The alarming rise in cases of a fungal disease in health-care facilities will continue to pose a threat until an effective drug treatment can be developed, a Northeastern biotechnology expert says.

“If (Candida auris) is resistant to antifungal medications, it’s just going to continue to become more dominant,” says Jared Auclair, director of bionnovation in the Office of the Provost at Northeastern University.

Candida auris, also known as C. auris, is one of the newer fungal diseases known to health officials in the U.S., where it was first reported in 2016.

The number of cases in the U.S. has skyrocketed in recent years, going from 153 through August of 2017 to 2,377 in 2022 alone, for a total of 3,270 clinical cases, according to the CDC. 

Resistant to antifungal drugs

One of the major concerns of public health officials  is the disease’s resistance to multiple antifungal drugs commonly used to treat C. auris.

“Some strains are resistant to all three available classes of antifungals,” the CDC says. In 2021, the number of cases resistant to the most recommended treatment, echinocandins, tripled, the federal agency says.

“If it’s resistant to drugs, it’s going to have to run its course,” Auclair says. 

There’s little health professionals can do other than using medications to treat symptoms and boost the patient’s immune system, he says. “You have to leave it to your natural defenses.”

The Centers for Disease Control issued a press release March 20 to sound the alarm about the rise of the fungal disease in health-care facilities including nursing homes and hospitals.

Besides drug resistance, C. auris is also remarkably persistent, according to the CDC, which says, “Even after treatment for invasive infections, patients generally remain colonized with C. auris for long periods, and perhaps indefinitely.”

Not a risk for the healthy 

“Most healthy people can clear the infection,” Auclair says.

Individuals who are immunocompromised or have other health conditions are in danger of becoming ill after exposure to C. auris, which the National Institutes of Health says can live on surfaces for two weeks.

The CDC says that “in general, C. auris is not a threat to healthy people. People who are very sick, have invasive medical devices or have long or frequent stays in health-care facilities are at increased risk of acquiring C. auris.”

The federal agency says there have been outbreaks of the fungal infection in health-care facilities from contact with infected patients and contaminated equipment.

Medically fragile people are at risk of dying from C. auris, especially if it enters the blood, heart or brain, the CDC says. 

“Symptoms are diverse,” Auclair says. “It could be an ear infection.”

Causes

The alarming rise in cases most likely can be traced to mutations of the yeast that causes Candida auris, Auclair says.

Just as scientists worry about the COVID-19 virus becoming resistant to vaccines through mutation, fungal infections can also evolve to resist therapeutic intervention, he says. 

“You have a bazillion of these fungi floating around. Some percentage of them are resistant (to treatment). They then become the predominant strain,” Auclair says.

Making detection worse, it is difficult to identify with standard lab methods and can be misidentified without specific technology, the CDC says.

The federal agency says it is working to strengthen laboratory capacity through supplemental funding supported by the American Rescue Plan.

“These efforts include increasing susceptibility testing for C. auris from seven regional labs to more than 26 labs nationwide,” the CDC says.

The CDC says case counts have increased for many reasons, “including poor general infection prevention and control practices in healthcare facilities.”

Federal health officials also pointed to an increase in screening to detect cases, which has also identified thousands of cases in which people were carrying but not sickened by C. auris.

“It’s most likely just random in terms of why it spiked up,” Auclair says.

Cynthia McCormick Hibbert is a Northeastern Global News reporter. Email her at c.hibbert@northeastern.edu or contact her on Twitter @HibbertCynthia