Clinical laboratories and microbiologists will want to be on the alert for this deadly infectious agent that has killed patients through blood infections

Healthcare continues to struggle with the issue of how much to disclose to the public when new and deadly infectious agents are identified in a limited number of patients. Timely disclosure of new pathogens is a matter of great concern to clinical laboratory scientists, microbiologists, and clinical pathologists because their laboratories get specimens from infected patients and they must correctly identify rare or emerging pathogens to help minimize the spread of disease.

This is why many medical laboratory professionals were surprised to see national news headlines recently about a particularly deadly new form of a pathogen. The Centers for Disease Control and Prevention (CDC) has been dealing with one particularly nasty example of Candida auris, or C. auris. This “superbug” fungus has been appearing in hospitals and healthcare clinics across the globe and it has killed people.

The news coverage of C. auris focused on two elements:

  • First, how the pathogen was recognized by such healthcare agencies as the CDC.
  • Second, why CDC and others did not issue a public alert to hospitals, physicians, and other caregivers once it was known that C. auris was responsible for the death of several patients.

Once C. auris takes hold, it can enter a patient’s bloodstream or wounds and cause life- threatening complications like sepsis. When hospitals rooms are not properly decontaminated, life-threatening hospital-acquired infections (HAIs), also known as nosocomial infections, can occur.

Incidences of HAIs have been on the rise in the past few years. Dark Daily has reported on this disturbing trend many times.

The New York Times (NYT) reported on one such HAI that had tragic consequences. A patient admitted to Mount Sinai Hospital in New York for abdominal surgery was later discovered to have contracted C. auris. He was immediately isolated and spent 90 days in the hospital before passing away. Tests showed that Candida auris was everywhere in his room.

“Everything was positive—the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump,” Scott Lorin, MD, President and Chief Operating Officer at Mount Sinai Brooklyn Hospital, told the NYT. “The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive,” he said.

The hospital had to use special cleaning equipment to sterilize the room and even found it necessary to tear out some ceiling and floor tiles to annihilate the fungus, the NYT reported.

Media News Coverage of ‘Culture of Secrecy’ 

When this deadly fungus first emerged in America, it was not disclosed to the public for a lengthy period of time. Then, when details of deaths in hospitals due to the superbug went public, the national news media reacted but then went silent. Why?

The New York Times (NYT) covered the debate over public disclosure of outbreaks involving drug-resistant infections at healthcare facilities in “Culture of Secrecy Shields Hospitals with Outbreaks of Drug-Resistant Infections.”

In that article, the NYT states that “under its agreement with states, the CDC is barred from publicly identifying hospitals that are battling to contain the spread of dangerous pathogens.” So, the CDC is prevented from revealing to the public the names and locations of facilities that are dealing with C. auris. And state governments typically do not share that information either. 

The NYT article also states, “The CDC declined to comment, but in the past officials have said their approach to confidentiality is necessary to encourage the cooperation of hospitals and nursing homes, which might otherwise seek to conceal infectious outbreaks.”

And that, “Those pushing for increased transparency say they are up against powerful medical institutions eager to protect their reputations, as well as state health officials who also shield hospitals from public scrutiny.”

“Who’s speaking up for the baby that got the flu from the hospital worker or for the patient who got MRSA from a bedrail? The idea isn’t to embarrass or humiliate anyone, but if we don’t draw more attention to infectious disease outbreaks, nothing is going to change,” Arthur Caplan, PhD (above), told the NYT. Caplan is Drs. William F and Virginia Connolly Mitty Professor and founding head of the Division of Medical Ethics at NYU School of Medicine in New York City. (Photo copyright: NYU Langone Health.)

Common Yeast Infection or Killer Superbug? Both!

C. auris grows as a common yeast infection. However, it can be life threatening if it enters the bloodstream.

“The average person calls Candida infections yeast infections,” William Schaffner, MD, Professor and Chair, Department of Preventative Medicine at Vanderbilt University Medical Center, told Prevention. “However, Candida auris infections are much more serious than your standard yeast infection. They’re a variety of so-called superbugs [that] can complicate the therapy of very sick people.”

The CDC reports that, as of May 31, 2019, there have been a total of 685 cases of C. auris reported in the US. The majority of those cases occurred in Illinois (180), New Jersey (124), and New York (336). Twenty more cases were reported in Florida, and eight other states—California, Connecticut, Indiana, Maryland, Massachusetts, Oklahoma, Texas, and Virginia—each had less than 10 confirmed cases of C. auris.

The CDC states the infection seems to be most prominent among populations that have had extended stays in hospitals or nursing facilities. Patients who have had lines or tubes such as breathing tubes, feeding tubes, or central venous catheters entering their body, and those who have recently been given antibiotics or antifungal medications, seem to be the most vulnerable to contracting C. auris.

The fungus typically attacks people who are already sick or have weakened immune systems, which can make it challenging to diagnose, the CDC notes. C. auris infections are typically diagnosed with special clinical laboratory testing of blood specimens or other body fluids. Infections have been found in patients of all ages, from infants to the elderly.

Data from the CDC indicates that C. auris can cause bloodstream infections, wound infections, and ear infections. Common symptoms that indicate a person has Candida auris include fever, chills, weakness, low blood pressure, and general malaise that do not improve with antibiotics.

“A patient’s temperature may go up, their blood pressure can go down, and they have complications of a pre-existing illness because of Candida auris,” Schaffner told Prevention.

The CDC reports that more than one in three patients with invasive C. auris dies. Even though the mortality rates for Candida auris are high, it is unclear whether patients are dying from the infection or from their underlying illnesses. “Whatever the cause, having Candida auris doesn’t help a patient in any way,” Schaffner noted.

The CDC states that it and its public health partners are working hard to discover more about this fungus, and to devise ways to protect people from contracting it. Average healthy people probably don’t need to worry about becoming infected with Candida auris. However, individuals who are at high risk, and healthcare professionals, microbiologists, and pathologists, should be on the alert for this new superbug strain of fungus. 

—JP Schlingman

Related Information:

A Mysterious Infection, Spanning the Globe in a Climate of Secrecy

Culture of Secrecy Shields Hospitals with Outbreaks of Drug-Resistant Infections

Candida auris: A Drug-Resistant Germ That Spreads in Healthcare Facilities

A Deadly Superbug Fungus Called Candida auris Has Been Detected in 12 States—Here’s What You Need to Know

A Deadly Fungal Infection Called Candida auris Is Spreading across the Globe, and No One Knows How to Stop It

Study: Colonized Candida auris Patients Shed Fungus via Skin

The Deadly Yeast Infection You Must Know About

What You Need to Know Candida auris, a Dangerous Fungal Infection That’s on the Rise

With Candida auris, a Lack of Transparency Could Make Things Worse

Could Proximity of Toilets to Sinks in Medical Intensive Care Units Contribute to Hospital-Acquired Infections?