Pittsburgh-area doctors sound alarm about deadly fungal superbug | TribLIVE.com

Pittsburgh-area doctors sound alarm about deadly fungal superbug

Emily Balser
Science Photo Library
A computer illustration of the unicellular fungus (yeast) Candida auris. C. auris was first identified in 2009. It causes serious multidrug-resistant infections in hospitalized patients and leads to high mortality rates. It causes bloodstream, wound and ear infections and has also been isolated from respiratory and urine specimens. Most C. auris infections are treatable with antifungals from the echinocandin group of drugs.

A deadly fungus that is outsmarting major antifungal medications is slowly spreading across the United States, prompting infectious-disease doctors in Western Pennsylvania to prepare for its eventual arrival.

The fungus, called Candida auris, has been confirmed in New York and New Jersey, but no cases have been reported in Pennsylvania, according to the state Department of Health. As of March, the Centers for Disease Control and Prevention reported 617 cases nationwide.

“It’s only a matter of time before we see these organisms spread,” said Dr. Tom Walsh, an infectious disease specialist and medical director of quality at Allegheny General Hospital in Pittsburgh. “We’re learning a lot from all of the places that do have it.”

Nate Wardle, spokesman for the Health Department, said health care facilities are required to report a confirmed case. It also shares all information with health care facilities through regular notices and its health alert network, among other things.

The CDC considers the fungus a “serious global health threat.” In addition to confirmed cases in 12 states, more than 20 countries have reported cases of Candida auris, according to data collected by the CDC.

“The mortality is very high,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security and a Pittsburgh-based infectious disease physician. “This is a very challenging microorganism to deal with.”

Adalja said the people most at risk appear to be patients who already have a chronic illness or a compromised immune system as well as patients who are already admitted to a health care facility.

The fungus can cause bloodstream infections, wound infections and ear infections, according to the CDC.

The fungus can be difficult to diagnose because conventional lab tests could lead to misidentification and inappropriate treatment, making it difficult to control the spread of Candida auris.

It’s difficult to treat because it is often resistant to most common antifungal medicines and is typically found in health care settings — including hospitals and nursing homes — where it could spread quickly. Some strains can be treated with high doses of multiple medications, but some are completely resistant, according to the CDC.

Difficult to prevent

Adalja said there isn’t much the average person can do to prevent getting the fungus outside of normal hygiene practices such as hand washing. There often aren’t any symptoms until it has progressed significantly.

“You may not have any symptoms when it’s just colonizing,” he said. “It’s hard for the general public to take a specific action.”

Dr. Graham Snyder, director of infection prevention at UPMC, said because there are so many unknowns about Candida auris, it’s hard to know exactly what to expect.

“What’s fascinating about this bug — and there’s a lot still to learn — is we don’t know where it came from,” he said. “It emerged in multiple different places in the world at the same time.”

Snyder said it’s hard to predict how it will continue to spread. Right now, it’s typically found in health care settings, but that might not always be the case.

He points to MRSA infections as an example of a drug-resistant bug that began only in medical facilities but, after a few years, started showing up elsewhere. The infections are now reported in places such as schools and among athletes who play sports with a lot of physical contact.

“It’s very early in the Candida auris story,” Snyder said. “It’s hard to give a person advice to say, ‘You should do x, y, z to prevent getting Candida auris.’”

Nevertheless, hospitals are preparing for the day when a patient could be diagnosed with the fungus.

Walsh said Allegheny Health Network has begun doing more extensive testing when a patient tests positive for any kind of Candida to ensure they aren’t missing Candida auris. UPMC is doing similar testing.

Walsh said early identification is key because the sooner a patient is diagnosed, the sooner the hospital can isolate and treat them before it spreads to other patients.

“It’s a lot more work, (but) we want to make sure we’re ahead of it,” he said.

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