Candida auris: a major health threat

A mysterious deadly Infection is spanning the globe and shrouded in secrecy and is spreading like wildfire but word of it is not: Candida Auris

Photo hehealthyhomeeconomist.com

the bIg Wobble,

7 April, 2019

A mysterious deadly infection is loose around our planet and is shrouded in a cloak of secrecy and the drug-resistant germ called Candida auris is on the rise and has become a very serious health threat around the globe, leading the federal Centers for Disease Control and Prevention to add it to a list of germs deemed “urgent threats.”

‘No need’ to tell the public 

The New York Times reports, in late 2015, Dr Johanna Rhodes, an infectious disease expert at Imperial College London, got a panicked call from the Royal Brompton Hospital, a British medical centre outside London.

C. auris had taken root there months earlier, and the hospital couldn’t clear it.

‘We have no idea where it’s coming from. We’ve never heard of it. It’s just spread like wildfire,’” Dr Rhodes said she was told.

She agreed to help the hospital identify the fungus’s genetic profile and clean it from rooms.

Under her direction, hospital workers used a special device to spray aerosolized hydrogen peroxide around a room used for a patient with C. auris, the theory being that the vapour would scour each nook and cranny.

They left the device going for a week.

Then they put a “settle plate” in the middle of the room with a gel at the bottom that would serve as a place for any surviving microbes to grow, Dr Rhodes said.

Only one organism grew back. C. auris. It was spreading, but word of it was not. 

The hospital, a speciality lung and heart centre that draws wealthy patients from the Middle East and around Europe, alerted the British government and told infected patients, but made no public announcement.

“There was no need to put out a news release during the outbreak,” said Oliver Wilkinson, a spokesman for the hospital.

Dr Silke Schelenz, Royal Brompton’s infectious disease specialist, found the lack of urgency from the government and hospital in the early stages of the outbreak “very, very frustrating.”

“They obviously didn’t want to lose reputation,” Dr Schelenz said.

“It hasn't impacted our surgical outcomes.”

By the end of June 2016, a scientific paper reported “an ongoing outbreak of 50 C. auris cases” at Royal Brompton, and the hospital took an extraordinary step: It shut down its I.C.U. for 11 days, moving intensive care patients to another floor, again with no announcement.

Days later the hospital finally acknowledged to a newspaper that it had a problem.

A headline in The Daily Telegraph warned, “Intensive Care Unit Closed After Deadly New Superbug Emerges in the U.K.”

(Later research said there were eventually 72 total cases, though some patients were only carriers and were not infected by the fungus.)

Yet the issue remained little known internationally, while an even bigger outbreak had begun in Valencia, Spain, at the 992-bed Hospital Universitari i Politècnic La Fe.

There, unbeknown to the public or unaffected patients, 372 people were colonized — meaning they had the germ on their body but were not sick with it — and 85 developed bloodstream infections.

A paper in the journal Mycoses reported that 41 per cent of the infected patients died within 30 days. A statement from the hospital said it was not necessarily C. auris that killed them.

“It is very difficult to discern whether patients die from the pathogen or with it since they are patients with many underlying diseases and in very serious general condition,” the statement said.

As with Royal Brompton, the hospital in Spain did not make any public announcement. It still has not.

Coming to America In the United States

587 cases of people having contracted C. auris have been reported in the US, concentrated with 309 in New York, 104 in New Jersey and 144 in Illinois, according to the C.D.C.
The symptoms — fever, aches and fatigue — are seemingly ordinary, but when a person gets infected, particularly someone already unhealthy, such commonplace symptoms can be fatal. 

 Reports and more information can be found here at the Mycotic Diseases Branch at the Centers for Disease Control and Prevention (CDC). As part of the CDC Expert Commentary Series on Medscape, I would like to tell you about Candida auris, a novel yeast that is behaving in unexpected and concerning ways, causing severe disease in countries across the globe, including the United States. 

Today we'll share how you can protect your patients from this potentially deadly infection, the history of this unusual bug, and how the United States is working with global partners to combat its spread.

Several features set C auris apart from other Candida species and make it a particular concern:

C auris can spread between patients in healthcare facilities and cause outbreaks. In this way, it appears to behave much like some multidrug-resistant bacteria (eg, methicillin-resistant Staphylococcus aureus or Acinetobacter). Using contact precautions to prevent transmission may sound strange for Candida, but for C auris, they are a key part of the control strategy.

C auris can colonize a patient's skin for months or longer. It can be readily detected by culturing swabs of a colonized patient's axilla, groin, or other body sites. In light of this, use of contact precautions, as well as strict attention to hand hygiene, are critical elements in controlling spread. CDC is also working with partners to better understand the role of topical agents to prevent spread by reducing colonization.

This hardy yeast can live on surfaces for a month or more, and preliminary testing suggests that quaternary ammonium compounds commonly used for healthcare disinfection may not be sufficiently effective against C auris. Until further testing is available, CDC recommends that healthcare facilities meticulously perform daily and terminal cleaning of rooms of patients who were infected or colonized with C auris with an EPA-registered disinfectant that is effective against Clostridium difficile spores.

C auris is quickly becoming more common. In some international healthcare facilities, it has gone from an unknown pathogen to a cause of 40% of invasive Candida infections within a few years. We need to act now to prevent this from happening in the United States.

C auris is often multidrug resistant. Some strains have been resistant to all three major antifungal classes, including echinocandins, the first-line treatment for Candida infections.

C auris has reportedly never been isolated from the natural environment, and it does not seem to have been a common colonizer of humans before 2009. More research is needed to understand where in the environment C auris lives and why it began affecting humans only recently.

CDC's website has the most up-to-date guidance on identifying, treating, and controlling the spread ofC auris.

WHO warns: antibiotic resistance is now a bigger crisis than the AIDS epidemic

Doling out too many antibiotics 'will make even scratches deadly': WHO warns that crisis could be worse than Aids

• Spread of deadly superbugs that evade antibiotics is happening globally
• It's now a major threat to public health, the World Health Organisation says
• It could mean minor injuries and common infections become fatal

the Daily Mail,

30 April, 2014

Deaths from cuts and grazes, diarrhoea and flu will soon be common as antibiotics lose their power to fight minor infections, experts have warned.

The World Health Organisation says the problem has been caused by antibiotics being so widely prescribed that bacteria have begun to evolve and develop resistance.

It claims the crisis is worse than the Aids epidemic – which has caused 25million deaths worldwide – and threatens to turn the clock back on modern medicine.

Antibiotic resistance needs to be taken as seriously as AIDS was in the 1980s, experts say

Antibiotic resistance needs to be taken as seriously as AIDS was in the 1980s, experts say

The WHO warns that the public should ‘anticipate many more deaths’ as it may become routine for children to develop lethal infections from minor grazes, while hospital operations become deadly as patients are at risk of developing infections that were previously treatable.

Doctors are increasingly finding that antibiotics no longer work against urinary and skin infections, tuberculosis and gonorrhoea.

The WHO is urging the public to take simple precautions, such as washing hands to prevent bacteria from spreading in the first place.

Stem cell jab is 'five times better than drugs' for treating people with life-threatening heart conditions

Doctors are also being told to prescribe antibiotics sparingly and ensure patients finish the full course, as if they stop mid-way the bacteria may become resistant. In England last year some 41.7million prescriptions were written out, up from 37.2million in 2006.

SUPERBUGS: THE GUIDE TO BUGS RENDERING ANTIBIOTICS OBSOLETE

MRSA - Patients infected with MRSA (methicillin-resistant Staphylococcus aureus) are 64 per cent more likely to die than those with a non-resistant form of S. aureus.

People infected by resistant superbugs are also likely to stay longer in hospital and may need intensive care, pushing up costs.

C. difficile - This bacteria produces spores that are resistant to high temperatures and are very difficult to eliminate. It is spread through contaminated food and objects and can cause blood poisoning and tears in the large intestine.

E. coli - this now accounts for one in three cases of bacterial infections in the blood in the UK and a new strain is resistant to most antibiotics. It is highly contagious and could cause more than 3,000 deaths a year.

Acinetobacter Baumannii - a common bacteria which is resistant to most antibiotics and which can easily infect patients in a hospital. It can cause meningitis and is fatal in about 80 per cent of patients.

CRKP - this is a bacterium that is associated with extremely difficult to treat blood infections and meningitis. It is resistant to nearly all antibiotics and is fatal in 50 per cent of cases.

....

Multi-drug resistant tuberculosis is estimated to kill 150,000 people globally each year.

NDM-1 - a bacteria detected in India of which some strains are resistant to all antibiotics.

Dr Keiji Fukuda, the WHO’s assistant director for health security, said: ‘Without urgent, co-ordinated action, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.

‘Effective antibiotics have been one of the pillars allowing us to live longer, live healthier, and benefit from modern medicine.

‘Unless we take significant actions to improve efforts to prevent infections, and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating.

‘We should anticipate to see many more deaths.

‘We are going to see people who have untreatable infections.’

Only last month, Britain’s chief medical officer Dame Sally Davies criticised GPs for needlessly ‘dishing out’ antibiotics to patients.

In the largest study of its kind, the WHO looked at data from 114 countries on seven major types of bacteria. Experts are particularly concerned about bacteria responsible for pneumonia, urinary tract infections, skin infections, diarrhoea and gonorrhoea.

They are also worried that antiviral medicines are becoming increasingly less effective against flu.

Dr Danilo Lo Fo Wong, a senior adviser at the WHO, said: ‘A child falling off their bike and developing a fatal infection would be a freak occurrence in the UK, but that is where we are heading.’

British experts likened the problem to the Aids epidemic of the 1980s. Professor Laura Piddock, who specialises in microbiology at the University of Birmingham, said: ‘The world needs to respond as it did to the Aids crisis.

‘We still need a better understanding of all aspects of resistance as well as new discovery, research and development of new antibiotics.’

The first antibiotic, penicillin, was developed by Sir Alexander Fleming in 1929. But their use has soared since the 1960s, and in 1998 the Government issued guidelines to doctors urging them to curb prescriptions. Nonetheless, surveys suggest they are still prescribed for 80 per cent of coughs, colds and sore throats

Antibiotic resistance

We are told 'this is NOW, not in the future'. Does this sound like another of humanity's predicaments?

Antibiotic resistance 'a global threat'

The World Health Organisation (WHO)says common infections can once again be considered potentially fatal because of growing resistance worldwide to antibiotics.

Radio NZ,

1 May, 2014

In a comprehensive global study of the topic released overnight, the United Nations organisation says the world is headed for a post-antibiotic era.

The organisation analysed data from 114 countries and said resistance was happening now in every region of the world.

It described a post-antibiotic era, where people die from simple infections that have been treatable for decades.

There were likely to be devastating implications unless significant action was taken urgently, it added.

The report focused on seven different bacteria responsible for common serious diseases such as pneumonia, diarrhoea and blood infections.

It suggested two key antibiotics no longer work in more than half of people being treated in some countries.

One of them - carbapenem - is a so-called last-resort drug used to treat people with life-threatening infections such as pneumonia, bloodstream infections, and infections in newborns, caused by the bacteria K.pneumoniae.

Bacteria naturally mutate to eventually become immune to antibiotics, but the misuse of these drugs - such as doctors over-prescribing them and patients failing to finish courses - means it is happening much faster than expected.

The WHO said more new antibiotics need to be developed, while governments and individuals should take steps to slow this process, the BBC reports.

In its report, it said resistance to antibiotics for E.coli urinary tract infections had increased from "virtually zero" in the 1980s to being ineffective in more than half of cases today. In some countries resistance to antibiotics used to treat the bacteria would not work in more than half of people treated.

Low rates of resistance in NZ

An antibiotics specialist in New Zealand says more research is needed to find out how much of a problem drug resistance is in the country.

Environmental Science and Research clinical microboiologist Deborah Williamson said New Zealand has low rates of antibiotic resistance compared to other countries but should not be complacent.

"One of the big knowledge gaps is how much antibiotic is used and who gets it, and that's something that people are actively looking at at the moment," she said.

Superbugs

UK raises alarm on deadly rise of superbugs

Britain to call for G8 action against spread of drug-resistant bacteria by clamping down on overuse of antibiotics

The Guardian,

11 June, 2013

Britain is to urge the G8 to take action against the spread of drug-resistant microbes as medical and veterinary experts warn that co-ordinated international action is needed to prevent soaring rates of potentially lethal infections turning into a public health catastrophe.

David Willetts, the science minister, will propose far-reaching measures that would clamp down on the overuse of antibiotics by GPs and hospital doctors. He will also try to restrict usage on farms and fisheries, where the drugs are blended with feed to boost yields.

Willetts will push for a consensus on ways to ramp up the discovery of new drugs to fight bacteria, speed their approval and delivery to patients, and strengthen cross-border surveillance for emerging resistant strains.

"Across the G8, we should regard the spread of antibiotic resistance as a global challenge that is up there with climate change, water stress and environmental damage, and there are genuine policy consequences that follow from that," Willetts told the Guardian ahead of Wednesday's meeting of science ministers at the Royal Society in London.

Drug-resistance is an inevitable consequence of antibiotics. The drugs wipe out susceptible infections but leave resistant organisms behind. The survivors multiply and, in time, can become immune to even the strongest antibiotics. Though improved surveillance and hygiene has reduced levels of life-threatening MRSA and C difficile "superbugs" in hospitals, resistant strains are on the rise.

In Britain, doctors see ever more resistant strains of TB, E coli and Klebsiella, which causes pneumonia. Some 80% of gonorrhoea is now resistant to the frontline antibiotic tetracycline. Of serious concern is the rise of resistance to powerful drugs called carbapenems, the antibiotics of last resort. The first few cases were detected in Britain in 2003, but since then the numbers have soared to 217 cases in the first six months of 2011.

Willetts has asked England's chief medical officer, Dame Sally Davies, to brief the meeting after she warned in a March report that untreatable infections posed a "catastrophic threat" to the population.

Davies has asked for antibiotic resistance to be added to the government's national risk register, a move that makes the issue easier to raise abroad.

Davies has already briefed senior figures in Whitehall on the threat and has rallied international experts and chief medical officers in other countries to push the EU and World Health Organisation to beef up their action plans. Ultimately, she seeks a UN treaty that would ban antibiotics in food production, such as fish farming and fruit growing, streamline the regulatory process for licensing new drugs, and commit nations to educational drives that instil more prudent usage of the drugs."The soaring number of antibiotic-resistant infections poses such a great threat to society that in 20 years' time we could be taken back to a 19th century environment where everyday infections kill us as a result of routine operations," Davies said.

The government is to publish its antimicrobial resistance strategy next month. It will set out plans to slow the emergence and spread of drug-resistant bugs, maintain the effectiveness of existing drugs and bolster support for researchers.

The G8 meeting is seen as an opportunity to urge other nations to follow suit. "We can't tackle the problem on our own and urgently need coordinated international action," Davies said.

New research published by the Guardian also reveals that GPs in some areas are almost three times more likely than elsewhere to prescribe antibiotics. Keith Ridge, NHS England's chief pharmaceutical officer, said he was aware of this worryingly wide variation and keen to see if lessons from hospitals' improved prescription of antibiotics could now be applied to England's 8,500 GP practices.

Davies said: "Our proposals are far-reaching, including stimulating development of new drugs through some sort of public-private partnership, cutting down the antibiotics given to farm animals and used in medical practice, making infection surveillance go across borders, and getting countries to sign up to their own education programmes."

Dr Clare Gerada, chair of the Royal College of GPs, said some GPs were over-prescribing antibiotics to patients simply because they were overworked, increasing the long-term risks.

"I'm not blaming them. I've been there myself, at the end of a very busy clinic. If you're running over time and have a queue of patients waiting, sometimes the least worst option is to give a prescription, even though you know that medically it's of little value," she said.

In the past, drug resistance was countered by a steady flow of new antibiotics on to the market. Over the past 60 years, the pharmaceutical industry released three generations of drugs, starting with natural penicillins, then synthetic penicillins, and most recently the carbapenems. But the supply has dried up. The number of new drugs in the pipeline is at an all-time low as research was shelved in favour of more profitable drugs in the 1990s, coupled with the difficulties in discovering new medication.

Meanwhile, other experts are warning that increasing use of the drugs on farms poses a threat to people. Recent studies have shown that the overuse of antibiotics in intensive livestock farming could lead to the evolution of strains of dangerous bacteria, including MRSA, E coli and salmonella, that are resistant to some of the strongest antibiotics. An increasing body of evidence shows they can spread from farms to farm workers and their families as well as to consumers through affected meat.

Farms in the UK are not supposed to use antibiotics routinely, as happens in many non-EU countries, but the Guardian has uncovered clear problems with this regime as the current monitoring of usage does not give government regulators enough information to decide how the drugs are used in practice.

Antibiotics are routinely dumped into animal feed in the US – where 80% of antibiotics are used for animals – and Latin America and other regions because they help animals put on weight faster.

Zac Goldsmith, the Conservative MP who has tabled a motion in parliament for stronger regulation, said dealing with antibiotics on farms was as urgent as changing prescribing practices and hygiene in hospitals. "We need to phase out the routine use of antibiotics on intensive farms altogether, starting with those most important in human medicine."

John Rex, vice-president and medical director for infection at Astra Zeneca, said necessary changes were planned for the regulatory process too. "The idea that we as a society should wait for these cases before we start drug development is a non-starter. Bacterial infections can kill you in a couple of days, We are now treating young women with complicated urinary tract infections with intravenous antibiotics, not a pill. We are seeing strains of gonorrhoea for which we have no antibiotics, not just a small number, not just one, but zero," he said.

This summer, the European Medicines Agency will overturn this system by allowing trials of antibiotics to be done differently. Trials will no longer need to recruit people with the same infection in the same place.

Instead, they can pool people with infections at any body area, such as the lungs, stomach, or skin, as long as they are caused by the same bug. The shift means trials can be run much faster, said Rex. The US Food and Drug Administration is expected to make similar changes to its guidelines.

Drug-Resistant Gonorrhea Rises In Great Britain

Forms of gonorrhea that don't respond to the last line of antibiotics have rapidly spread in Great Britain, expanding the reach of drug-resistant disease

NPR,

11 June, 2013

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The number of gonorrhea cases with decreased sensitivity to the front-line drug cefixime increased by nearly six times from 2004 to 2011 in England and Wales, a team from the U.K.'s Health Protection Agency reported Tuesday in The Lancet Infectious Diseases.

Drug-resistant gonorrhea is a growing trend worldwide, with cases rising in Asia, North America and Europe. Japan has even documented a superresistant strain of gonorrhea that can thwart all available drugs.

Sixty years ago, doctors had a large arsenal against gonorrhea, including penicillin, ampicillin, tetracycline and doxycycline. But one by one, each of those antibiotics stopped working. Now there are only two drugs left: cefixime, which is taken orally, and ceftriaxone, which is injected into muscle.

Last summer, evidence emerged that cefixime had stopped working against gonorrhea in the U.S. The data were so worrisome that the Centers for Disease Control and Prevention sounded the alarm and issued new guidelines for treating the sexually transmitted disease. Then in January, Canada documented the first case of cefixime-resistant gonorrhea.

Gonorrhea, aka "the clap," is the second-most-common sexually transmitted disease in the U.S., with more than 300,000 cases reported in 2011.

In the current study, epidemiologists tested drug sensitivity for more than 7,000 gonorrhea cases in England and Wales. Strains that showed signs of resisting cefixime steadily increased from 2004 to 2010, when 17 percent of cases didn't respond to normal doses of the medication. This percentage then fell to 10.8 in 2011.

The gonorrhea cases that didn't respond well to cefixime also showed resistance to ceftriaxone.

These two drugs are in the same class of antibiotics. So many scientists worry that once the bacterium conquers one of them, it will eventually knock out the other, too.

The world doesn't have any backup treatments for gonorrhea. Once this class of antibiotics is gone, we've got a big problem

A new superbug

'Worse than AIDS' - sex 'superbug' discovered in Japan called disaster in waiting

Doctors are warning that a drug-resistant strain of gonorrhea could be more deadly than AIDS, and are urging members of US Congress to spend $54 million for the development of a drug that would fight it.

RT,

26 January, 2013

"This might be a lot worse than AIDS in the short run because the bacteria is more aggressive and will affect more people quickly," Alan Christianson, a doctor of naturopathic medicine, told CNBC.

The new strain of gonorrhea, H041, was first discovered in 2009 after a sex worker fell victim to the superbug in Japan. Medical officials reported that the medication-resilient ‘sex superbug’ was discovered in Hawaii in May 2011, and has since spread to California and Norway, the International Business Times reports.

Nearly 30 million people die from AIDS-related causes each year, and the H041 superbug could have similar consequences, according to Alan Christianson, a doctor of naturopathic medicine.

"Getting gonorrhea from this strain might put someone into septic shock and death in a matter of days,"Christianson said. "This is very dangerous."

The gonorrhea strain has not yet claimed any lives, but the US Centers for Disease Control and Prevention (CDC) have asked Congress for $54 million to find an antibiotic to treat the strain.

In a Capitol Hill briefing last week, health officials said an education and public awareness campaign is crucial in minimizing the effective of HO41. William Smith, executive director of the National Coalition for STD Directors, said that if the ‘sex superbug’ spreads, it could quickly kill many people before a treatment is discovered. And that risk becomes increasingly more likely if Congress does not provide the funds to find a cure, he said.

"It's an emergency situation. As time moves on, it's getting more hazardous," he told members of Congress.

"We have to keep beating the drum on this," he added. "The potential for disaster is great."

In the United States, there are 20 million new STD infections each year, which results in about $16 billion in medical costs, the CDC reports. More than 800,000 of these cases gonorrhea infections, most of which occur in young people ages 15 to 24. Gonorrhea is sometimes difficult to detect, since it shows no symptoms in about half of all women. Those who fall ill to the deadly strain may not notice it until it’s too late.

“That’s what’s kind of scary about this,” Smith said.

Although health officials have widely reported that cases of H041 were discovered in California, Hawaii and Norway, the CDC has disputed those claims and told CNBC on Monday that the infection has not been confirmed anywhere outside of Japan. The CDC did, however, make an announcement in 2011 that it was noticing greater gonorrhea bacterial resistance to certain types of antibiotics in Hawaii and California. 

CDC officials said that the US and Norwegian cases were treated effectively with antibiotics not routinely recommended and that these cases were mistakenly identified as H041. But the agency continues to urge Congress for research funding, indicating that the risk of infection is high regardless of where the cases occurred.

Christianson is urging people to practice safe sex and get STD tests if they are in a new relationship, since a superbug infection could be around the corner.

"This is a disaster just waiting to happen," he told CNBC. "It's time to do something about it before it explodes. These superbugs, including the gonorrhea strain, are a health threat. We need to move now before it gets out of hand."