Candida auris - The mysterious drug resistant fungus threatens the survival of all humanity

Last May, an elderly man was taken to the Mount Sinai Institute's Brooklyn branch, to perform a simple abdominal surgery. But when the blood was tested, the doctor discovered that he was infected with a mysterious and deadly bacterium. The man was quickly isolated in the special treatment area.

The scary disease is a fungus called Candida auris , focusing on individuals with weakened immune systems, and in silence, they are spreading to every corner of the globe. During the past 5 years, it has appeared in an infant care unit in Venezuela, attacking a hospital in Spain, forcing a health care center in the UK to stop working, rooting in the ground. India, Pakistan and South Africa.

Just recently, C. auris reached New York, New Jersey and Illinois, prompting the US Centers for Disease Control and Prevention (CDC) to immediately put deadly bacteria into the threat category. emergency'.

The infected man at the Mount Sinai facility died after 90 days of hospitalization, but C. auris did not. Tests showed that it appeared on every surface in the care room, so unpredictable that the hospital had to resort to special cleaning tools, to peel off all the ceiling and walls of C. auris to be able to thoroughly remove it. Fear of scary bacteria.

' Everything is positive for bacteria - room walls, sick beds, doors, window blinds, phones, sinks, white boards, room poles, water pumps ', hospital director Mr. Scott Lorin recount in horror. ' Bed sheets, bed frames, air vents, window lightings, ceilings, everything in the room is positive .'

Part of the scary C. auris reason: it is immune to the major pharmaceutical antifungals available , making it the latest case-study in the long list of factors affecting the health of mankind. . This is the new wave of drug-resistant bacteria .

For decades, health experts have warned of other drug abuse at risk of reducing the effects of drugs, the gods of life-saving drugs at the time of just losing their hands also lost their lives. . But recently, not only bacteria but also fungi have been resistant, making the modern medicine industry more dangerous to worry about.

' This is a serious problem ,' said Matthew Fisher, a professor of fungal disease outbreaks at the Royal College of London, co-author of a study of the emergence of resistant fungi. ' We only know based on the cure with antifungal drugs '.

But even when the top leaders of the health sector repeatedly petitioned to be more strict in prescribing antibiotics, the first step is necessary to combat resistant bacteria and fungi, but clinics, hospitals and Even the livestock sector continues to use bluff antibiotics.

The drug-resistant bacteria are still called 'dear' as a virus , they are not killers, they only attack individuals with weak immune systems or immature bodies. Older people, young children, smokers, obese people and people with autoimmune diseases are the most vulnerable groups.

Scientists warn: if new drugs cannot be found and stop using antibiotics indiscriminately, the virus will spread to a healthy population . A study conducted by the British government showed that if we do not soon prevent the spread of drug-resistant bacteria, 10 million people will die in 2050, more than the number of deaths due to estimated cancer. count.

In the United States, 2 million people suffer from a drug-resistant disease, CDC estimates that 23,000 people die. The above data are based on the results of a survey in 2010, the newer estimates made by Washington University of Pharmacy show that the number of deaths must be up to 162,000. The number of people who have perished worldwide must choke 700,000.

Antibiotics and antifungals are key to human side attacks, but antimicrobial drugs are also indiscriminately used in the livestock industry, antifungal drugs are widely used in farming. Some scientists point out evidence that fungicides used in agriculture have helped resistant fungi find a foothold in modern society.

The problem is increasingly difficult, but the vast majority of us do not understand the nature of the problem and its severity - in part because the disease related to the virus is still covered by many people.

The hospital as well as the local authorities fear that if news is published about the outbreak of disease, people will see places where news originates as the point of spreading disease. Even the CDC is bound by state law, it is not allowed to publish the location or names of the relevant medical facilities. Governments in many places only stop at 'knowing that the disease appears locally', and then refuse to announce the official news.

While people do nothing, bacteria do not sit back and discuss where to attack is most effective; they still spread and were not strictly controlled. They come from the patient's hand and the person who comes into contact with the source of the disease, the utterly unpasteurized medical equipment, from the source of contaminated meat or from the vegetables fertilized with the bacteria. Food carries bacteria along the way, not everywhere, patients from shopping centers bring diseases to the locality.

C. auris, which lived in a man's body at Mount Sinai Institute, is just one of more than a dozen bacteria and fungi that are resistant to the drug.

Candida fungi usually appear when the patient is infected with blood, but other Candida types do not appear resistant to the disease, only Candida auris are monstrous. It is estimated that over 90% of C. auris-related diseases are resistant to at least one drug, about 30% of C. auris is resistant to two or more drugs.

Dr Lynn Sosa, an epidemiologist in Connecticut state, said that C. auris is a leading threat in the fight against drug-resistant bacteria. ' Basically, the disease is incurable and very difficult to detect '.

Up to half of patients infected with C. auris die within 90 days, but the world's leading experts have not identified the source of the scary bacteria.'It is a creature that rose from the black swamp , ' said Professor Tom Chiller, head of CDC's mushroom-related treatment branch . 'At first it was just air bubbles floating up here, and now it has spread everywhere.'

"There is no need for the public to know"

At the end of 2015, Dr. Johanna Rhodes, an infectious disease specialist from the Royal College of London, received an urgent call from the Royal Hospital Brompton, a medical center in London: C. auris appeared at This has been 3 months, but the hospital cannot eliminate it in any way.

"We don't know where it came from." Not even heard of it, it kept spreading like a wildfire, " Rhodes recalled. She agreed to join forces with the hospital, eradicating the evil pathogen.

Under Johanna Rhodes's direction, the hospital staff used a special machine, sprayed on the wall, which once cured C. auris, a hydrogen peroxide disinfectant. In theory, the vapors would creep into every corner, clearing all traces of pathogens, they were careful to run the machine continuously for a week. In the middle of the room, they put a plate containing a special gel, allowing all bacteria that survive the purge to stay.

Only one creature continues to grow in the dish, it is C. auris.

Germs spread, but warnings about it did not. This prestigious hospital is a place trusted by wealthy billionaires, announced to the British government and listed a list of infectious patients, but they did not officially announce the situation of concern.

' There is no need to tell the media about the outbreak, ' said Oliver Wilkinson, a hospital spokesman.

Hospitals all over the world follow this secretive method. National-level organizations are not willing to inform people of a drug-resistant pandemic threatening human survival, arguing: there is no reason to make current and future patients have to fear the hospital.

Dr Silke Schelenz, an infectious disease specialist at Brompton Royal Hospital, immensely inhibited the decision of authorities to make a decision when the outbreak of the disease was still conceived.

By the end of June 2016, a scientific news page mentioned "50 cases of C. auris infection" at Brompton Hospital, at which time the hospital administration offered a countermeasure: closing the resuscitation department in 11 days, transfer patients to another floor and then . no further notice.

Several days later, they confirmed to the press that the hospital had problems with the virus. Immediately, The Daily Telegraph reported: "The emergency recovery room stopped working after the deadly virus appeared in the UK" . These star reports show a total of 72 people infected, but some of them only carry disease on humans, not affected by C. auris.

But the international media did not know anything about the incident; Meanwhile, an outbreak took place in Valencia, Spain, at a 992-bed hospital called Hospital Universitari i Politècnic La Fe . Neither the public nor the uninfected people knew that C. auris had appeared in 372 people, of whom 85 had symptoms of septicemia. Scientific journal Mycoses reported: 41% of infected people died within 30 days.

The hospital declared again: it is not certain that C. auris is the perpetrator of the dead.'It is very difficult to determine whether the patient died from the pathogen, or the death of the pathogen, because at the time of their last breath, they are suffering from serious illnesses' , the hospital announced officially. .

Like the Brompton Royal Hospital, the hospital in Spain did not release the outbreak. The author of the paper on Mycoses, a doctor at the institute, said that the management did not want the doctor to contact the media, because they were worried about the hospital image in the eyes of the residents.

Keeping the secret to the lawyers representing the extremely angry patients, they said the patient had the right to know of an outbreak of the disease in progress. They can freely decide whether to continue the surgery at the hospital, especially if the patient has an advance surgery appointment, the surgery is not endangered.

'How the hell do we have to read the news for a year and a half, not on the first page on the day the disease was discovered? 'Dr. Kevin Kavanagh, president of the US non-profit organization Health Watch. ' You won't sit still if the same thing happens with a restaurant with food poisoning '.

Authorities believe that the announcement of the outbreak will make patients more worried about things that they cannot help, especially when the risk of disease is still unclear.

Officials in London also contacted the CDC, reporting the outbreak at the Brompton Royal Hospital. CDC found that it was necessary to inform early hospitals in the US; June 24, 2016, CDC issued a nationwide warning, set up email address [email protected], entrusted the responsibility to approve mail for Professor Snigdha Vallabhaneni, a key member of the mushroom-related disease team. They predict that 'a few months will be sent to a mail '.

They were surprised to see that the mailbox was constantly being "bombarded" by reports of deadly pathogens.

Plague comes to "promised land"

In the US, reports from the CDC show a total of 587 cases of C. auris infection, of which 309 were in New York, 104 in New Jersey and 144 in Illinois.

Symptoms of fungal infection are nothing special - just a fever, body aches, feeling exhausted - but once infected, especially with patients who are not in good condition, common symptoms can be take away human life.

The earliest fungal infection ever recorded in the US was on May 6, 2013, a woman was hospitalized with difficulty breathing. The 61-year-old woman, from the United Arab Emirates, died only hours after being diagnosed with C. auris infection. At the time of the patient's death, the doctors did not ask too many questions, but when the CDC issued a national warning, they sent the disease to the US Centers for Disease Control and Prevention.

It has spread to extended health care facilities. According to a CDC report, in Chicago, 50% of people live in nursing homes infected with C. auris. The baseline survey showed that C. auris developed in the building's airways.

Health care professionals for C. auris infected people worry when they hear about the scary fungus. Dr. Matthew McCarthy, who has been involved in treating some patients with C. auris infection at New York's Weill Cornell Medical Center, described the fear he rarely faced.

'I didn't want to touch the patient,' he said. 'I don't want to bring the disease from them and then transmit it elsewhere'. He still fulfilled his duty, but added: 'The fear encompasses me, worried that the pathogen will cling to the clothes on me.'

What role does pesticides play in the spread of C.auris?

CDC still does everything it can to prevent C. auris from spreading, those who investigate deadly fungi are still trying to answer the unanswered question: Where does C. auris come from?

The first time the doctor met C. auris was in 2009, it was hiding in the ears of a Japanese woman (Latin auris means 'ears'). At that time, the disease was not difficult, just a common dose of antifungal drugs.

Three years later, it appeared in the laboratory results of Dr. Jacques Meis, a Dutch microbiologist, between blood samples taken from 18 patients with septicemia at a hospital in India. . In the following months, C. auris fungi appeared in other parts of the world.

CDC researchers hypothesize: C. auris comes from Asia and spreads globally. But when they compared C. auris' genetic samples from India, Pakistan, Venezuela, South Africa and Japan, they found that the origin of the mushroom did not come from these countries, because the samples obtained were not just one single gene sequence.

Without final results, the researchers still make hypotheses about the emergence of C. auris, wishing to find links to existing facts to draw conclusions. Dutch researcher Dr. Meis believes that thanks to the use of blameless fungicides in cultivation, resistant fungi find their way of development.

For the first time, Mr. Meis noticed the resistant fungus, the case of a 63-year-old patient in the Netherlands who died in 2005, infected with a fungus called Aspergillus. Evil mushroom resistant to itraconazole, effective fungal treatment is widely used. This drug is an incomplete copy of zole pesticide, which is widely used in animal husbandry, which must account for about 1/3 of the marketable fungicide sold.

In 2013, a scientific report published in Plos Pathogens wrote that it was no coincidence that Aspergillus resistant fungi appeared in the widely used azole fungicide area. This fungus appears in 12% of the soil samples analyzed in the Netherlands,

Dr. Meis came to CDC last year to share the research he had done, hypothesized: the same thing happened with C. auris, the fungus also appeared in the soil a lot; Azole has created an environment that is difficult to live with fungi, forcing them to evolve to survive, resulting in drug-resistant fungi that survive the pesticide and fungal bombardment.

This story is similar to the way antibiotic resistant bacteria appear: it is also due to abuse of antibiotics in livestock, not far away. People who apply azole on crops are no different from cattle and poultry with antibiotics. Not taking into account the use of antibiotic-filled feces of animals to apply to the fields and gardens.

Dr. Chiller also hypothesized that C. auris benefits from uncontrolled use of fungicides. According to him, C. auris has existed for thousands of years, but they are not creatures that tend to attack other species. But because azole destroyed a huge amount of mushrooms, C. auris has space to grow. The fungus that is now resistant to the drug has no longer had to compete with the fungi that are being gradually eliminated by drugs.

The mystery encompassing C. auris still has no answer, but it doesn't matter anymore: at the present time, we need to focus on preventing C. auris from spreading.

Last spring, Miss Jasmine Cutler visited a 72-year-old father who was nursing at a health care center in New York; The old father had to be hospitalized due to events after surgery.

When she arrived at the hospital room, she saw the father sitting there with waste pants: nobody helped the 72-year-old patient to go to the bathroom. At that time, Miss Cutler broke down, no one dared to help her father because the blood test showed that the patient had C. auris in him.

' I see doctors and nurses watching from the window, ' Miss Cutler said. ' My father is not a test subject. You can't treat him like a circus monster . '

The old father was also discharged from the hospital, diagnosed as not carrying C. auris. However, he refused to reveal his identity, fearing that people would think he could still carry a horrifying mushroom.