Candida auris (C. auris) facts*
*C. auris facts by Charles Patrick Davis, MD, PhD
- Candida auris (C. auris) is a yeast-like fungus related to Candida albicans. It was first described as a pathogen in 2009 when isolated from a patient with an ear infection in Japan. The fungus causes invasive infections with a high death rate (about 57%) and causes mainly bloodstream, wound, and ear infections.
- The CDC considers C. auris to be an emerging pathogen that is invasive and multiply drug-resistant in contrast to other fungal diseases related to Candida spp.; also, C. auris is usually associated in outbreaks in health care settings like hospitals.
- Signs and symptoms of C. auris include
- fever and chills while on antimicrobial medication,
- isolation of Candida-like yeast from the patient's blood, and
- little or no patient response or improvement with conventional antifungal therapy.
- Coma, organ failure (as the infection spreads to multiple organs), and death may occur if appropriate treatment is delayed.
- C. auris is difficult to diagnose by routine fungal cultures of blood or other body fluids. Special sophisticated molecular methods are needed to identify the fungus, and not all laboratories are able to identify this organism.
- People at risk are usually in health care settings and have undergone recent surgery, have a central venous catheter, have diabetes, and/or have undergone broad-spectrum antibiotic and/or antifungal therapy. These fungal infections have been found in all age groups.
- A review of Candida strains and species found the first strain was cultured but not named in 1996 in South Korea.
- C. auris was named because it was a yeast-like fungus with biologic properties that fit into the genus Candida and was first isolated as an infectious agent from a patient's ear (auris means "ear" in Latin).
- Infections have occurred globally in Japan, South Korea, India, Pakistan, South Africa, Kenya, Kuwait, Israel, Venezuela, Colombia, the United Kingdom, Canada, and in the United States. The CDC speculates the organisms are in other countries that probably cannot identify the fungi because of the specialized laboratory methods needed to do so are not available.
- DNA studies of C. auris globally suggest that strains of this fungus, although similar, emerged independently in world regions at about the same time.
- C. auris may be weakly contagious. The CDC is continuing studies about the contagiousness of this organism as it has been found on the skin of several patients and on other surfaces in the patient's rooms.
- The CDC reports that, in the U.S., seven individuals have been identified as infected from May 2013 to August 2016 in four states (Illinois, Maryland, New Jersey, and New York) with four deaths. Since August 2016, an additional six individuals have been identified. All patients had serious underlying medical problems. As of Apr. 11, 2019, the CDC reports an outbreak of infections -- 587 documented cases mainly in New York, Illinois, and New Jersey, with nine additional states reporting a few C. auris infections.
- If you suspect you have a C. auris infection, contact a medical caregiver immediately; doctors who are specialists in fungal diseases (infectious disease specialists) should be consulted -- other specialists who may treat these patients may include critical care specialists, hospitalists, infection-control personnel, and CDC specialists.
- C. auris infections are treatable with certain antifungal drugs (for example, echinocandins). However, the drug(s) of choice depend on which drugs the fungus is susceptible; this requires a positive identification of the C. auris infecting strain and laboratory determination of the strain's drug susceptibility. Some clinicians prefer to use more than one antifungal drug to treat these multiple drug-resistant invasive organisms.
- C. auris spread, according to the CDC, is likely due to contact with contaminated surfaces or equipment or even possibly by direct physical person-to-person contact, but the CDC is still gathering the data on the spread of this disease as some people may be carriers this fungus for many months.
- Prevention of C. auris spread is detailed in the CDC's infection-control publications and the CDC encourages environmental cleaning with an EPA-registered hospital-grade disinfectant that is effective against fungi.
C. auris and Sepsis
Blood poisoning is a nonspecific term used mainly by nonmedical individuals that describes, in the broadest sense, any adverse medical condition(s) due to the presence of any toxic agent in the blood. Usually, the layperson using the term blood poisoning is referring to the medical condition(s) that arise when bacteria or their products (or both) reach the blood. Blood poisoning is not a medical term and does not appear in many medical dictionaries or scientific publications. However, when it is used, the correct medical term that most closely matches its intended meaning is sepsis. Many medical authors consider the terms blood poisoning and sepsis to be interchangeable, but the trend in the medical literature is to use the term sepsis.
What is Candida auris (C. auris)?
Candida auris is an emerging fungus that presents a serious global health threat. Healthcare facilities in several countries have reported that C. auris has caused severe illness in hospitalized patients. Some strains of Candida auris are resistant to all three major classes of antifungal drugs. This type of multidrug resistance has not been seen before in other species of Candida.
C. auris is difficult to identify with standard laboratory methods and can be misidentified in labs without specific technology.
Healthcare facilities in several countries have reported that C. auris has been causing severe illness in hospitalized patients. In some patients, this yeast can enter the bloodstream and spread throughout the body, causing serious invasive infections. This yeast often does not respond to commonly used antifungal drugs, making infections difficult to treat. Patients who have been in the intensive care unit for a long time or have a central venous catheter placed in a large vein, and have previously received antibiotics or antifungal medications, appear to be at highest risk of infection with this yeast.
Specialized laboratory methods are needed to accurately identify C. auris. Conventional lab techniques could lead to misidentification and inappropriate treatment, making it difficult to control the spread of C. auris in healthcare settings.
Candida auris (C. auris)
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Why is CDC concerned about C. auris infections?
CDC is concerned about C. auris for three main reasons:
- It is often multidrug-resistant, meaning that it is resistant to multiple antifungal drugs commonly used to treat Candida infections.
- It is difficult to identify with standard laboratory methods, and it can be misidentified in labs without specific technology. Misidentification may lead to inappropriate management.
- It has caused outbreaks in healthcare settings. For this reason, it is important to quickly identify C. auris in a hospitalized patient so that healthcare facilities can take special precautions to stop its spread.
What types of infections can C. auris cause?
C. auris has caused bloodstream infections, wound infections, and ear infections. It also has been isolated from respiratory and urine specimens, but it is unclear if it causes infections in the lung or bladder.
How is C. auris infection diagnosed?
Like other Candida infections, C. auris infections are usually diagnosed by culture of blood or other body fluids. However, C. auris is harder to identify from cultures than other, more common types of Candida. For example, it can be confused with other types of yeasts, particularly Candida haemulonii. Special laboratory tests are needed to identify C. auris.
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Who is at risk for infection from C. auris?
Limited data suggest that the risk factors for Candida auris infections are generally similar to risk factors for other types of Candida infections. These risk factors include recent surgery, diabetes, broad-spectrum antibiotic and antifungal use. People who have recently spent time in nursing homes and have lines and tubes that go into their body (such as breathing tubes, feeding tubes and central venous catheters), seem to be at highest risk for C. auris infection. Infections have been found in patients of all ages, from preterm infants to the elderly. Further study is needed to learn more about risk factors for C. auris infection.
What are the symptoms of C. auris infection?
- Symptoms may not be noticeable, because patients with C. auris infection are often already sick in the hospital with another serious illness or condition.
- Symptoms of C. auris infection depend on the part of the body affected. C. auris can cause many different types of infection, such as bloodstream infection, wound infection, and ear infection.
- Because symptoms can vary greatly, a laboratory test is needed to determine whether a patient has a C. auris infection.
When was C. auris first reported?
C. auris was first identified in 2009 in Japan. Retrospective review of Candida strain collections found that the earliest known strain of C. auris dates to 1996 in South Korea. CDC considers C. auris an emerging pathogen because increasing numbers of infections have been identified in multiple countries since it was recognized.
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How did C. auris get its name?
Auris is the Latin word for ear. Despite its name, C. auris can also affect many other regions of the body and can cause invasive infections, including bloodstream infections and wound infections.
Where have C. auris infections occurred globally?
C. auris infections have been reported from over 20 countries, including the United States. Because identification of C. auris requires specialized laboratory methods, infections likely have occurred in other countries but have not been identified or reported.
How did C. auris infection spread globally?
CDC conducted whole genome sequencing of C. auris specimens from countries in the regions of eastern Asia, southern Asia, southern Africa, and South America. Whole genome sequencing produces detailed DNA fingerprints of organisms. CDC found that isolates within each region are quite similar to one another, but are relatively different across regions. These differences suggest that C. auris has emerged independently in multiple regions at roughly the same time.
Would someone be likely to get a C. auris infection if they travel to any of
It is unlikely that routine travel to countries with documented C. auris infections would increase the chance of someone getting sick from C. auris. Infections have occurred primarily in patients who were already in the hospital for other reasons. People who travel to these countries to seek medical care or who are hospitalized there for a long time may have an increased risk for C. auris infection.
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Have C. auris infections occurred in the United States?
Cases of C. auris infections have been reported in the United States. As laboratories continue to look for this fungus, it is likely that more cases will be reported.
What should someone do if they suspect they have a C. auris infection?
CDC recommends that anyone who believes they have any fungal infection or healthcare-associated infection see a healthcare provider.
Are C. auris infections treatable?
Most C. auris infections are treatable with a class of antifungal drugs called echinocandins. However, some C. auris infections have been resistant to all three main classes of antifungal medications, making them more difficult to treat. In this situation, multiple classes of antifungals at high doses may be required to treat the infection. Treatment decisions should be made in consultation with a healthcare provider experienced in treating patients with fungal infections.
Can a person die from infection with C. auris?
Yes. Invasive infections with any Candida species can be fatal. We don't know if patients with invasive C. auris infection are more likely to die than patients with other invasive Candida infections. Based on information from a limited number of patients, 30%-60% of people with C. auris infections have died. However, many of these people had other serious illnesses that also increased their risk of death.
How does C. auris spread?
C. auris can spread in healthcare settings through contact with contaminated environmental surfaces or equipment, or from person to person. More work is needed to further understand how it spreads.
What is CDC doing to address C. auris?
CDC is providing guidance for clinicians and infection control personnel. CDC also is working with state and local health agencies, healthcare facilities, and clinical microbiology laboratories to ensure that laboratories are using proper methods to detect C. auris and know the limitations of certain tests for detecting C. auris.
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United States. Centers for Disease Control and Prevention. "Fungal Diseases: Candida auris." Dec. 21, 2018. <http://www.cdc.gov/fungal/diseases/candidiasis/candida-auris.html>.