Louisiana ‘Superbug’ fungus not cause for panic, but more hospital cases likely | Coronavirus

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

But despite the “superbug” status granted to C. auris because it is so difficult to kill, its presence is not a cause for panic among the general public, doctors and researchers have said. C. auris generally doesn’t impact most people, although it is a problem for hospitals already taxed by COVID-19 patients and people hospitalized with complicated health conditions.

“Candida auris will now be on the list of suspects,” said Jeffery Hobden, professor of microbiology at LSU Health Sciences Center, noting that it’s not something doctors usually worry about. But he was quick to notice that only a small subset of patients need be affected.

“It’s not the end of the world,” Hobden said. “Most normal healthy people, it’s just one more bug that’s going to grow on you.”

Only in some patients and healthcare workers does the presence of the fungus in Louisiana set off alarm bells. Almost immediately after hearing about the two patients at the University Medical Center, Dr. Alfred Luk, a physician who specializes in infectious diseases in transplant patients at Tulane Health System, put on a medical gown and swabbed a patient himself. for C. auris. He’s never treated a patient for this rare type of fungus, but it lurks in his mind as a possibility after outbreaks in hospitals in Miami and Texas last year.

“He has an incredible ability to colonize people,” Luk said. “It’s become a big problem for closed units – it can spread quickly from patient to patient.”

Candida auris was first detected in the United States in 2009, and infections are increasing every year. It spreads easily – from skin to skin or even from an infected healthcare worker touching an object like a bed sheet.

C. auris is part of a family of yeast fungi, some of which grow naturally on the skin, intestines and genital tract. But this strain is what is called an opportunistic fungus – it grows out of control in some people, enters the body through a wound or medical device, and causes life-threatening infections when it reaches other organs, such as the kidneys or the brain.

When this happens, doctors don’t have as many options as with other mushrooms. Yeast has evolved to become resistant to the few antibiotics in the infectious disease toolbox, a product of the overuse of antibiotics in humans and on farms.

“Ever since they introduced penicillin in the 1940s, there has been an arms race between microorganisms and humanity,” Hobden said. “Every time we come up with new antibiotics and bring them into the clinic, the body finds ways to compete, they evolve and develop resistance.”

What happens next will largely depend on the source of C. auris. Past outbreaks in other regions 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 transferred the pathogen between patients. Since the University Medical Center in New Orleans had two patients diagnosed with C. auris, they should follow protocols that compare all potential common sources between these patients, Hobden said.

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

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

COVID-19 further prepares hospital settings for Candida auris outbreaks, health experts have said.

While infection precautions like wearing gowns, masks, and hand washing may seem to help prevent the spread of infectious disease, C. auris preys on people who have long hospital stays, like COVID patients in intensive care units. Steroids that doctors have found effective against the coronavirus expose patients to pathogens like C. auris because they work by dampening the immune system’s response. And devices that help keep patients alive while fighting COVID — ventilators, IV lines, catheters — give the germ additional entry points into the body.

“They represent a perfect colonization risk,” said Luk, of COVID patients. “Their immune system is dulled, so they’re definitely at risk of getting an invasive infection.”

Mortality risk is high in 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 have been identified. excluded.

Symptoms are common, such as fever and headache, and the fungus often infects people who have a host of other medical conditions, said Dr Hong Xin, who studies the development of vaccines and monoclonal antibodies for Candida infection at LSU Health Sciences Center. Newborns and infected people in nursing homes should be tested more often for the fungus.

“They can deteriorate very quickly without even being diagnosed or knowing what’s going on,” Xin said.

But the fungus won’t kill most people, even if it starts to grow 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 who are battling a number of conditions. However, the cost and burden of an already resource-strapped medical system is high, Xin said, totaling billions a year. According to a study published in Clinical infectious diseases in 2020, the average cost of hospitalization for someone with invasive candidiasis was between $64,723 and $153,090 depending on insurance.

Emily Woodruff covers public health for The Times-Picayune | The New Orleans lawyer as a member of the Report For America body.

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