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RIO – Brazil registered its first suspected case of superfungal infection on Monday Candida auris, which has already caused infections in other countries in South America The pathogen was identified in a sample from the tip of a catheter from a patient who had been admitted to Covid-19 in an intensive care unit in Bahia. According to an article in BMC Infectious Diseases, their mortality rate is 39%.
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The National Health Surveillance Agency (Anvisa) even issued an alert on Tuesday, noting that the Candida auris It is “an emerging fungus that poses a serious threat to global health” and some strains are resistant to all major classes of antifungal drugs.
According to Flávio Telles, professor of infectious diseases at the Federal University of Paraná (UFPR) and coordinator of the mycology committee of the Brazilian Society of Infectious Diseases (SBI), the arrival of Candida auris in Brazil gives rise to an alert, but does not represent a danger equivalent to the arrival of SARS-CoV-2.
The infectologist explains that the superfungal is an intrahospital germ and habitually colonizes equipment, instruments and hospitalized patients. For high-risk patients, who are in the ICU or who have undergone surgery, it poses a greater threat as it can enter the body and cause a serious disease known as invasive candidiasis or candidemia, a type of sepitis on the chain that can lead to death.
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Candidemia can be caused by other species of the fungus, but the Candida auris It is striking because it is particularly resistant to available yeast treatments. And, in the context of the Covid-19 pandemic, the risks posed by the superfungal have another aggravating factor:
– Since Covid-19 has caused many hospitalizations and prolonged hospitalizations, the risk of contagion by Candida auris is older. If it spreads, it will be more of a public health problem. It is difficult to be removed from the hospital – says the infectologist.
Even according to the infectologist, only 5% of the samples of Candida auris they are resistant to all available antifungals. However, on a large scale, even this small proportion can represent a challenge for public health management.
Furthermore, the detection of superfungal relies on complex and expensive technology that is currently concentrated in specialized microbiology laboratories, such as the Central Public Health Laboratories (Lacens).
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– In practice, the Candida auris it can be confused with other species of the fungus, making treatment difficult. The germ is detected by mass spectrometry using a method called Maldi Tof. Each team costs around R $ 1 million, Telles estimates.
However, the infectologist recalls that the Candida auris It is usually restricted to hospital settings and is not as contagious as other pathogens, such as the SARS-Cov-2 virus, which causes Covid-19, for example.
Since 2009, when the first case was reported in Japan, there have been around 4,700 episodes of infection with Candida auris worldwide, according to an article published by Chinese researchers in the scientific journal “BMC Infectious Diseases.” The largest recorded outbreak of superfungal occurred in London in 2015, with 22 patients infected and another 28 colonized.
Studies show that, unlike Covid-19, which also pollutes the air, the superfungal is spread by contact with infected surfaces. Therefore, to prevent the pathogen from advancing, the infected patient must be isolated from others and the hospitalization site must be cleaned with specific hospital disinfectants, during and immediately after their stay.
Advance in Latin America
According to Telles, Candida auris it is a known pathogen in the world and was already on the radar of the Sanitary Surveillance, but so far no case has been identified on Brazilian soil. It has already caused infections in 33 countries.
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The fungus was first detected in 2009, in the ear canal of a patient in Japan, and in the following years its presence spread to Asia, Europe and North America.
In 2016, the Pan American Health Organization (PAHO) issued an alert to the Latin American and Caribbean region about a possible outbreak of Candida auris in the region. That year, five cases of superfungal infection in Cartagena, Colombia, were attributed to other species of the fungus until more modern diagnostic equipment was able to detect the superfungal. In 2018, it arrived in Venezuela in an outbreak that affected 18 patients. Cases have also been reported in Chile.
In Brazil, samples from the first suspected case were sent to the Profº Gonçalo Moniz Central Public Health Laboratory (LACEN / BA) and by the Laboratory of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HCFMUSP), which indicated the presence of pathogen. Now, tests will be carried out in the Special Laboratory of Mycology of the Escola Paulista de Medicina (LEMI – UNIFESP) to determine the degree of resistance of the pathogen and carry out its genetic sequencing.
