{"id":39438,"date":"2017-08-08T05:56:36","date_gmt":"2017-08-08T05:56:36","guid":{"rendered":"https:\/\/www.biphoo.com\/bipnews\/?p=39438"},"modified":"2017-08-08T05:56:36","modified_gmt":"2017-08-08T05:56:36","slug":"a-perfect-storm-superbug-how-an-invasive-fungus-got-health-officials-attention","status":"publish","type":"post","link":"https:\/\/www.biphoo.com\/bipnews\/health\/medical\/a-perfect-storm-superbug-how-an-invasive-fungus-got-health-officials-attention.html","title":{"rendered":"A \u2018perfect storm\u2019 superbug: How an invasive fungus got health officials\u2019 attention"},"content":{"rendered":"

A \u2018perfect storm\u2019 superbug: How an invasive fungus got health officials\u2019 attention<\/span><\/strong><\/span><\/h2>\n

A \u2018perfect storm\u2019 superbug: How an invasive fungus got health officials\u2019 attention:- Try as they might, the infection control specialists at Royal Brompton Hospital could not eradicate the invasive fungus that was attacking already gravely ill patients in the intensive care unit.<\/span><\/p>\n

Enhanced cleaning didn\u2019t stop the dangerous bug from spreading from one patient to the next in the 296-bed hospital. Neither did segregating infected patients, to keep them from spreading the fungus.<\/span><\/p>\n

Eventually, officials who run the Royal Brompton, located a couple of miles from Buckingham Palace in London\u2019s tony Chelsea neighborhood, resorted to a last-ditch move no hospital ever wants to have to take. They temporarily shut their ICU. That appears to have put a stop to the more than year-long outbreak, which ended last year and which involved at least 50 patients.<\/span><\/p>\n

The lengths to which the Royal Brompton was forced to resort to rid the hospital of Candida auris \u2014 a member of a broader fungal family named Candida \u2014 raised red flags for the small community of scientists who study fungi that infect people.<\/span><\/p>\n

\u201cThey did the Cadillac of drastic actions to make that happen, which we generally wouldn\u2019t be doing for Candidal infections,\u201d Dr. Tom Chiller, the chief of mycotic \u2014 fungal \u2014 diseases at the Centers for Disease Control and Prevention, told STAT in a recent interview.<\/span><\/p>\n

The fear is that that\u2019s what U.S. hospitals may be facing if C. auris breaches their infection control defenses. Last year at this time, the CDC knew of a single U.S. case, which occurred in 2013. As of mid-July, the case count had risen to 98 in nine states, though the lion\u2019s share have been reported by two \u2014 New York (68) and neighboring New Jersey (20).<\/span><\/p>\n

On the ever-growing list of bad bugs, C. auris is one of the most unsettling. Dr. Anne Schuchat, who served as the CDC\u2019s acting director this spring, termed it a \u201ccatastrophic threat.\u201d<\/span><\/p>\n

Said Chiller: \u201cIt\u2019s a high priority for really sick people right now and we at CDC are taking a very aggressive approach to see if we can\u2019t control, contain, and even eradicate it from the places it exists.\u201d<\/span><\/p>\n

But doing that won\u2019t be easy.<\/span><\/p>\n

Most fungal infections are acquired when a person picks up the fungus from the environment. But it seems C. auris can be transmitted from person to person, at least in a hospital setting. The fungus is hellishly difficult to eradicate from a space, once it settles in. And some versions of it seem to be impervious to the drugs \u2014 the dismayingly few drugs, it must be noted \u2014 that combat fungal infections.<\/span><\/p>\n

\u201cIt\u2019s almost a perfect storm kind of organism. It has all the bad characteristics of a large number of bad pathogens,\u201d said Dr. Alex Kallen, a medical officer with the division of health care quality promotion at the CDC.<\/span><\/p>\n

The resistant strains of the fungus seem to be as robust as the non-resistant strains \u2014 which is a disappointment and a concern. Often organisms that develop resistance pay a price; they are weakened in the process and don\u2019t spread as well. But with this fungus there is no \u201cfitness\u201d tradeoff for acquiring resistance. \u201cAnd that\u2019s again another scary thing about it. Because we don\u2019t want fit resistant organisms,\u201d Chiller said.<\/span><\/p>\n

None of these dire characteristics was apparent when the fungus was first detected, in 2009. Then it was simply a new fungus grown from discharge swabbed out of the ear of a 70-year-old woman in a Japanese hospital.<\/span><\/p>\n

Finding new additions to the fungal family tree is not uncommon; nor is it considered alarming, generally speaking.<\/span><\/p>\n

But then the radar pinged again. Some scientists in Pakistan were investigating puzzling bloodstream infections in hospitalized patients that they thought were caused by another type of yeast, called Saccharomyces. They shipped samples to Atlanta in the hopes the CDC could help. The culprit was actually C. auris.<\/span><\/p>\n

\u201cThat caught our attention,\u201d Chiller admitted. \u201cFor the first time we\u2019re like, \u2018Huh? Candida auris? A cluster that big in a hospital?\u2019\u201d<\/span><\/p>\n

Other countries started reporting cases. In fairly short order after the Japanese report, countries on three continents disclosed having seen infections caused by this fungus.<\/span><\/p>\n

The widespread and virtually simultaneous appearances of C. auris raised suspicions that travelers were moving the fungus around \u2014 but that turned out not to be accurate. Comparing genetic sequences from various places showed different strains in each place \u2014 a phenomenon that remains a bit of a mystery. \u201cIt doesn\u2019t seem like it\u2019s one thing,\u201d said Kallen, when asked how to explain the dissemination of the fungus.<\/span><\/p>\n

To be clear, C. auris isn\u2019t the zombie apocalypse. Healthy people aren\u2019t going to be felled in the street by this fungus.<\/span><\/p>\n

In fact, like lots of other pathogens, some of us carry Candida fungi on our skin \u2014 C. auris seems to especially like the warmth of armpits and the groin. As is true with other bugs, this fungus doesn\u2019t generally cause problems when it\u2019s on the outside of a healthy person being kept in check by other bugs with which it shares human turf.<\/span><\/p>\n

It\u2019s when someone gets sick that C. auris can become a problem. The fungus can infiltrate the bloodstream \u2014 wending its way into the body along a catheter or an intravenous line used to deliver fluids and medicines. When that happens, sick people become a lot sicker.<\/span><\/p>\n

It is estimated that about five or six out of every 10 people that have been seen to be infected with C. auris die. Chiller cautioned, though, one cannot say the fungus kills 50 percent or 60 percent of its victims. As often is the case with secondary infections \u2014 bugs that infect people who are already fighting off another serious ailment \u2014 it can be tough to determine who died \u201cfrom\u201d the fungus, and in whom the infection merely contributed to the death.<\/span><\/p>\n

Keeping C. auris from getting into and spreading within hospitals is the big goal here. But it\u2019s likely to prove challenging. At the Royal Brompton, in London, doctors found that when a patient with C. auris was moved out of a hospital room, the next patient to move in would pick up the fungus. Even after cleaning, the fungus could be found on multiple surfaces \u2014 the bed, the floor \u2014 in the room.<\/span><\/p>\n

The team of researchers there who investigated the outbreak declined requests for interviews.<\/span><\/p>\n

Dr. Curtis Donskey, chief of infectious diseases at the Louis Stokes Cleveland VA Medical Center, has been studying C. auris in the laboratory, trying to determine how long it can survive on surfaces in hospitals and which cleaning regimens can effectively destroy it.<\/span><\/p>\n

In an upcoming paper, he and colleagues will report that the disinfectants most commonly used in U.S. hospitals are not that effective against this fungus.<\/span><\/p>\n

They also found that C. auris is able to live on surfaces for at least seven days. And that is probably not the end of the C. auris story. \u201cWe certainly suspect that they would last longer than that,\u201d Donskey said. \u201cThat\u2019s just how long we tested.\u201d<\/span><\/p>\n

Aware of this problem, the CDC has recommended hospitals use bleach to clean rooms that housed patients with C. auris. But that\u2019s not a fail-safe solution. \u201cWe found more of it on moist surfaces that are not typically cleaned with bleach at all,\u201d said Donskey, pointing to sink drains.<\/span><\/p>\n

And bleach isn\u2019t the easiest of cleaning regimens. \u201cIt\u2019s damaging, it doesn\u2019t smell good, causes occupational health issues,\u201d CDC\u2019s Kallen said.<\/span><\/p>\n

Likewise, there are surfaces hospitals might not think to clean between every patient that can harbor the bacteria \u2014 for instance, the privacy curtains that separate patients in a multi-bed room.<\/span><\/p>\n

Adopting the enhanced cleaning techniques used to control C. difficile \u2014 a bacteria that forms a spore and is also challenging to control \u2014 should help with C. auris, said Donskey.<\/span>
\nHe\u2019s hoping, though, that the lessons hospitals learned as they battled that bacteria \u2014 for example, clean those privacy curtains after a patient with C. difficile is moved out of a room \u2014 will give them a head start in the era of C. auris.<\/span><\/p>\n

\u201cI think that the environment is much more appreciated now than it was a decade ago as a source for transmission,\u201d he said. \u201cAnd I think we would do the same things if we see Candida auris that we already are very well used to for trying to control C. diff and other pathogens.\u201d<\/span><\/p>\n

source: http:\/\/www.foxnews.com\/health\/2017\/08\/07\/perfect-storm-superbug-how-invasive-fungus-got-health-officials-attention.html<\/span><\/p>\n

\n\t\t\t
\n\t\t\t <\/div><\/div>\n\t\t