U.S. health officials said Thursday they have evidence of an untreatable fungus spreading in two Dallas-area hospitals, according to the Centers for Disease Control and Prevention.
The fungus, Candida auris, is a harmful form of yeast that is considered dangerous to hospital and nursing home patients with serious medical problems. It is most deadly when it enters the bloodstream, heart or brain. Outbreaks in health care facilities have been spurred when the fungus spread through patient contact or on contaminated surfaces.
“It is a very serious infection, and if it’s in the bloodstream, it can infect all of the organs and cause multi organ failure,” said Dr. Beth Kassanoff-Piper, president of the Dallas County Medical Society. “If it infects the brain, it can certainly cause a brain infection that can make people comatose. It’s very dangerous. It’s deadly.”
Officials have not publicly identified which two hospitals have been affected. Out of more than 20 cases, two patients at the Dallas-area hospitals had invasive fungal infections that were impervious to all three major classes of medications.
“These organisms are smart; just like COVID, it creates new variants. These other organisms can create resistance to the treatment options we have. And some of these funguses are far more likely to develop resistance than others are,” Kassanoff-Piper said. “And this particular strain is one that has very commonly developed resistance.”
In past cases, when patients have been resistant to drugs used to treat the infection, scientists concluded the resistance to the drugs formed during treatment. In this case, the health officials said the fungus did spread from person to person.
“This is really the first time we’ve started seeing clustering of resistance” in which patients seemed to be getting the infections from each other, said the CDC’s Dr. Meghan Lyman.
“When we see clusters of patients, in the same facility, with the same resistance pattern, it’s more likely that that is an infection that’s been spread from person to person,” Kassanoff-Piper said.
Just because Candida auris is resistant to multiple drugs, it doesn’t necessarily mean there is no way to treat it, Kassanoff-Piper said. Doctors can use a combination of different antifungals, at the same time, to treat it. The difference is, if the patient didn’t have any resistance, just one of the antifungals that’s available would likely get rid of it, she said.
But the general public does not need to worry, Kassanoff-Piper said.
“It is a fungus that really can cause problems in people who have a lot of underlying health conditions,” she said.
It is really a concern for those who are severely ill or have chronic medical conditions where they need long-term care, Kassanoff-Piper said.
Elderly people could also be at a higher risk even if they have no underlying health issues.
If you are going to visit someone in the hospital who may be at greater risk of getting the fungus, be diligent about washing your hands, Kassanoff-Piper said.
Trish Perl-DeLisle, chief of infectious diseases at UT Southwestern, said that while the general public is not at great risk of contracting the infection, it is important for people to understand that the fungus is an “incredibly sticky” pathogen that stays in the environment. This makes it easy to contaminate people who are at a greater risk of becoming infected, and resistance is becoming more frequent.
“Because people can have this bacteria on their skin and not have any signs or symptoms, it makes it easy to spread. People can easily contaminate the environment with it,” said Dr. Diana Cervantes, director of the UNT Health Science Center’s epidemiology program..
An outbreak of the “superbug” also has been reported in a Washington, D.C, nursing home.
A cluster of 22 cases in the two Dallas-area hospitals included two with resistance to all medications, the CDC said. Those cases were seen from January to April. Out of five people who were fully resistant to treatment, three died — two Texas patients and one in Washington.
Lyman, with the CDC, said both are ongoing outbreaks and that additional infections have been identified since April. But those added numbers were not reported.
“We’re definitely seeing clusters of these cases because there has been some type of a break in the infection control procedures,” Kassanoff-Piper said, adding, “This is one of the reasons it’s so important to have good infection control in hospitals to prevent spread from person to person, of all kinds of things.”
Kassanoff-Piper said to fix the break in the infection control procedures, hospital staff and visitors need to “redouble” their efforts to be extremely cautious. Infected patients are moved to an isolation situation where the rooms are cleaned more diligently, and their caregivers wear gowns and gloves that are disposed of when leaving the room, she said.
There are several reasons for the apparent rise in Candida auris cases. In January, Candida auris became a Texas notifiable condition, according to the Texas Department of State Health Services. Since then, more cases have been reported.
Now that it is reportable, there is more surveillance of it. And more invasive procedures and medical tourism have increased the chances of an infection like this to occur, Cervantes said.
There have also been some outbreaks of the fungus in COVID-19 specialty care units.
Cervantes said COVID-19 patients who end up needing long-term care or are put on ventilators have an increased risk of contracting the fungus. She said critical COVDI-19 patients are often placed in a prone position , are attached to invasive lines and may need invasive procedures. These factors put patients at a higher risk for having infections
“So, in that case, you’re going to see more Candida type infections,” Cervantes said.
The best way to stop transmission of the fungus it to “gown up,” “glove up,” and “wash your hands,” said Morvarid Rezaie, an internal medicine physician with TCMS.
“Individual public health and hospitals have to be vigilant ambassadors of best practice so we don’t continue to have environments that are going to produce these organisms,” Perl-DeLisle said.
The most common symptoms of the fungal infection are a fever and chills that don’t improve after antibiotic treatment, according to the CDC. Lab tests are needed to confirm the diagnosis.