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The National Sanitary Surveillance Agency (Anvisa) issued an alert on Monday (7/12) about an ongoing investigation into the possible first positive case in the country of Candida auris, a drug-resistant fungus responsible for hospital infections that has become one one of the most feared in the world.
In its alert, Anvisa stated that Candida auris (C. auris) “It is an emerging fungus that represents a serious threat to public health.”
C. auris infection is resistant to drugs and can be fatal. Worldwide, it is estimated that invasive fungal infections of C. auris have caused the death of 30% to 60% of patients.
According to the Anvisa alert, the fungus was identified in “a sample from the tip of a catheter from a patient admitted to an ICU for adults in a hospital in the State of Bahia.” The sample was analyzed by the Profº Gonçalo Moniz Central Public Health Laboratory (Lacen-BA), in Salvador, and by the Laboratory of the Hospital das Clínicas, Faculty of Medicine, University of São Paulo.
Anvisa affirms that the sample will continue to be subjected to “phenotypic analysis (to verify the sensitivity and resistance profile)” and “genetic sequencing of the microorganism (gold standard)” until the official confirmation of the case.
Given the suspicion, Anvisa recommended strengthening laboratory surveillance of the fungus in all the country’s health services, among other control and prevention measures to prevent an outbreak.
Control and prevention obstacles
The fungus was first identified in 2009 in the ear canal of a patient in Japan. Since then, cases have been identified in countries such as India, South Africa, Venezuela, Colombia, the United States, Israel, Pakistan, Kenya, Kuwait, the United Kingdom. and Spain.
In 2016, PAHO, the arm of the World Health Organization for Latin America and the Caribbean, issued an alert recommending the adoption of preventive and control measures for outbreaks related to fungi in the region. The first outbreak in the region occurred in Venezuela, between 2012 and 2013, affecting 18 patients.
Additionally, C. auris is often mistaken for other infections, leading to inappropriate treatment.
“C. auris survives in hospital environments and therefore cleanliness is essential for control. The discovery (of the fungus) can be a serious problem for both patients and the hospital, as control can be difficult,” explained Elaine Cloutman-Green, MD, an infection control specialist and professor at University College London (UCL).
Not all hospitals identify C. auris in the same way. Sometimes the fungus is mistaken for other fungal infections, such as common yeast infection.
In 2017, a survey published by Alessandro Pasqualotto, of the Santa Casa de Misericórdia in Porto Alegre, analyzed 130 laboratories of reference medical centers in Latin America and found that only 10% of them have the capacity to detect invasive fungal diseases according to to standards. Europeans.
According to Anvisa, the 2016 outbreak in Cartagena, Colombia, is an example of how difficult it is to identify the microorganism. Five cases of infection were identified as three different fungi until a more modern analysis method correctly diagnosed the pathogen as C. auris.
Also, C. auris is very hardy and can survive on surfaces for a long time.
Nor is it possible to remove it using the most common detergents and disinfectants.
Therefore, it is important to use the proper cleaning chemicals in hospitals, especially if there is an outbreak.
In an alert issued in 2017, Anvisa explained that it is not known for sure what is the most precise way to transmit the fungus within a health unit. Studies indicate that this can occur through contact with contaminated surfaces or equipment and from person to person.
The largest outbreak related to C. auris occurred in 2015 in London, with 22 patients infected and another 28 colonized.
Drug resistance
Resistance to common antifungals, such as fluconazole, has been identified in most strains of C. auris found in patients.
This means that these drugs do not work to fight C. auris. Because of this, less common antifungal medications have been used to treat these infections, but C. auris has also developed resistance to them.
“There is a record of resistance to azoles, echinocandins and even polyenes, such as amphotericin B. This means that the fungus can be resistant to the three main classes of drugs available to treat systemic fungal infections,” explained epidemiologist and microbiologist Alison Chaves , On twitter. .
DNA analysis also indicates that antifungal resistance genes present in C. auris have been transmitted to other species of fungi, such as Candida albicans (C. albicans), one of the main causes of candidiasis (a common disease that can affect skin, nails). and genitalia, and is relatively easy to treat).
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