A deadly new germ that preys on people with lowered immunity is creeping across the globe, thanks in large part to decades of overprescribing antimicrobial drugs and the use of antifungicides on crops.
The New York Times reported Saturday that the infection is caused by a fungus known as Candida auris that kills nearly half of all patients who contract it within 90 days, according to the Centers for Disease Control and Prevention.
The bug was first discovered in 2009 after a 70-year-old Japanese woman arrived at a hospital in Tokyo with C. auris in her ear canal. Since then, the aggressive yeast infection has begun spreading across Asia and Europe. It arrived in the U.S. in 2016, the Times noted:
The earliest known case in the United States involved a woman who arrived at a New York hospital on May 6, 2013, seeking care for respiratory failure. She was 61 and from the United Arab Emirates, and she died a week later, after testing positive for the fungus. At the time, the hospital hadn’t thought much of it, but three years later, it sent the case to the C.D.C. after reading the agency’s June 2016 advisory.
In the last five years alone, it has swept through a hospital in Spain, hit a neonatal unit in Venezuela, spread throughout India, Pakistan and South Africa, and forced a prestigious British medical center to close its ICU for nearly two weeks:
By the end of June 2016, a scientific paper reported “an ongoing outbreak of 50 C. auris cases” at Royal Brompton, and the hospital took an extraordinary step: It shut down its I.C.U. for 11 days, moving intensive care patients to another floor, again with no announcement.
Days later the hospital finally acknowledged to a newspaper that it had a problem. A headline in The Daily Telegraph warned, “Intensive Care Unit Closed After Deadly New Superbug Emerges in the U.K.” (Later research said there were eventually 72 total cases, though some patients were only carriers and were not infected by the fungus.)
After the germ spread to New York, New Jersey, and Illinois, the CDC added the bug to a list of other germs deemed an “urgent threat.”
Almost a year ago, an elderly man was admitted to the Mount Sinai Hospital’s Brooklyn wing for abdominal surgery, and was found to be infected with the drug-resistant bug. He died after spending 90 days in the hospital.
The Times reported that C. auris was found to have infested his hospital room to the point where special cleaning equipment had to be brought in to get rid of it. Also, workers had to rip out the ceiling and floor tiles to remove it completely.
“Everything was positive — the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump,” said Hospital president Dr. Scott Lorin. “The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive.”
Health experts and immunologists say bugs like this one are simply evolving beyond modern medical science’s ability to kill them.
“It’s an enormous problem,” noted Imperial College of London fungal epidemiology professor Matthew Fisher, who co-authored a recent scientific review on the rise of resistant fungi. “We depend on being able to treat those patients with antifungals.”
The Times noted that health experts and researchers found that the germ morphed nearly simultaneously around the planet:
The C.D.C. investigators theorized that C. auris started in Asia and spread across the globe. But when the agency compared the entire genome of auris samples from India and Pakistan, Venezuela, South Africa and Japan, it found that its origin was not a single place, and there was not a single auris strain. …
The genome sequencing showed that there were four distinctive versions of the fungus, with differences so profound that they suggested that these strains had diverged thousands of years ago and emerged as resistant pathogens from harmless environmental strains in four different places at the same time.
“Somehow, it made a jump almost seemingly simultaneously and seemed to spread and it is drug resistant, which is really mind-boggling,” said CDC fungal expert Dr. Snigdha Vallabhaneni.
Dutch microbiologist Jacques Meis believes drug-resistant fungi are developing thanks in large part to the heavy use of fungicides on crops, according to the Times:
Dr. Meis visited the C.D.C. last summer to share research and theorize that the same thing is happening with C. auris, which is also found in the soil: Azoles have created an environment so hostile that the fungi are evolving, with resistant strains surviving.
This is similar to concerns that resistant bacteria are growing because of excessive use of antibiotics in livestock for health and growth promotion. As with antibiotics in farm animals, azoles are used widely on crops.
“On everything — potatoes, beans, wheat, anything you can think of, tomatoes, onions,” said Dr. Johanna Rodes, an infectious disease expert at Imperial College London. “We are driving this with the use of antifungicides on crops.”