A dangerous, drug-resistant fungus has been making headlines as it spreads at an alarming rate in the U.S. in recent years.
Known as Candida auris, the fungus that can lead to potentially deadly infections has tripled in case numbers over the last three years, and more than half of U.S. states have now reported it, a new study from Centers for Disease Control and Prevention researchers found.
The increases, “especially in the most recent years, are really concerning to us,” the study’s lead author, Dr. Meghan Lyman, chief medical officer in the CDC’s Mycotic Diseases Branch, said in an interview with NBC News. “We’ve seen increases not just in areas of ongoing transmission, but also in new areas.”
The study was published Monday by the Annals of Internal Medicine.
Data from the CDC shows that Illinois was among the states with the highest number of reported cases through the end of 2022, joining just five other states in reaching between 100 and 500 cases.
But what is the fungus and what do you need to know?
What is Candida auris?
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The fungus, Candida auris, is a form of yeast that is usually not harmful to healthy people but can be a deadly risk to fragile hospital and nursing home patients. It spreads easily and can infect wounds, ears and the bloodstream. Some strains are so-called superbugs that are resistant to all three classes of antibiotic drugs used to treat fungal infections.
"Not surprisingly, the spread of these organisms that can be very hard to treat or are drug resistant or can spread in health care," Chicago Department of Public Health Commissioner Dr. Allison Arwady said. "We've seen some more of that and so, now, many, many more states are seeing Candida Auris."
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The yeast can lead to infections in the bloodstream, in wounds or in ears.
"This yeast often does not respond to commonly used antifungal drugs, making infections difficult to treat," the CDC's website states. "Patients who have been hospitalized in a health care facility a long time, have a central venous catheter, or other lines or tubes entering their body, or have previously received antibiotics or antifungal medications, appear to be at highest risk of infection with this yeast."
How is Candida auris spread?
Candida auris is most often spread in health care settings via contact with contaminated surfaces or equipment, according to the CDC, though it can also spread from person to person.
"More work is needed to further understand how it spreads," the CDC reports.
Why is Candida auris dangerous and can it be fatal?
While the fungus can be treated with certain antifungal drugs, some infections have grown resistant to all three classes of medications, "making them more difficult to treat."
Some infections can be fatal, and the CDC reports limited data has shown 30-60% of people with such infections have died, though many of those individuals also had other illnesses that increased their risk of death.
"It can be really serious, especially in people who are immunocompromised on ventilators, really ill in hospitals," Arwady said.
Should Illinoisans be worried?
Chicago's top doctor discussed the news Tuesday during an unrelated Facebook Live, saying it's a "real concern." She noted, however, that Illinois may be better prepared for such a rise than others.
"The good news is that while there's been a lot of focus on Candida Auris -and there should be, it's a real concern - we are known here in Chicago, in Illinois as being one of the places that detected it early, has put a lot of resources into controlling it and, even during COVID, have managed to keep it under reasonably good control from a spread perspective," Arwady said.
What could be behind the rise in cases?
According to the study and Arwady, the COVID-19 pandemic likely drove part of the increase as hospital workers were strained by coronavirus patients, which likely shifted their focus away from disinfecting some other kinds of germs.
"So during COVID, where there was a lot of stress on the health care system ... there may have been some more reuse of personal protective equipment early on where those supply chains were disrupted," Arwady said. "We've seen a lot of other things take priority."
When was the fungus first identified in the U.S. and where do things stand now?
The fungus was first identified in Japan in 2009 and has been seen in more and more countries since. The first U.S. case occurred in 2013, but it was not reported until 2016. That year, U.S. health officials reported 53 cases.
The new study found cases have continued to shoot up, rising to 476 in 2019, to 756 in 2020, and then to 1,471 in 2021. Doctors have also detected the fungus on the skin of thousands of other patients, making them a transmission risk to others.
Many of the first U.S. cases were infections that had been imported from abroad, but now most infections are spread within the U.S., the authors noted.
Arwady said Illinois was among the states hit hardest during the fungus' introduction in the U.S.
"When Candida auris was really identified as a significant health care threat, it actually was in New York and in Illinois, where we first had some of the detection in place and some of the work to very intensively work in our high-risk settings to limit that spread, make sure it's being recognized and treated," Arwady, who worked with the CDC and Illinois Department of Public Health at the time, said.
What else should you know?
Post-COVID fungal infections, though rare, have been reported during the pandemic, particularly in those with compromised immune systems.
"So it's very rare, but it has been described," Dr. Kamal Singh, chair of microbiology and virology at Cook County Health, told NBC Chicago last month. "And in essence, where we have seen it is in the very sick patients who have been treated with very heavy doses of immunosuppressive drugs."
The Centers for Disease Control and Prevention noted that "COVID-19-associated fungal infections can lead to severe illness and death."
"COVID-19 likely increases the risk for fungal infections because of its effect on the immune system and because treatments for COVID-19 (like steroids and other drugs) can weaken the body’s defenses against fungi," the CDC states.
The news of rising infections, however, comes amid concerns over the spread of another fungus, and amid heightened awareness following the popularity of the hit show "The Last of Us."
According to a recent study, "a fungal disease endemic to the southwestern United States" known for causing what is known as valley fever, is projected to spread east over the next several decades due to warming temperatures.
"I think we definitely have our radar on the fungi. I can tell you that several years ago, it was less of a priority, but just last year, I want to say even the [World Health Organization] stepped up and said, 'You know what? We have to keep our eyes out on it,'" Singh said. "So they released a report in 2022 and said that, you know, we have a list of these fungi and and we should, you know, keep a lookout for them. ... So I I think there's much more attention being paid to the fungi."
The WHO report highlighted the "the first-ever list of fungal 'priority pathogens.'"
“Emerging from the shadows of the bacterial antimicrobial resistance pandemic, fungal infections are growing, and are ever more resistant to treatments, becoming a public health concern worldwide” Dr. Hanan Balkhy, WHO assistant director-general for antimicrobial resistance, said in a statement.
