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‘Superbug’ fungus in Louisiana does not cause panic, but more cases in hospitals probably | Coronavirus

One day after hospital officials found the first two cases of the fungus Candida auris in Louisiana, health experts predict that there are likely to be more cases of the drug-resistant yeast lurking in hospitals, causing mysterious, difficult-to-treat infections.

But despite the "superbug" status given to C. auris because it is so hard to kill, its presence does not cause panic in the general public, doctors and researchers said. C. auris typically does not affect most people, although it is a problem for hospitals already taxed by COVID-19 patients and people hospitalized with complicated health problems.

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"Candida auris will be on the list of suspects now," said Jeffery Hobden, professor of microbiology at the LSU Health Sciences Center, noting that it is not something that typically thinks of doctors. But he was quick to point out that only a small proportion of patients should be concerned.

"This is not the end of the world," Hobden said. "Most normal healthy people, this is just another bug that will grow on you."

It is only among some patients and healthcare professionals that the presence of the fungus is that Louisiana triggers alarm bells. Almost immediately after hearing about the two patients at University Medical Center, Dr. Alfred Luk, a physician specializing in infectious diseases in transplant patients at the Tulane Health System, put on a doctor's dress and washed a patient for C. auris himself. He has never treated a patient for this rare type of fungus, but it has lurked in the back of his mind as an option after outbreaks at Miami and Texas hospitals last year.

"It has an eerie ability to colonize people," Luk said. "It became a big problem for closed devices - it can quickly spread from patient to patient."

Candida auris was first discovered in the United States in 2009, and infections have grown every year. It spreads easily - from skin to skin or even by an infected healthcare worker touching an object like a bedding.

C. auris is part of a family of yeasts, some of which grow naturally on the skin, intestines and genitals. But this strain is what is known as an opportunistic fungus - it grows out of control in some people, enters the body through a wound or medical device and causes deadly infections when it reaches other organs, such as the kidney or brain.

When this happens, doctors do not have as many options as they have with other fungi. The yeast developed to be resistant to the few antibiotics in the infectious disease toolkit, a product of overuse of antibiotics in humans and on farms.

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"Ever since they introduced penicillin back in the '40s, there has been an arms race between microorganisms and humanity," Hobden said. "When we come up with new antibiotics and introduce them clinically, the organism finds ways to compete, they evolve and develop resistance."

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What happens next will largely depend on the source of C. auris. Previous outbreaks in other areas have shown that sometimes the spread can be traced to a single source, which is easier to eliminate, Luk said.

In one case reported in the New England Journal of Medicine, a reusable temperature probe transmits the pathogen between patients. Because the University Medical Center in New Orleans had two patients diagnosed with C. auris, they should follow protocols that compare all the common potential sources between these patients, Hobden said.

C. auris can also contaminate a hospital room so thoroughly that ceiling tiles and drywall may need to be removed, said Luk, who recalled a case in New York City.

A representative of University Medical Center, which is owned by LCMC Health, said there were no updates to share about additional patients or a common source of infection.

COVID-19 is another prime hospital setting for Candida auris outbreaks, health experts said.

While infectious measures such as wearing dresses, masks and hand washing may seem like they would help prevent the spread of infectious diseases, C. auris prey on people who have long hospital stays, such as COVID patients in intensive care units. The steroids that doctors have found work well against coronavirus, putting patients at risk for pathogens like C. auris because they work by slowing down the immune system's response. And the devices that help keep patients alive while fighting COVID - ventilators, IV tubes, catheters - provide the germ with additional entry points into the body.

"They are a perfect risk of colonization," Luk said of COVID patients. "Their immune system is dull, so they are definitely at risk of getting an invasive infection."

The risk of mortality is high among people identified with C. auris - between 30% and 60% - but it can be very difficult to diagnose and is often only detected in very sick people, for whom all other causes are excluded.

Symptoms are common, such as fever and headaches, and the fungus often infects people who have a wide range of other medical problems, said Dr. Hong Xin, who is researching the development of vaccines and monoclonal antibodies against Candida infection at the LSU Health Sciences Center. Newborns and people in nursing homes with infections should be tested more often to check for the fungus.

"They can get worse really quickly without even being diagnosed or knowing what's going on," Xin said.

But the fungus will not kill most people, even if it happens to start growing on their skin. It is considered a secondary infection that occurs after someone has already been hospitalized for something else. Deaths usually occur in people struggling with a variety of conditions. But the cost and burden of an already strained medical system is high, Xin said, totaling billions annually. According to a study published in Clinical Infectious Diseases in 2020, the average cost of hospitalization for a person with invasive candida ranged from $ 64,723 to $ 153,090 depending on the insurance.

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Emily Woodruff covers public health for The Times-Picayune | The New Orleans Advocate as a Report For America Corps Member.

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