Coronavirus could fuel the antibiotic-resistant infections caused by the super fungus Candida Auris (yeast). This news spread like wildfire after a report published in the Journal of Fungi on 17 March 2021. The research was led by Arnaldo Colombo, head of the Special Mycology Laboratory at the Federal University of São Paulo (UNIFESP). He and his co-workers observe that it spreads because of the overcrowding of the hospitals during the era of COVID-19. Thus, the current COVID-19 may provide an ideal condition for the growth of this superbug.
Researchers began to inform the people about the bad condition when the Brazilian doctors confirmed a rapidly spreading potentially lethal fungal infection caused by Candida Auris. Thus, there was a sudden rise in this invasive antibiotic-resistant infection, particularly in the patients with COVID-19 treated in the hospital.
Additionally, the US has also reported an increased number of drug-resistant C. Auris confirmed cases throughout the pandemic. According to the Centers for Disease Control and Prevention (CDC), the outbreaks of antibiotic-resistant infections may be due to the change in infection control standards. They include an insufficient quantity of medical coats and gloves or their reuse. Another reason for the outbreaks is the modified practices of disinfection and cleaning. Unfortunately, the running disinfection practice is not sensitive to Candida Auris.
What is Candida Auris?
Candida Auris is one of the fetal superbugs. This pathogen can cause severe conditions of infection that could ultimately cause the death of the infected person. In addition, it is also capable of evading the antibiotic made to destroy it. The species colonizes the skin of the patient.
According to the expert, the current COVID-19 pandemic may thrive the infections caused by this dangerous superbug in the hospitals. The prominent appearance of cases in the hospital setting is the over flooding with hundreds of people.
These superbugs are very sticky. They can stubbornly adhere to several solid surfaces, such as doors, bed railings, sheets, and medical devices. It makes the fungus easier to colonize the skin of the affected person. Additionally, it can easily transmit from one person to another.
As the fungus can easily stick on medical devices, the patients who are using this equipment are at the highest risk for getting its infection. These devices could be the tiny tube going inside the blood vessels (such as catheters) or for feeding or breathing purposes. As the patients with COVID-19 get respiratory failure in the late stages of viral infection, these invasive medical procedures are often used for Coronavirus patients. Thus, they are at high risk during the late stages.
How did the outbreaks of antibiotic-resistant infections spread in Brazil?
In December 2020, Brazil confirmed its first two cases with the Candida Auris infection at a hospital in Salvador State. Since then, there is a high alert to fight against this emerging fungal infection.
The first outbreak of this fungal infection was reported in 2016 in a South American country, Venezuela. Soon after, it spread to Colombia, Chile, Panama, and the US. However, until December 2020, Brazil never reported any confirmed case. Shortly after the second wave of COVID-19, the outbreaks started from the northeast region of Brazil, that is, Salvador.
Colombo and his colleagues identified C. Auris in the samples taken from the patients of the first two confirmed cases. He diagnosed both of them in an intensive care unit of COVID-19 at the hospital in Salvador. Furthermore, nine other new cases were also reported in the same hospital with the asymptomatic colonization by this super fungus.
C. auris is highly susceptible to the antifungal drugs
Colombo reported in his research paper that this fungus is still very susceptive to many antifungal drugs. Additionally, they have also noticed a quick increase in the resistance of this super fungus to most of the widely used drugs in the patients. These antifungal drugs include fluconazole and others belonging to the echinocandins class.
They tested it by increasing the doses of these drugs to inactivate the C. Auris in hospital samples. That is the reason behind the persistence of species in hospitals that result in the colonization on the skin of health workers and other infected patients with COVID-19.
The infection has a high mortality rate
Colombo and his co-workers informed that several fungi of the same genus (Candida) are part of the human body. For example, they are present as symbiotic organisms in the human gut microbiota and may only cause illness when not balanced. They further added that C. Auris could cause wounds, candidemia (bloodstream infections), and ear infections in patients.
The mortality rate of C. Auris infection is high, and it can reach up to 30 to 60%. Unfortunately, the surviving patients also identified with other life-threatening problems. According to the estimated value, more than 50% of the superinfected patients by C. Auris, also in critical condition with COVID-19, have a 30-day mortality rate.
Before the pandemic, the infection only affected long-term patients in Brazil. Right now, the condition has changed. C. Auris has been observed in the COVID-19 patients since the beginning of the pandemic.
After Brazil, the United States also has reported an increased C. Auris infections. Meghan Marie Lyman is a researcher at the CDC in the Mycotic Diseases Branch. According to her, the cases are also appearing in those areas where they did not report previously. The hot spots areas of the U.S. where the outbreaks have gone on included New York State, California, and Illinois.
Ideal conditions for fungal spreading
According to the experts, the COVID-19 pandemic makes ideal conditions for spreading all antibiotic-resistant infections, such as C. auris, C. albicans, and mucormycosis (in the case of India).
Dexamethasone is a steroid used to treat severely ill patients with COVID-19 at the beginning of the pandemic. However, this compound also has some side effects, including a suppressed immunity to other infections.
Furthermore, Dexamethasone works like a broad-spectrum antibiotic that is helpful to treat multiple types of infections. But, unfortunately, these types of antibiotics also kill symbiotic bacteria that live on the human skin and in the gut. These symbiotic bacteria fight with the entering fungi and bacteria to resist their infections.
With the help of a medical device, catheters (a thin tube used for surgical purposes), doctors allow C. Auris stains to enter the urinary tract and bloodstream. And, it causes vaginal yeast infection and invasive candidiasis, known as candidemia, respectively.
According to the evidence, COVID-19 also causes damage to the intestinal mucous lining. As a result, it makes way for the fungus to enter the bloodstream. Due to the worsened response of the immune system and the invasion of C. Auris to the bloodstream, it may cause the failure of several organs in the COVID-19 patients.
Protective measures for antibiotic-resistant infections
Lyman said that cleaning standards and protective measures could be the main reason for spreading this fungus. In July 2020, CDC’s researcher advised using the multiple layers of PPE (personal protective equipment) during the pandemic in its report of an outbreak in Florida.
Lyman further added, some new cases of C. Auris are also observed without any links to the reported one. This data suggests an undetected transmission of disease throughout America.
According to her, regular screening of long-term patients and healthcare facilities for the colonization of C. Auris could decrease its spreading. But, unfortunately, the resources are limited right now, as they have been diverting to respond to COVID-19 since the start of the pandemic.
Reasons for spreading
In 2009, C. Auris was first diagnosed in Japan. Since then, infections have been spreading to more than 30 other countries. One of the main reasons for C. Auris spreading could be using specialized, very expensive laboratory equipment. This equipment is necessary to differentiate C. Auris from the other infections of the same genera, Candida.
Additionally, most of the stains of this genera are susceptible to echinocandins. As a result, even some strains resist all three leading classes of antifungal drugs. Another reason is the limited treatment options for these antibiotic-resistant infections, Dr. Lyman said in his report.
Experts suggested that the actual number of infected cases with this infection is beyond our expectations. That is because many cases have been reported without any symptoms so far. The fungus may be the contributor to the tens of thousands of deaths happening during this pandemic.
Doctors around entire America are sounding the alarm after the outbreak of a relatively new super fungus in Brazil. According to health experts, COVID-19 could fuel this dangerous condition worldwide. The reason behind this is the over flooding of the hospital, where it can spread quickly during this pandemic era. That is why Brazilian doctors seem that the overcrowding of people in the hospital setting will open the door for spreading and emerging antibiotic-resistant infections. This super fungus is known as Candida Auris (yeast). The problem is that it shows a quick resistance against most antifungal drug classes, reported in a research paper published in the Journal of Fungi.