Candida auris: Another Emerging Global Health Challenge

Candidiasis is one of the most common causes of fungal infection on a global scale and includes both superficial and invasive infections. The primary concern is associated with patients in intensive care units (ICU) with high mortality rates. Several fungal species are isolated in the clinical setting responsible for these infections. Candida albicans is the most studied and frequently isolated species from nosocomial infections, but recently, a new species named Candida auris has raised great concern regarding disorders caused by fungi. In the ever-evolving landscape of public health, specific pathogens have the potential to disrupt the status quo and demand our undivided attention. Candida auris, a relatively recent addition to the list of infectious threats, is silently gaining notoriety as a significant public health concern. In this article, we delve into the biology of Candida auris, explore its genetic relations, understand why it's a growing concern, examine its global prevalence and incidence, identify at-risk populations, analyze its antibiotic resistance, and discuss preventive measures.

 Candida auris is not your typical fungal pathogen. It is a multidrug-resistant yeast belonging to the Candida genus. It's remarkable ability to survive on surfaces in healthcare environments for weeks, if not months, sets it apart. This resilience makes it a formidable foe in the fight against healthcare-associated infections. Candida auris disorders can manifest in various forms, including bloodstream infections, wound infections, and ear infections. Candida auris shares genetic similarities with other Candida species, notably Candida haemulonii and Candida duobushaemulonii. These resemblances pose a diagnostic challenge, as traditional methods may struggle to differentiate between them. Misdiagnosis and delayed treatment can significantly impact patient outcomes (1).

First identified in Japan in 2009, Candida auris has since traversed the globe, spreading its influence in healthcare settings (3). Its prevalence is deeply concerning, mainly due to its resistance to multiple antifungal drugs. This resistance can transform what might have been a manageable infection into a life-threatening one.

Understanding the epidemiology of Candida auris is crucial. It thrives in healthcare settings, with a penchant for intensive care units and long-term care facilities. Its reach extends to over 45 countries, with the highest incidence reported in regions such as India, South Africa, and South America. According to the World Health Organization (WHO), Candida auris is an "emerging global health threat." The organization emphasizes the need for coordinated international efforts to combat its spread.

Countries with reported C. auris infection or colonization cases from January 2009 to June 2020 (2).

(A) Number of countries belonging to each continent that have reported infection or colonization with C. auris. (B) Countries with reported cases from January 2009 to June 2020. The first reported case from each country is denoted in red text. ARE, United Arab Emirates; AUS, Australia; AUT, Austria; BEL, Belgium; BGD, Bangladesh; CAN, Canada; CHE, Switzerland; CHL, Chile; CHN, China; COL, Colombia; CRI, Costa Rica; DEU, Germany; EGY, Egypt; ESP, Spain; FRA, France; GBR, United Kingdom; GRC, Greece; IND, India; IRN, Iran; ISR, Israel; ITA, Italy; JPN, Japan; KEN, Kenya; KOR, Korea (South); KWT, Kuwait; MYS, Malaysia; NLD, the Netherlands; NOR, Norway; OMN, Oman; PAK, Pakistan; PAN, Panama; POL, Poland; RUS, Russia; SAU, Saudi Arabia; SDN, Sudan; SGP, Singapore; THA, Thailand; USA, United States of America; VEN, Venezuela; ZAF, South Africa(4-10).

The spread of Candida auris in the United States, according to the report by The CDC (January 2022 - December 2022).

Certain groups face a higher risk of Candida auris infections. This includes individuals with weakened immune systems, recent surgical patients, and those with indwelling medical devices such as catheters. Vulnerable populations, including the elderly and premature infants, are particularly susceptible. One of the most alarming aspects of Candida auris is its resistance to antifungal drugs. The most common antifungal drugs for Candida auris are a class echinocandins, Diflucan (fluconazole) or Nystatin. However, Candida auris is often multidrug-resistant resistant to multiple antifungal drugs commonly used to treat Candida infections (10). This resistance makes treatment exceedingly challenging as the available therapeutic options become limited. It is crucial to note that developing new antifungal medications is urgently needed to combat this growing threat.

 Preventing Candida auris infections requires a multifaceted approach. Healthcare facilities must rigorously adhere to infection control practices, encompassing stringent hand hygiene, thorough disinfection of patient rooms and equipment, and meticulous patient isolation protocols. On an individual level, patients and healthcare workers should diligently follow infection control guidelines and promptly report any signs of infection.

In conclusion, Candida auris demands our attention as an emerging global health challenge. Its resilience, antibiotic resistance, and propensity for transmission within healthcare settings make it a formidable adversary. To effectively combat this silent menace, international collaboration, increased awareness, research, and the development of novel antifungal treatments are imperative. We can mitigate its impact on public health, save lives, and strengthen our global healthcare response by working together.

References

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2.            Du H, Bing J, Hu T, Ennis CL, Nobile CJ, Huang G. 2020. Candida auris: Epidemiology, biology, antifungal resistance, and virulence. PLoS pathogens 16:e1008921.

3.            Satoh K, Makimura K, Hasumi Y, Nishiyama Y, Uchida K, Yamaguchi H. 2009. Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiology and immunology 53:41-44.

4.            Emara M, Ahmad S, Khan Z, Joseph L, Al-Obaid Im, Purohit P, Bafna R. 2015. Candida auris candidemia in Kuwait, 2014.

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6.            Calvo B, Melo AS, Perozo-Mena A, Hernandez M, Francisco EC, Hagen F, Meis JF, Colombo AL. 2016. First report of Candida auris in America: clinical and microbiological aspects of 18 episodes of candidemia. Journal of Infection 73:369-374.

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8.            Mohsin J, Hagen F, Al‐Balushi ZA, de Hoog GS, Chowdhary A, Meis JF, Al‐Hatmi AM. 2017. The first cases of Candida auris candidaemia in Oman. Mycoses 60:569-575.

9.            Ben-Ami R, Berman J, Novikov A, Bash E, Shachor-Meyouhas Y, Zakin S, Maor Y, Tarabia J, Schechner V, Adler A. 2017. Multidrug-resistant candida haemulonii and C. Auris, tel aviv, Israel. Emerging infectious diseases 23:195.

10.         Chowdhary A, Prakash A, Sharma C, Kordalewska M, Kumar A, Sarma S, Tarai B, Singh A, Upadhyaya G, Upadhyay S. 2018. A multicentre study of antifungal susceptibility patterns among 350 Candida auris isolates (2009–17) in India: role of the ERG11 and FKS1 genes in azole and echinocandin resistance. Journal of Antimicrobial Chemotherapy 73:891-899.