fungus Candida auris has disproportionately affected New York
health care facilities, raising questions about its origins,
whether it’s here to stay and which health care facilities
have been impacted by it.
There have been
319 confirmed cases and four probable ones statewide since the
fungus, known as C. auris, was identified in New York two
years ago. The four probable cases are undergoing further
testing at Wadsworth Center, the state laboratory in Albany.
More than 600 instances of the infection have been diagnosed
The microbe can
be carried on the bottom of shoes, clings to surfaces in
hospital rooms, flourishes on floors, and adheres to
patients’ skin, phones and food trays, health officials
said. It also is odorless and invisible.
hospitals be identified that have had cases of the fungal
A: Not without
extraordinary difficulty. Although the state Department of
Health indicated that nine cases and two deaths involving C.
auris occurred in Nassau County, representatives for the
majority of the acute care hospitals in Nassau told Newsday
they have had no cases of the fungus from 2017 through this
month. South Nassau Communities Hospital did not respond to
Newsday’s query. The state Health Department will not
disclose the names of the institution or institutions where
the cases were confirmed.
Q: What is drug
resistance is one of the biggest health threats facing
communities worldwide today. It means that infections can no
longer be easily treated with available drugs. In some
instances, infections can’t be treated at all. Drug
resistance occurs when organisms are overexposed to the
medications used to destroy them. Overexposure forces
pathogens to develop mechanisms to thwart the drugs. An
example of overexposure is the use of human antifungal drugs
in floriculture. The medications are used on flowers,
particularly tulips, with the aim of preventing fungal damage
on the plant. But overexposure causes fungi to develop
mechanisms to repel the medications and pass along that
ability to its offspring.
Q: Is the
misuse of antifungal drugs the only problem doctors have in
treating C. auris infections?
A: No. Big
Pharma largely has abandoned research and development on new
antimicrobial agents, drugs that treat both fungi and
bacteria. Some doctors fear we are on a path in which
pathogens have become impervious to many existing medications.
This is called multidrug resistance.
Q: Sen. Chuck
Schumer (D-N.Y.) has called on the Centers for Disease Control
and Prevention to declare C. auris a public health emergency
in New York because more than 300 cases have been confirmed
here, the majority of those diagnosed nationwide. Will this
A: If the CDC
makes the declaration, New York becomes eligible for millions
of dollars in federal emergency funds. The senator hopes such
funding might be used to develop a diagnostic that improves
doctors’ ability to rapidly diagnose C. auris infections.
Current diagnostics can confuse C. auris with other Candida
subspecies. Funding also can be used to develop public health
campaigns to raise awareness about the fungus, Schumer said.
Q: Why is C.
auris considered a threat? Is it more serious than other
pathogens that affect medical facilities?
A: Dr. Tom
Chiller, who heads the CDC’s fungal diseases division,
defines C. auris as an emerging multidrug-resistant pathogen,
which means it has been recently identified in human
populations and repels most — and on rare occasions — all
drugs used against it. The pathogen affects the sickest of the
sick. C. auris was first diagnosed a decade ago in Japan.
Within that time, it has been diagnosed worldwide. The
pathogen joins other emerging, multidrug-resistant infectious
agents, the majority of which are bacterial. Multidrug-resistant
infections of all kinds are difficult and sometimes impossible
Q: Is C. auris
A: Dr. Matt
McCarthy, a specialist in fungal diseases at Weill Cornell
Medicine in Manhattan, said combinations of current antifungal
drugs can cure the infection in patients. However, the death
rate is high — about 35 percent — studies have shown. Two
patients died in New York City last month because their
infections were “pan resistant,” which means the fungi
repelled every drug that doctors used.
Q: Is anyone
working on a cure?
efforts are underway to address C. auris. For example, fungal
expert Dr. Maurizio Del Poeta, of Stony Brook Renaissance
School of Medicine, is working on a treatment, which is being
tested in animal models. In New Jersey, a biotech company,
Scynexis, is sponsoring clinical testing of a C. auris-specific
Q: Have other
pathogens spread around the world like C. auris?
A: Yes, many.
The pattern has been most frequently associated with bacteria.
C. auris is the first fungus to exhibit this tendency. MRSA,
which is a bacterium, was the first to show it, emerging in
the early 1960s in multiple sites worldwide. MRSA stands for
Methicillin-Resistant Staphylococcus Aureus. The bacteria bear
the name “methicillin-resistant,” which signifies the
first antibiotic it repelled. But MRSA thwarts numerous
antibiotics. Another threat, so-called “nightmare
bacteria,” or carbapenem-resistant Enterobacteriaceae,
emerged in the early 2000s and has become a significant
multidrug-resistant infection worldwide.
Q: How do
are moved around the world through human travel, the transport
of infected animals and contaminated crops. But this is
exacerbated by biological mechanisms within the organisms
themselves. For example, C. auris has developed biological
pumps that allow it to force out antifungal drugs that flow
into it. Bacteria, on the other hand, have multiple methods of
resistance, but also are transported globally by human travel
and the transport of infected animals.
Q: Why did
major pharmaceutical companies abandon antimicrobial drug
A: Most major
pharmaceutical companies left research and development for
these drugs years ago because the return on investment is low.
The drugs, which cost pennies per dose, are not moneymakers
for pharmaceutical companies as are cancer medications. For
example, cancer drugs can run hundreds of thousands of dollars
for a year of treatment, even though they do not improve the
condition or significantly extend life. They do, however,
attract investors and bolster Big Pharma’s profits.
— C. auris,
as it is known, became entrenched in New York about eight
years after its initial detection in Japan in 2009. Doctors
there isolated the microbe from a patient who had an ear
infection. However, studies in South Korea of archived
biological specimens suggest C. auris may have been evident in
that country as early as 1995. “Auris means ear in Latin,”
said Dr. Maurizio Del Poeta of Stony Brook University, noting
how the fungus got its name. How it became the source of a New
York outbreak is still a matter of debate.
scientists posit that C. auris spread around the world after
its discovery in Japan. Others, such as Del Poeta, suggest
simultaneous infections that began globally, all around the
— The microbe
clings to surfaces in hospital rooms, flourishes on floors,
and adheres to patients’ skin, phones and food trays. It is
odorless and invisible.
— C. auris
can cause lethal bloodstream infections in people with
weakened immunity, which include organ transplant recipients,
anyone with cancer, HIV/AIDS or other forms of immune