CDC says cases of lethal fungus tripled in recent years

Cases of a deadly fungus have tripled in the U.S. from 2019 to 2021, according to data from the Centers for Disease Control and Prevention (CDC).

Candida aurist was reported in the U.S. in 2016 and cases have climbed ever since. Annual clinical case counts rose to 476 in 2019 before increasing to 756 in 2020, a 59% jump. Cases then soared to 1,471 in 2021, which is an additional 95% jump.

Colonization screening of cases also increased, researchers from the CDC wrote in the Annals of Internal Medicine. There were 1,310 cases in 2020, a 21% increase from 2019, and a 209% increase to 4,041 cases in 2021.

There were a total of 3,270 clinical cases and 7,413 screening cases of C. auris from 2019 to 2021, with 17 states reporting their initial cases.

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The authors from the CDC wrote that, since its detection in the U.S., C. auris “has continued to cause illness and death nationwide.” They also said the CDC has rated it as “an ‘urgent threat,’ the highest level of concern, because it is often multidrug-resistant; spreads easily in healthcare facilities; and can cause severe, invasive infections with high mortality rates.”

Treatment-resistant cases rose from six pan-resistant and three echinocandin-resistant isolates reported in 2020 to seven pan-resistant and 19 echinocandin-resistant isolates in 2021.

“Even this subtle increase is concerning because echinocandins are the first-line therapy for invasive Candida infections and most C. auris infections,” the authors wrote. “Several new antifungal medications are in development, but more research is needed to understand outcomes for patients with these highly resistant strains and to guide treatment.”

One of the authors, Meghan Lyman, wrote in a press release that “the rapid rise and geographic spread of cases is concerning and emphasizes the need for continued surveillance, expanded lab capacity, quicker diagnostic tests, and adherence to proven infection prevention and control.”

The CDC’s 2019 Antibiotic Resistance Threats Report identified C. auris as an urgent threat in the U.S. 

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And last year, the World Health Organization put it on the fungal priority pathogens list. WHO assistant director-general of antimicrobial resistance Hanan Balkhy said in a press release at the time, “fungal infections are growing, and are ever more resistant to treatments, becoming a public health concern worldwide.”

A CDC fact sheet citing data from a listed number of patients notes that 30% to 60% of people with C. auris infections have died. 

“We don’t know if patients with invasive C. auris infection are more likely to die than patients with other invasive Candida infections,” the CDC wrote.

Cases appeared to be imported from other countries when it was first detected. But recently, healthcare transmission has been responsible for most, if not all, cases, according to the authors from the CDC. 

“Most spread in the United States has occurred in high-acuity post-acute care facilities, specifically long-term acute care hospitals and ventilator-capable skilled-nursing facilities,” they wrote. “C. auris cases tend to occur in patients who have multiple or prolonged healthcare encounters or indwelling devices, including those receiving mechanical ventilation.”

The current study may underestimate cases because screening resources have been limited, but the CDC has increased screening availability through the American Rescue Plan Act. Through the bill approved in 2021, screening capacity has risen from seven regional labs to more than 26 laboratories across the U.S.

“C. auris remains an ongoing health threat in the United States. Public health and healthcare facilities already have limited resources and IPC [infection prevention and control] capacity, and they experience further challenges with MDRO [multidrug-resistant organism] surveillance and prevention when those limited resources shift to fight other threats, such as the COVID-19 pandemic,” the authors from the CDC wrote. “Still, mitigation and even regional containment are possible.”