The Centers for Disease Control and Prevention is sounding the alarm this week about a dangerous fungus that has grown more prevalent in the US since the start of the Covid-19 pandemic, and poses a deadly threat, especially to those hospital.
It all sounds a bit like the setup for the HBO show The last of us, set after a fungal infection has effectively ended civilization. This fungus will not lead to the next pandemic. But its resistance to antifungal drugs, and its rapid spread in the US, is worrisome, and new data from the CDC paint the fungus as an important threat for the health care system to deal with.
So what’s the CDC up to? Here is a brief primer.
What is Candida Auris?
The fungus is known as Candida auris. First identified in 2009 in the ear of a patient at a hospital in Japan, C. auris is a yeast; one of hundreds of yeast species within the genus Candida. It is a cousin to C. albicans, a common yeast that causes infections such as thrush. Other species of Candida can also cause infections, commonly known as candidiasis.
C. auris first appeared in the US in 2016, with some cases appearing in New York City and Chicago. It is now spreading widely across the country, with infections seen in more than half of the states across the US
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The main concern for CDC officials is that most samples of the fungus seen in the US are resistant to some of the drugs used to control fungal infections, and some are resistant to three major classes of antifungal drugs used to fight candidiasis.
How Much Does a Health Threat Do? C. Auris pose?
The fungus is generally not a direct threat to healthy people, but it is often fatal to people who are very sick. The CDC says that people who are seriously ill, people with invasive medical devices such as breathing and feeding tubes, and people in health care facilities are at the highest risk. For these people, the fungus can be serious and often fatal. The CDC said which is 30% to 60% of people with C. auris infections died, though data are limited.
Why Are We Talking About This Now?
CDC scientists on Monday night published a paper in the scientific journal Annals of Internal Medicine in the spread of C. auris in the US from 2019 to 2021.
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Scientists saw a 44% increase in clinical cases in 2019, and a 95% increase in 2021, as the fungus spread to 17 new states. Perhaps the most worrying, the number of cases of C. auris resistance to the most important therapy for candidiasis, known as echinocandins, tripled in 2021.
The actual number of C. auris Cases remain relatively small, but are growing rapidly. CDC experts have counted 3,270 clinical infections since the fungus was first detected in the US The number of cases has grown rapidly, from 765 in 2020 to 1,471 in 2021.
Antifungal resistance is also on the rise, the scientists found. Most samples of C. auris Those tested are resistant to a class of antifungals known as azoles, many are resistant to amphotericin B, and a small but growing number are resistant to echinocandins.
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The number of patients with infections resistant to echinocandins jumped to 15 in 2020, from 2 in 2018. Although only four patients identified before 2020 had infections resistant to all three antifungal classes, there were six patients in 2020, and seven in 2021.
“Although echinocandin resistance is uncommon, the number of cases with echinocandin resistance is slowly increasing, with a significant increase in 2021 and multiple outbreaks of these resistant strains raising concerns about delivery,” wrote the scientist. “Even this mild increase is concerning because echinocandins are the first-line therapy for invasive Candida infection and crowd C. auris infections.”
Why Does This Happen?
The CDC authors say several factors likely contributed to the spread of the fungus, including not identifying cases of C. auris early infection, and lack of infection control measures.
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They say the explosion of cases during the heat of the Covid-19 pandemic may be due in part to the strain the pandemic has placed on healthcare systems and public health infrastructure. While the pandemic has increased attention on some aspects of infection control, the paper suggests that other infection control measures unrelated to Covid-19 are lagging at the time, allowing the fungus to spread in some areas. health care settings.
What Can Be Done to Prevent the Spread of Fungus?
Most cases of C. auris in the US occurs in long-term acute care hospitals, where patients often have extended stays. The authors write that reducing the spread of the fungus will require “investment to improve case detection and infection control, particularly in long-term care facilities.”
The paper’s lead author, a CDC epidemiologist named Dr. Meghan Lyman, told a statement that the spread of the fungus “underscores the need for continued surveillance, expanded lab capacity, faster diagnostic testing, and adherence to proven infection prevention and control.”
Are There Companies That Make Treatments for C. Auris?
Yes, thanks in part to funding from the US government’s Biomedical Advanced Research and Development Authority, announced late last year funding for the development of new antifungals. Biotech Scynexis (ticker: SCYX) is developing a novel antifungal called Ibrexafungerp that can treat C. auris, among other fungal infections. Scynexis shares rose 31.2% on Tuesday. Pfizer ( PFE ) is testing an antifungal called fosmanogepix, a drug it acquired in 2021 in its deal with bought private biotech Amplyx Pharmaceuticals.
Write to Josh Nathan-Kazis at josh.nathan-kazis@barrons.com
