Biology:Candida auris

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Short description: Species of fungus

Candida auris
Candida-auris 2016-250px.jpg
Scientific classification edit
Domain: Eukaryota
Kingdom: Fungi
Division: Ascomycota
Class: Saccharomycetes
Order: Saccharomycetales
Family: Saccharomycetaceae
Genus: Candida
Species:
C. auris
Binomial name
Candida auris
Satoh & Makimura, 2009[1]
Type strain
DSM 21092[2]
Proposed scheme for the emergence of C. auris.[3]

Candida auris is a species of fungus that grows as yeast.[1] It is one of the few species of the genus Candida which cause candidiasis in humans. Often, candidiasis is acquired in hospitals by patients with weakened immune systems. C. auris can cause invasive candidiasis (fungemia) in which the bloodstream, the central nervous system, and internal organs are infected. It has attracted widespread attention because of its multiple drug resistance. Treatment is also complicated because it is easily misidentified as other Candida species.

Candida auris was first described in 2009 after it was isolated from the ear canal of a 70-year-old Japanese woman at the Tokyo Metropolitan Geriatric Hospital in Japan. In 2011, South Korea saw its first cases of disease-causing C. auris. Reportedly, this spread across Asia and Europe, and first appeared in the U.S. in 2013.[4]

DNA analysis of four distinct but drug-resistant strains of Candida auris indicate an evolutionary divergence taking place at least 4,000 years ago, with a common leap among the four varieties into drug-resistance possibly linked to widespread azole-type antifungal use in agriculture.[4] However, explanations for its emergence remain speculative.

Identification and morphology

First identified in 2009, Candida auris is a species of ascomycetous fungus of the genus Candida that grows as a yeast.[1] Its name comes from the Latin word for ear, auris.[5] It forms smooth, shiny, whitish-gray, viscous colonies on growth media. Microscopically, cells are ellipsoid in shape.[1]

Clinical significance

Candida auris has attracted increased clinical attention because of its multiple drug resistance.[6][7][4]

In vitro, more than 90% of C. auris isolates are resistant to fluconazole[8][9] and a range of 3–73% of C. auris isolates are resistant to voriconazole,[9][10] while other triazoles (posaconazole, itraconazole, and isavuconazole) display better activity.[8][9][10] Of isolates, 13% to 35% were reported resistant to amphotericin B;[8][10] however, most isolates are susceptible to echinocandins.[8][9][10]

Treatment is complicated because C. auris is easily misidentified as various other Candida species.[6][7] [11][12] A brief outline of its clinical relevance (As of 2016), understandable by general audiences, was published by the Center for Infectious Disease Research and Policy at the University of Minnesota.[13]

According to papers published from 2011 to 2016, mortality of people with C. auris bloodstream infections (BSI) ranged from 30 to 60%.[14] Many of these people had other serious illnesses and conditions (comorbidities) that increased their risk of death.[14][15]

Vaccine development

(As of January 2024) there is no human vaccine against Candida auris.[16] Experiments involving the NDV-3A vaccine have successfully immunized mice against the fungus.[17] The vaccine also improved the protective efficacy of the antifungal drug micafungin against C. auris infection in the mouse bloodstream.[18]

Genome

Several draft genomes from whole genome sequencing have been published.[6][19] C. auris has a genome size of 12.3–12.5 Mb with a GC-content of 44.5–44.8%.[6][19] The C. auris genome was found to encode several genes for the ABC transporter family, a major facilitator superfamily, which helps to explain its multiple drug resistance.[6] Its genome also encodes virulence-related gene families such as lipases, oligopeptide transporters, mannosyl transferases and transcription factors which facilitate colonization, invasion, and iron acquisition.[6] Another factor contributing to antifungal resistance is the presence of a set of genes known to be involved in biofilm formation.[6]

More studies are needed to determine whether the phylogenetic divergence of C. auris clones exhibits region-specific patterns of invasiveness, virulence, and/or drug resistance.[20]

Epidemiology

Geographical differentiation

The phylogenetics of C. auris suggest distinct genotypes exist in different geographical regions with substantial genomic diversity.[20] A variety of sequence-based analytical methods have been used to support this finding.[citation needed]

Whole genome sequencing and analyses of isolates from Pakistan, India, South Africa, Venezuela, Japan, and previously sequenced C. auris genomes deposited in the National Center for Biotechnology Information's Sequence Read Archive[21] identified a distinct geographic distribution of genotypes.[8] Four distinct clades separated by tens of thousands of single-nucleotide polymorphisms were identified.[8] The distribution of these clades segregated geographically to South Asia (India and Pakistan), South Africa, Venezuela, and Japan with minimal observed intraregion genetic diversity.[8]

Amplified fragment length polymorphism analysis of C. auris isolates from the United Kingdom, India, Japan, South Africa, South Korea, and Venezuela suggested that the London isolates formed a distinct cluster compared to the others.[22]

Comparison of ribosomal DNA sequences of C. auris isolates from Israel, Asia, South Africa, and Kuwait found that the strains from Israel were phylogenetically distinct from those from the other regions.[23] Chatterjee et al. wrote in 2015, "Its actual global distribution remains obscure as the current commercial methods of clinical diagnosis misidentify it as C. haemulonii."[6]

History

Candida auris infections, world distribution as of 2019
Map of Candida auris infections in United States as of 2019

Candida auris was first described in 2009 after it was isolated from the ear canal of a 70-year-old Japanese woman at the Tokyo Metropolitan Geriatric Hospital in Japan.[1] It was isolated based on its ability to grow in the presence of the fungicide micafungin, an echinocandin class fungicide.[1] Phenotypic, chemotaxonomic and phylogenetic analyses established C. auris as a new strain of the genus Candida.[1][24]

The first three cases of disease-causing C. auris were reported from South Korea in 2011.[25] Two isolates had been obtained during a 2009 study and a third was discovered in a stored sample from 1996.[25] All three cases had persistent fungemia, i.e. bloodstream infection, and two of the patients subsequently died due to complications.[25] Notably, the isolates initially were misidentified as Candida haemulonii and Rhodotorula glutinis using standard methods, until sequence analysis correctly identified them as C. auris.[25] These first cases emphasize the importance of accurate species identification and timely application of the correct antifungal for the effective treatment of candidiasis with C. auris.[25]

During 2009–2011, 12 C. auris isolates were obtained from patients at two hospitals in Delhi, India.[26] The same genotype was found in distinct settings: intensive care, surgical, medical, oncologic, neonatal, and pediatric wards, which were mutually exclusive with respect to health care personnel.[26] Most had persistent candidemia and a high mortality rate was observed.[26] All isolates were of the same clonal strain, however, and were only identified positively by DNA sequence analysis.[26] As previously, the strain was misidentified with established diagnostic laboratory tests.[26] The Indian researchers wrote in 2013 that C. auris was much more prevalent than published reports indicate since most diagnostic laboratories do not use sequence-based methods for strain identification.[26]

The fungus spread to other continents and eventually, a multi-drug-resistant strain was discovered in Southeast Asian countries in early 2016.[27]

The first report of a C. auris outbreak in Europe was an October 2016 in Royal Brompton Hospital, a London cardio-thoracic hospital.[22] In April 2017, CDC director Anne Schuchat named it a "catastrophic threat".[28] (As of May 2017) the CDC had reported 77 cases in the United States. Of these, 69 were from samples collected in New York and New Jersey.[29]

(As of August 2019) the number of cases of people having contracted C. auris in the United States had risen to 806, with 388 reported in New York, 137 in New Jersey and 227 in Illinois, according to the CDC.[4][30]

Since it was first observed in the United Kingdom, it has spread to more than 20 NHS Trust hospitals and infected 200 people.[31]

(As of April 2019), the CDC has documented cases of C. auris from the following countries: Australia, Austria, Belgium, Canada, China, Colombia, France, Germany, India, Iran, Israel, Japan, Kenya, Kuwait, Malaysia, Mexico, the Netherlands, Norway, Oman, Pakistan, Panama, Russia, Saudi Arabia, Singapore, South Africa, South Korea, Spain, Switzerland, Taiwan, Thailand, the United Arab Emirates, the United Kingdom, the United States, and Venezuela.[30]

Candida auris fungus (C. auris) is a multi-drug–resistant fungal infection that spreads in hospitals and is extremely deadly—killing as many as one in three who get it.

—Abby Haglage of Yahoo! Lifestyle,[32] citing the Centers for Disease Control and Prevention[33]

Arturo Casadevall, MD, PhD, and Molecular Microbiology and Immunology chair at Johns Hopkins Bloomberg School of Public Health stated:

What this study suggests is this is the beginning of fungi adapting to higher temperatures, and we are going to have more and more problems as the century goes on. Global warming will lead to selection of fungal lineages that are more thermally tolerant.[32]

The COVID-19 pandemic has taken resources away from combating and tracking the fungus, which has led to outbreaks.[34] Shortages of personal protective equipment forced medical personnel to reuse of gowns and masks during the pandemic, which has contributed to the fungi's spread.[34] In 2021, the CDC identified strains of Candida auris that were immune to all existing medications used to treat fungal infections.[35] Research published in Annals of Internal Medicine tracking the spread of Candida auris from 2019 through 2021 revealed the fungus was present in over half of American states.[36][37][38]

Context

Antimicrobial resistance in general is an increasingly common phenomenon. In 2010, two million people were reported to have contracted resistant infections in the United States – 23,000 fatally.[upper-alpha 1] "[M]ore recent estimates from researchers at Washington University School of Medicine put the death toll at 162,000. Worldwide fatalities from resistant infections are estimated at 700,000 per year.[4][39] C. auris is one of the many microbial contributors to this global AMR estimation.[39]

See also

References

Notes

  1. ↑ According to official Center for Disease Control estimations.[4]

Citations

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 "Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital". Microbiology and Immunology 53 (1): 41–4. January 2009. doi:10.1111/j.1348-0421.2008.00083.x. PMID 19161556. 
  2. ↑ "Candida auris". DSMZ – German Collection of Microorganisms and Cell Cultures. https://www.dsmz.de/catalogues/details/culture/DSM-21092.html. 
  3. ↑ "On the Emergence of Candida auris: Climate Change, Azoles, Swamps, and Birds". mBio 10 (4): e01397–19. July 2019. doi:10.1128/mBio.01397-19. PMID 31337723. 
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Richtel, Matt; Jacobs, Andrew (6 April 2019). "A Mysterious Infection, Spanning the Globe in a Climate of Secrecy". The New York Times. ISSN 0362-4331. https://www.nytimes.com/2019/04/06/health/drug-resistant-candida-auris.html. "C. auris is so tenacious, in part, because it is impervious to major antifungal medications, making it a new example of one of the world's most intractable health threats: the rise of drug-resistant infections." 
  5. ↑ "Candida auris Questions and Answers". Centers for Disease Control and Prevention (CDC). 4 November 2016. https://www.cdc.gov/fungal/diseases/candidiasis/candida-auris-qanda.html. 
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 "Draft genome of a commonly misdiagnosed multidrug resistant pathogen Candida auris". BMC Genomics 16 (1): 686. September 2015. doi:10.1186/s12864-015-1863-z. PMID 26346253. 
  7. ↑ 7.0 7.1 "Identification of Candida auris". Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/fungal/diseases/candidiasis/recommendations.html. 
  8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 "Simultaneous Emergence of Multidrug-Resistant Candida auris on 3 Continents Confirmed by Whole-Genome Sequencing and Epidemiological Analyses". Clinical Infectious Diseases 64 (2): 134–140. January 2017. doi:10.1093/cid/ciw691. PMID 27988485. 
  9. ↑ 9.0 9.1 9.2 9.3 "Multidrug-resistant endemic clonal strain of Candida auris in India". European Journal of Clinical Microbiology & Infectious Diseases 33 (6): 919–26. June 2014. doi:10.1007/s10096-013-2027-1. PMID 24357342. 
  10. ↑ 10.0 10.1 10.2 10.3 "Candida auris candidaemia in Indian ICUs: analysis of risk factors". The Journal of Antimicrobial Chemotherapy 72 (6): 1794–1801. June 2017. doi:10.1093/jac/dkx034. PMID 28333181. 
  11. ↑ "Clinical Alert to U.S. Healthcare Facilities - June 2016". Centers for Disease Control and Prevention (CDC). 2019-06-27. https://www.cdc.gov/fungal/candida-auris/candida-auris-alert.html. 
  12. ↑ "Candida auris Clinical Update - September 2017". Centers for Disease Control and Prevention (CDC). 2019-06-27. https://www.cdc.gov/fungal/candida-auris/c-auris-alert-09-17.html. 
  13. ↑ Dall, Chris (2016-06-29). "CDC issues warning on multidrug-resistant yeast infection". CIDRAP News. http://www.cidrap.umn.edu/news-perspective/2016/06/cdc-issues-warning-multidrug-resistant-yeast-infection. 
  14. ↑ 14.0 14.1 Kraft, Colleen Suzanne, ed (February 2018). "Candida auris: An Emerging Fungal Pathogen". Journal of Clinical Microbiology 56 (2): e01588–17. doi:10.1128/JCM.01588-17. PMID 29167291. 
  15. ↑ "Incidence, characteristics and outcome of ICU-acquired candidemia in India". Intensive Care Medicine 41 (2): 285–95. February 2015. doi:10.1007/s00134-014-3603-2. PMID 25510301. 
  16. ↑ "Candida Auris". Philadelphia Department of Public Health. 8 August 2022. https://hip.phila.gov/disease-control/diseasesconditions/candida-auris/. 
  17. ↑ Harper, Rachel (7 August 2019). "Major step towards Candida auris vaccine developed". https://www.europeanpharmaceuticalreview.com/news/96289/major-step-candida-auris-vaccine/. 
  18. ↑ Singh, Shakti; Uppuluri, Priya; Mamouei, Zeinab; Alqarihi, Abdullah; Elhassan, Hana; French, Samuel; Lockhart, Shawn R.; Chiller, Tom et al. (August 2019). "The NDV-3A vaccine protects mice from multidrug resistant Candida auris infection". PLOS Pathogens 15 (8): e1007460. doi:10.1371/journal.ppat.1007460. ISSN 1553-7374. PMID 31381597. 
  19. ↑ 19.0 19.1 "Draft Genome Sequence of a Fluconazole-Resistant Candida auris Strain from a Candidemia Patient in India". Genome Announcements 3 (4): e00722–15. July 2015. doi:10.1128/genomeA.00722-15. PMID 26184929. 
  20. ↑ 20.0 20.1 "Multidrug-Resistant Candida haemulonii and C. auris, Tel Aviv, Israel". Emerging Infectious Diseases 23 (1): 195–203. February 2017. doi:10.3201/eid2302.161486. PMID 28098529. 
  21. ↑ National Center for Biotechnology Information's Sequence Read Archive U.S. National Library of Medicine, retrieved 31 May 2017
  22. ↑ 22.0 22.1 "Candida auris in a European hospital". Antimicrobial Resistance and Infection Control 5: 35. 2016-10-19. doi:10.1186/s13756-016-0132-5. PMID 27777756. 
  23. ↑ "Hospital design". Hospitals 40 (7): 91–4. April 1966. PMID 5324804. 
  24. ↑ "Candida auris". MycoBank. http://www.mycobank.org/name/Candida%20auris. 
  25. ↑ 25.0 25.1 25.2 25.3 25.4 "First three reported cases of nosocomial fungemia caused by Candida auris". Journal of Clinical Microbiology 49 (9): 3139–42. September 2011. doi:10.1128/JCM.00319-11. PMID 21715586. 
  26. ↑ 26.0 26.1 26.2 26.3 26.4 26.5 "New clonal strain of Candida auris, Delhi, India". Emerging Infectious Diseases 19 (10): 1670–3. October 2013. doi:10.3201/eid1910.130393. PMID 24048006. 
  27. ↑ Maryn McKenna (7 November 2016). "Fatal Fungus Linked to 4 New Deaths – What You Need to Know". National Geographic. National Geographic Society. http://news.nationalgeographic.com/2016/11/deadly-fungus-drug-resistance-candida-auris-health-science/. 
  28. ↑ Blau, Max (21 April 2017). "'Catastrophic threat': CDC chief fears a deadly superbug's spread". Stat News. https://www.statnews.com/2017/04/21/superbug-cdc-fungus-candida-auris/. 
  29. ↑ "Notes from the Field: Ongoing Transmission of Candida auris in Health Care Facilities - United States, June 2016-May 2017". MMWR. Morbidity and Mortality Weekly Report 66 (19): 514–515. May 2017. doi:10.15585/mmwr.mm6619a7. PMID 28520710. 
  30. ↑ 30.0 30.1 "Tracking Candida auris". Centers for Disease Control and Prevention (CDC). 31 August 2019. https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html. 
  31. ↑ Henk, Daniel (2017-08-21). "A killer fungus is spreading through UK hospitals – here's what you need to know about Candida auris". The Independent. https://www.independent.co.uk/life-style/health-and-families/drug-resistant-killer-fungus-candida-auris-nhs-hospitals-japan-life-threatening-difficult-to-a7904451.html. 
  32. ↑ 32.0 32.1 Haglage, Abby (24 July 2019). "Deadly new fungal superbug is worrying doctors—here's what you need to know". Yahoo! Lifestyle. https://www.yahoo.com/lifestyle/deadly-new-fungal-superbug-is-worrying-doctors-heres-what-you-need-to-know-172932479.html. 
  33. ↑ "Candida auris: A Drug-resistant Germ That Spreads in Healthcare Facilities". Centers for Disease Control and Prevention. 21 December 2018. https://www.cdc.gov/fungal/candida-auris/c-auris-drug-resistant.html. 
  34. ↑ 34.0 34.1 Richtel, Matt (27 January 2021). "With All Eyes on Covid-19, Drug-Resistant Infections Crept In". The New York Times. https://www.nytimes.com/2021/01/27/health/covid-drug-resistant-infections.html?action=click&module=Top%20Stories&pgtype=Homepage. 
  35. ↑ Jacobs, Andrew (23 July 2021). "Outbreaks of Untreatable, Drug-Resistant Fungus Spread in 2 Cities". The New York Times. https://www.nytimes.com/2021/07/23/health/superbug-fungus-cdc.html?action=click&module=In%20Other%20News&pgtype=Homepage. 
  36. ↑ Richtel, Matt (20 March 2023). "Deadly Fungus Spread Rapidly During the Pandemic, C.D.C. Says". The New York Times. https://www.nytimes.com/2023/03/20/health/candida-auris-us-fungus.html. 
  37. ↑ Roboson, David (21 March 2023). "Strengthening Immunity and Promoting Well-being in the Face of Antifungal Resistance". Ulu Yoga. https://www.uluyoga.com/candida-auris-and-yoga-strengthening-immunity-and-promoting-well-being-in-the-face-of-antifungal-resistance/. 
  38. ↑ Lyman, Meghan; Forsberg, Kaitlin; Sexton, D. Joseph; Chow, Nancy A.; Lockhart, Shawn R.; Jackson, Brendan R.; Chiller, Tom (21 March 2023). "Worsening Spread of Candida auris in the United States, 2019 to 2021". Annals of Internal Medicine 176 (4): M22–3469. doi:10.7326/M22-3469. PMID 36940442. 
  39. ↑ 39.0 39.1 O'Neill, Jim (2016). Tackling drug-resistant infections globally : final report and recommendations.. OCLC 979367942. 

External links

Wikidata ☰ Q26816853 entry



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