Fungus Candida auris on the rise in United States

Fungus Candida auris on the rise in United States

As far as is known, Candida auris does not occur on a large scale in the Netherlands at the moment

The fungus Candida auris seems to be on the rise in the United States. The Radboudumc-CWZ Expertise Center for Fungal Infections and RIVM are preparing for a possible outbreak in the Netherlands. Five questions to Professor of Clinical Mycology Paul Verweij, an expert in the field of detection and treatment of fungal infections in patients with strongly reduced resistance.

What is Candida Auris?
Candida auris belongs to the family of fungi. Everyone carries fungi, often in the intestines, without making them ill. In people with a weakened immune system, fungi can get into the blood and cause a serious infection. In most cases, this concerns patients who have already been admitted to hospital. Candida auris was first discovered in 2009 and seems to be spreading worldwide in the last 15 years. This fungus is resistant to many drugs. Research by Radboud university medical center in 2020, for example, showed that Candida auris is difficult to combat. Read more about this previous research here.

How often does it occur?
As far as is known, Candida auris does not occur on a large scale in the Netherlands at the moment. There have been five cases in the Netherlands in recent years. This concerned patients who were transferred from a hospital abroad to a Dutch hospital. These patients were found to carry the fungus, but did not become ill from it. Candida auris is common in some countries, such as the United States, India and several countries in Africa. In Europe, the fungus has been found in Spain and Greece, among others. According to the guidelines, patients who are transferred to the Netherlands from a foreign hospital are tested for the presence of resistant bacteria. Candida auris has now been added to this protocol. For example, hospitals want to identify the fungus in time and thus prevent its spread.

How can people catch it?
Candida auris is not easy to catch, but can spread in hospitals and nursing homes. Spread can occur through contamination of hands or medical instruments. Unlike most types of fungi, Candida auris can survive outside the body. Most people don’t get sick from it; after infection you can carry Candida auris with you without being bothered by it.

If blood tests show the presence of Candida auris, follow-up testing will follow for possible spread to other patients. We would like to prevent that, especially when it concerns vulnerable patients. If spread has taken place, we speak of an outbreak. The Radboudumc-CWZ Expertise Center for Fungal Infections and the RIVM are the bodies in the Netherlands for advice and further characterization of the cultivated fungi in order to contain an outbreak quickly.

What are the symptoms of a Candida auris infection?
People with healthy immune systems generally do not become ill from Candida auris. They can clean up the mold themselves. People with a reduced immune system, for example after an organ transplant, can become seriously ill. There may be a deep infection, where Candida auris enters the bloodstream. This causes fever. There are antifungal drugs that counteract the infection, but in some cases there is resistance and they are not effective. About 35% of patients with a Candida auris infection in the bloodstream die.

What are Radboudumc and other health institutions doing?
The Radboudumc-CWZ Expertise Center for Fungal Infections has been designated together with RIVM as a reference and surveillance laboratory. Within this network, we investigate the severity of fungal infections and monitor trends in resistance to antifungal drugs. We are also preparing for the emergence of new fungi, such as Candida auris in this case. This is done, among other things, through international cooperation, methods to characterize the fungus and guideline development. By practicing staged outbreaks, we expect to be well prepared if an outbreak actually occurs in the Netherlands.

This article was written with the cooperation of Paul Verweij, Jochem Buil (Radboudumc), Eelco Meijer (CWZ), Jacques Meis (CWZ) and Thijs Bosch (RIVM).

Bron: Radboud UMC

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