a deadly superbug. Candida auris is a yeast fungus indirectly related to Candida albicans, the germ that causes vaginal yeast infections and oral thrush.
Unlike other fungal infections, which are often transient and easy to treat, Candida auris is of significant concern on a global scale due to the fact that it is extremely contagious and difficult to treat. With nearly 587 cases already diagnosed across the United States, this is a disease everyone needs to be aware of.
Is C. Auris Being Covered Up?
Given that the fungus is just as severe in nature as the incredibly infective and deadly MRSA, it should be getting the same amount of attention and precaution. But given that some facilities don’t even consider it a front-line test, that may not be happening.
Some experts are also placing the blame for exploding C. auris statistics squarely on hospitals and facilities with inadequate care standards. Failing to properly sterilize equipment, for example, can hasten the spread of C. auris patient-to-patient, but some experts believe facilities may be willingly limiting the spread of information when they identify infections.
Sadly, this puts patients at risk, especially before and after undergoing a procedure. By the time a physician or laboratory tests for the disease, it may already be too late.
Hospitals and facilities who announce their status as a facility with diagnosed C. auris cases often face other indirect consequences.
- Expensive clean-ups that may include structural tear-down and replacement of both equipment and furniture.
- Patient refusals to attend or use the hospital (especially if they’re staying in-hospital for surgery) out of fear of contracting the disease.
- Pressure from corporate healthcare leads to minimizing public hysteria by refusing to disclose the status of the facility after a diagnosis.
- Lawsuits from patients and large-scale organizations who believe facilities should be held responsible for not properly notifying the public and/or testing.
- Loss of licensure and/or regulatory access to practice medicine, in some cases, especially if investigations reveal a medical malpractice element.
Worldwide Refusal to Admit to Cases
In at least one case at the UK’s Royal Brompton hospital, the failure to properly notify and prevent C. auris led to several deaths. The hospital’s own Dr. Silke Schelenz cited a complete lack of urgency on the part of the hospital and government officials after an outbreak in 2015. Calling it “… very, very frustrating. They obviously didn’t want to lose reputation.”
By June of the following year, Royal Brompton had diagnosed 50 cases, several of which had led to death. They were even forced to shut down their ICU for 11 days, yet no announcement was made and patients attending the hospital were not notified.
Another outbreak in Valencia, Spain, at the Hospital Universitari i Politècnic La Fe, followed much the same path. Patients were diagnosed, became sick, and in some cases, died — all without any robust announcement being made.
It’s happening here on US soil, too:
- Mount Sinai Hospital diagnosed a case of C. auris in May of 2018. The patient involved was recovering from abdominal surgery when he was diagnosed; he died in-hospital just 90 days later. MSH continued to positively identify the fungus on surfaces. The hospital was forced to tear out walls, ceilings, and equipment in order to successfully eradicate it.
- Nearly 309 cases have been diagnosed in New York alone as of April 2019. These cases span across multiple facilities to make the state one of the most common areas for C. auris in the country. Information on where the cases occurred isn’t available, but news sources are reporting that a patient at Rochester General Hospital died of C. auris in April 2017.
- New Jersey is currently the second-most common state for C. auris infection and diagnoses, with over 144 confirmed cases. We weren’t able to find any public information for where these cases were diagnosed, either.
- In Illinois, diagnostic numbers are also on the rise. Officials across multiple facilities have diagnosed 132 new cases in the past year. There is little available evidence of where these cases were diagnosed, either.
It all comes down to an agreement between the CDC and American hospitals. According to this article from the New York Times, the CDC isn’t allowed to publicly identify hospitals battling C. auris.
This is the very definition of a “culture of secrecy,” and it’s hurting people just like you every single day.
What is Candida Auris?
Candida auris (C. auris) is a specific species of yeast, scientifically referred to as a “fungus.” While it is most commonly identified within the outer, middle, and inner ear canal, it can also colonize other areas of the skin, such as the groin, the folds of the neck, or the genitourinary system.
|Candida auris Disease Path:
The History of C. Auris
As potentially deadly as C. auris is, researchers still aren’t sure exactly how it migrates around the world. Tested fungi from the United States, for example, have different genetic markers than fungi tested in Japan, suggesting that it may have emerged at around the same time in multiple locations.
The CDC’s Mycotic Disease expert, Dr. Tom Chiller, lamented the lack of available information openly. WWe really can’t explain that,” he said, “unless it goes back thousands of years.”
Researchers also don’t know why C. auris is suddenly becoming so drug-resistant or less rare than it was a decade ago. Oxford University’s Dr. David Eyre writes that, “It’s a bit of a paradox, really. Why has it suddenly come to cause a problem at a similar time in different parts of the world?”
The first official discovery of C. auris occurred in South Korea in 2009; however, we now know that this was far from the first time it affected a human. Through retrospective analysis, Japanese researchers were able to find the fungi in specimens from as far back as 1996.
Why C. Auris is So Dangerous
Like C. albicans, C. auris can cause both skin and systemic symptoms, causing skin reactions, fever, and chills, but it behaves much differently than most other yeast or fungal germs in the human body. In a healthy adult human, the immune system will often fight off C. auris, preventing infection; in the immunocompromised, young, or elderly, it can evolve into fungemia, a potentially deadly systemic infection leading to organ damage, death, and septicemia.
Auris is also remarkably contagious by comparison to other yeast and fungus germs, especially in communal communal settings. Furthermore, it resists treatment with nearly all known antifungal drugs, especially the “gold standard” -azole groups like fluconazole and metronidazole. Patients who fail to respond to treatment are at significant risk for severe illness or even death.
It isn’t yet clear how the disease made its way to US soil. Researchers believe the fungus may have emerged separately in multiple locations due to changing global weather patterns and environmental conditions. We do know that C. auris thrives in conditions where the environment is moist, warm, and fairly dark.
Diagnosis of C. auris has been rare up until the last few months; this may be a direct result of the fact that it is so difficult to test for with current laboratory equipment.
Epidemic and Pandemic Risks
Like the deadly MRSA bacteria, outbreaks are of special concern within hospitals, nursing homes, and other medical and residential care centers because it can spread so rapidly without checks and balances in place.
Frighteningly, C. auris often doesn’t present with symptoms right away; by the time patients are visibly experiencing systemic harm, the disease may progress to far for treatment to be successful.
In a hospital setting, even a single failure in the sterilization process can lead to cross-contamination. A nurse, physician, or surgeon, for example, who fails to wash their hands properly after a procedure, could instantly transfer the germs to the next patient they see — without even realizing there is a problem.
Part of the concern with C. auris lies in the fact that it doesn’t only infect immunocompromised or unhealthy patients, nor does it only exist within the hospital or care facility setting. It can also be transferred between people as they travel on public transportation (airplanes, buses or trains) or while they are at work.
The Link Between the US and Healthcare In High-Risk Countries
The CDC has also admitted to a link between Americans spending time in foreign hospitals, which may have lower care standards, and unknowingly contracting the disease before they come home. High-risk countries include India, Kenya, Kuwait, Pakistan, South Africa, the United Arab Emirates, and Venezuela.
It is important to note that this link does not seem to be tied to immigration specifically. The CDC specifically outlines the fact that affected patients are American citizens who have either traveled out of the country for surgery or who have needed emergency surgeries while they are away.
Summing It Up
- C. auris is a fungus first diagnosed in Japan in 2009; retroactive testing shows the germ may have been around for much longer.
- It is extremely contagious and highly resistant to most antifungal medications, including -azole drugs like fluconazole and metronidazole.
- C. auris preys upon weak, immunocompromised patients staying in communal environments. It is of significant risk and concern to patients in a hospital or nursing home setting.
- Some experts believe that a “culture of secrecy” in the US healthcare industry may be contributing to escalating C. auris diagnoses.
- The CDC does report on C. auris cases, but its partnership with most hospitals prohibits it from disclosing where cases are diagnosed.
- Nearly 45 percent of all patients diagnosed with C. auris will die within the first 30 days of the disease.
The CDC may not be forced to disclose the details about cases of C. auris, but that doesn’t mean you can’t or shouldn’t do your own research. Don’t be afraid to ask hospital representatives if they’ve had cases before you have a procedure. If they refuse to tell you, it may be better to find a more transparent facility.