Treatment-resistant fungus worries countries

The United States is experiencing an exponential growth in cases, which can lead to death, of contamination by the fungus candida auris. Although present all over the world, the North American situation is worrisome, since, according to a report by the US Center for Disease Control and Preventionthe numbers went from 756 to 1,471 infected individuals in 2021.

“Candida is the name of the fungus, it exists in the body and is part of the colonizing flora: everyone carries it in the body, whether in the gastrointestinal tract, in the intestine or on the skin, it is the flora of the body”explains Max Igor Banks, infectologist responsible for the Reinfection Laboratory of the Hospital das Clínicas of the Faculty of Medicine of USP (University of Sao Paulo).

The difference is that, within the genre candidatethere are several species and the aurissince its discovery in 2009, is quite resistant to existing forms of treatment when the presence of this microorganism becomes a problem.

Resistance

“In certain situations of imbalance, especially when you have associated diseases, surgeries, catheter and intubation, invasive things, can allow these bacteria and fungi that live in the body to pass from a colonizing state to an invasive one”comments the expert.

It is very common to hear that using antibiotics constantly strengthens bacteria, viruses and fungi. In case of candida auris, this is no different. However, this species is already quite resistant: “What was worrying about this fungus is that, until then, there was no Candida species that was as resistant to drugs as this one. We have 3 main types of medicine to treat this and, in general, it is resistant to all 3. This lit a warning signal in the world”says Banks.

He also adds that the lethality of this fungus is around 30% to 60% of cases.

Surveillance

Banks points out who the most susceptible people are: “It is important that people are aware that it is just a spectrum of the situation. There is a concern about a risk in a very particular condition: who is inside the hospital, with many illnesses, needs very intensive medical support and is under pressure to treat several infections. Then it will start to create a condition for this fungus to appear, but even so, it has to exist in people and not everyone carries it”.

Thus, it is necessary to understand the real presence of this fungus, but this is not easy.

“Hospitals, in order to be able to identify people carrying this fungus, invest a lot. There is something called surveillance, you would have to research whether this fungus exists there. You usually do this by trying to find the fungus in the armpit, groin, skin, and even the rectum or mouth itself: places where the fungus can live.”comments the doctor.

But Banks adds that this demands spending on technology to differentiate, for example, the species auris from the albicans –which is natural from the human flora – and also constant surveillance, since the person may not have the fungus and be contaminated in the hospital environment.

“To what extent do I need to monitor this fungus? There are difficulties in knowing the potential size of this problem and researching this in people is a very intensive thing, with a lot of expense. Sometimes, this is not useful at first”completes the infectologist.

There is still no concrete relationship between the influence of covid-19 and the presence of the fungus candida aurisbut Banks gives some possible connections: “A very different thing with covid was a large number of people hospitalized in an ICU condition. [Unidade de Terapia Intensiva]. So, these are people who are very vulnerable and with the wide use of antibiotics. All this may have favored the increase of this fungus in some way inside hospitals”.

As for the Brazilian situation, 3 outbreaks were detected. Banks comments: “It’s risky. We have to stay alert. This is described in all the continents of the world, except Antarctica, so it is something that is widespread and today we know that there is a very large movement of people by air, the world is globalized. It was controlled in Brazil, it is important that people know, but it is in the world as a whole, so vigilance and concern always exist”.

With information from USP Journal.