Climate May be Pumping Super Infections

New York Times:

Last May, an elderly man was admitted to the Brooklyn branch of Mount Sinai Hospital for abdominal surgery. A blood test revealed that he was infected with a newly discovered germ as deadly as it was mysterious. Doctors swiftly isolated him in the intensive care unit.

The germ, a fungus called Candida auris, preys on people with weakened immune systems, and it is quietly spreading across the globe. Over the last five years, it has hit a neonatal unit in Venezuela, swept through a hospital in Spain, forced a prestigious British medical center to shut down its intensive care unit, and taken root in India, Pakistan and South Africa.

Recently C. auris reached New York, New Jersey and Illinois, leading the federal Centers for Disease Control and Prevention to add it to a list of germs deemed “urgent threats.”

The man at Mount Sinai died after 90 days in the hospital, but C. auris did not. Tests showed it was everywhere in his room, so invasive that the hospital needed special cleaning equipment and had to rip out some of the ceiling and floor tiles to eradicate it.

“Everything was positive — the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump,” said Dr. Scott Lorin, the hospital’s president. “The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive.”

C. auris is so tenacious, in part, because it is impervious to major antifungal medications, making it a new example of one of the world’s most intractable health threats: the rise of drug-resistant infections.

Denver Post:

Three years ago, U.S. health officials warned hundreds of thousands of clinicians in hospitals around the country to be on the lookout for a new, quickly spreading and highly drug-resistant type of yeast that was causing potentially fatal infections in hospitalized patients around the world.

Candida auris has become a serious global health threat since it was identified a decade ago, especially for patients with compromised immune systems. It has been reported in more than 30 countries and is probably more widespread than that because the organism is hard to identify without specialized laboratory methods.

It is resistant to multiple antifungal drugs, and can spread between patients in hospitals and other health care facilities and cause outbreaks. The fungus can lead to infections of the bloodstream, heart or brain, and early studies estimate that it is fatal in 30 percent to 60 percent of patients.

Researchers have never been able to isolate the fungus from the natural environment or figure out how genetically distinct versions emerged independently at roughly the same time in India, South Africa and South America.

Now researchers in the United States and the Netherlands have a new theory: They propose that global warming may have played a key role and suggest that this may be the first example of a new fungal disease emerging from climate change, according to a study published Tuesday in mBio, a journal of the American Society of Microbiology.

Fungal infections in humans are rare. Mammals have more advanced immune systems than other organisms at risk of fungal infections, and most fungi in the environment cannot grow at the temperatures of the human body, said Arturo Casadevall, one of the authors of the new study, who is a microbiologist and immunologist at Johns Hopkins Bloomberg School of Public Health.

But as the climate has gotten warmer, the researchers say, C. auris was able to adapt, which helped it replicate in the human body’s temperature of 98.6 degrees Fahrenheit. Casadevall and colleagues from the University of Texas MD Anderson Cancer Center and the Westerdijk Fungal Biodiversity Institute in Utrecht in the Netherlands compared C. auris to its most closely related species, and found that the deadly yeast was capable of growing at higher temperatures.

“The most mysterious thing is that Candida auris appeared simultaneously in three different continents, and it’s very hard to explain that,” Casadevall said. Something happened to allow the organism to “bubble up and cause disease.

“You gotta try to think, what could be the unifying cause here? These are different societies, different populations,” he said. “But the one thing they have in common is that the world is getting warmer.”

Newsweek:

“If Candida auris is indeed a harbinger of new fungal threats we will need better preparation for the future,” he told Newsweek. Casadevall suggested a three-pronged attack involving better surveillance of the fungal kingdom so that new pathogens are identified quickly; more research to develop a better understanding of how fungi cause disease; and the development of new antifungal drugs.

Pointing out the limitations of the study, Christina Cuomo, group leader for the Fungal GenomicsGroup at the Broad Institute of MIT and Harvard, who was not involved in the research, told Newsweek: “The authors acknowledge that global warming is unlikely to be the sole explanation for the emergence of Candida auris.

“Also, as Candida auris was only detected recently, it is not currently possible to trace when Candida auris became able to grow at higher temperatures,” she said. 

Cuomo continued: “A major question in understanding the emergence of Candida auris is identifying where else it was prior to the recent outbreaks and where it currently exists in the environment, on other animals, or how commonly it is asymptomatically associated with humans. This is essential both to understand the outbreak and to contain its spread.

“Current large-scale efforts to examine microbial diversity are generating data sets that could be examined for evidence of Candida auris,” Cuomo concluded. 

Dr. Axe:

Because many patients with C. auris infections are often already sick in the hospital with other serious illnesses or conditions, symptoms may not be noticeable. Symptoms also vary depending on the body part affected. A laboratory test is needed to find out if a patient has C. auris. (9) When symptoms are identified, they can include: (10)

Fever

Chills

Sepsis (blood poisoning)

Little or no response or improvement with conventional antifungal therapy

Coma

Organ failure

Death