The pandemic may favor the reappearance of the dangerous super fungus candida auris

Thanks to the coronavirus epidemic and the attention entirely focused on the emergency, the lethal superfungus Candida auris reappears with cases for the first time in Brazil. What we know about the pathogen, a threat also for the future

Computer illustration of the unicellular fungus Candida auris, discovered in Japan in 2009 (photo: Kateryna Kon / Science Photo Library) The pandemic could be complicit in the new appearance of the lethal superfungus Candida auris, discovered just over 10 years ago, which fortunately has caused sporadic episodes so far. Two new cases of this very serious infection, which appeared in December 2020 in Brazil, have just been documented by researchers from the Federal University of Sao Paulo (Unifesp). The first two cases were detected in a hospital in Salvador, in the state of Bahia, and the clinical history of the patients was studied by a research group coordinated by Arnaldo Colombo of Unifesp. The results are published in the Journal of Fungi. Patients were hospitalized in Covid-19 wards: hence the possible link. The alert on Covid-19 from healthcare personnel around the world is very high and operators and hospitals are overloaded. The scientists' hypothesis is that patients with severe Covid-19 may be more susceptible to developing fungal infections from Candida auris, hitherto silent, a pathogen that they may have been exposed to previously and lived with. What we know about the super mushroom and why it is good to keep your guard up.

A brief history of the superfungus

The name certainly reminds us of something else: the superfungus Candida auris in fact belongs to the genus Candida, some of which we know well some non-dangerous species, such as Candida albicans, with which it has nothing to do. But candida auris is quite another thing: the superfungus is associated with a high lethality, which also affects more than half of the cases, and fortunately few episodes are known worldwide. The threat lies in the fact that it is a novel pathogen and resistant to the main categories of antifungals. The earliest strain of auris was photographed in a 1996 retrospective study from South Korea, while the first actual human case was identified in 2009 in Japan, in the ear (hence the name auris, which in Latin means precisely ear). There have also been cases in the United States, where the first infection dates back to 2013.

Image obtained with a fluorescence microscope showing the structure of Candida auris (photo: João Nóbrega Almeida Júnior / Unifesp)

The danger of Candida auris

The superfungus can be present in the blood and cause systemic infections that are very harmful to the body. The risk is therefore not that of a simple local candida but of an invasive and generalized candidiasis, similar to the bacterial sepsis that scares us so much. The other problem is According to the evidence gathered so far, about 60% of people affected by this fungus die.

Infections in hospital

Patients affected in Salvador, Brazil , they were both hospitalized in Covid-19 intensive care wards. The topic of hospital infections is gaining increasing attention and in some way, even if it seems paradoxical, advances in medicine and technologies could play a role, a bit like the other side of the coin. Faced with the undisputed benefit against various pathologies, the use of latest generation therapies and devices, in fact, could lower the body's defenses, favoring its attack by various pathogens, including these fungi. For example, we are talking about drugs such as corticosteroids or antibiotics, often also used in the case of the Sars-Cov-2 coronavirus, which can affect the intestinal microbiota and devices such as the central venous catheter that allows easy access to the main venous blood vessels. In specific situations, explains the author Colombo, the patient can become more vulnerable to candidemia.

Beware of new fungi

For this reason, and for some years now, experts have been working hard to early detection and continuous monitoring of these cases and the Brazilian group has so far detected new fungi but not Candida auris, which has only now appeared. Currently, five subgroups of Candida auris have been described and the one identified in Brazil is more similar to a type previously discovered in Asia and not so much to that in Venezuela and other South American countries. The data suggests that the mushroom arrived here not from America or that alternatively there is an origin, a local source. Scientists are now studying the use of antifungals in increasing doses to understand how to attack Candida auris. A correct diagnosis is also very important, as Colombo points out, and confirming its presence without confusing the fungus with other candida species is not easy with conventional instrumentation. In particular, a mass spectrometry technique must be used, that is the matrix-assisted laser desorption / ionization, indicated by the acronym Maldi.


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