It's the end of the world as we know it and I feel fine.

 Birthday party, cheesecake, jellybean, boom. Thank you R.E.M. for a nice little ear worm. Here is a short post, and before you say anything, no I have not seen the last of us. I can’t sit still for more than 10 minutes. But I do find apocalyptic fungi pretty interesting. 

Candida is the most common pathogenic yeast in humans. Insert witty joke about bread consumption here. It is also found in our guts and is probably most well known for thrush in immune compromised persons and genital yeast infections with antibiotic use.  

Candidiasis is a not uncommon occurrence and cutaneous manifestations are quite ubiquitous. For the skin infections topical antifungals are generally sufficient. For candidemia, oral antifungals are required and may need courses from 2 weeks to lifelong therapy depending on the circumstances and source. 

Ok but I want to talk about a recent article about C. auris and some of implications. Though for us laypeople this may be new, it really isn’t but the news media won’t say anything unless they can make a catchy name like “unbeatable resistant fungi is the ‘Mike Tyson’ of fungi, the Rocky Balboa of mycoses, the tsar of yeast”.

Of note, this species, first officially isolated in 2009, is extensively drug resistant. Probably because it never listened to its parents and stayed away from the “bad boy” fungi in high school. A retrospective analysis of fungal samples in Japan did find a case from 1997 however. From Sharma & Kadosh “Overall, about 90% of C. auris strains have acquired resistance to at least 1 drug, 30% to 41% are resistant to 2 drugs and about 4% are resistant to all 3 antifungals (fluconazole, amp B, and echinocandins).”

Aside from the resistance, we only have 4 classes of antifungals to rely on. So proper stewardship is needed to prevent more resistance in C. auris and other pathogenic fungi. Surveillance is the next piece. In the same article quoted above, it outlines the widespread nature of the yeast. It kinda sounds like MRSA, plenty of people have it, but only those with higher risk (immune suppression and all that) get invasive disease. So transmission isn’t unlikely. 

The signs and symptoms also mirror that of bacterial infections, except there is no improvement on antibiotics. How often do we think of fungi when people come in to the clinic or hospital? I was saved by a doc who did think of it when I was younger and had unexplained SOB. They thought to check for blasto and bingo, they found it. Often patients I see who are at risk for opportunistic infections are on prophylactic fluconazole, what if it’s this resistant yeast? The patients to watch for may have a central catheter, immunosuppression, diabetes, CKD, concomitant bacteremia or fungemia, among others. 

Amp B is too toxic for long term use most of the time. And the echinocandins are hella expensive. Any ideas? 

I’m currently posting on antibiotics but will throw in some fungi posts to keep my interests sated. Peace out and watch out for the yeast. Does this mean no more bread? Personally a fan of sourdough myself. 

References

Candida Auris from StatPears at the NIH: National Library of Medicine by Sikora, Hash, and Zahra in 2023. 

Emergence and circulation of azole-resistant C. albicans, C. aurisand C. parapsilosis bloodstream isolates carrying Y132F, K143R or T220L Erg11p substitutions in Colombia from Frontiers in Cellular and Infection Microbiology by Ceballos-Garzon et al. in March 2023. 

Image of C. auris from the Wikipedias.

On the Rise, Candida auris Outwits Treatments and Travels Incognito in Health Care Settings from JAMA Network by R. Rubin in December 2022. 

Perspective on the origin, resistance, and spread of the emerging human fungal pathogen Candida auris in PLoS Pathogens by Sharma and Kadosh, March 2023. 

The Infectious Disease Puscast by Drs. Griffin and Dong, episode 24 from March 21, 2023.