Deadly Yeast – why Candida auris is so dangerous

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This yeast is not as harmless as it looks. Picture: AP / CDC

Deadly yeast – why Candida auris is so dangerous

Unstoppable, it seems, he is spreading: Candida auris, a yeast fungus, infects people in more and more countries around the world. For many of them the infestation ends fatally – Candida auris is a multi-drug resistant fungus that can trigger invasive infections. And, unlike other previously known species, it is transmitted from patient to patient and over contaminated surfaces. This makes him the terror of hospitals, which are only with difficulty mastering an outbreak of the pathogen.

The yeast fungus was first found in the ear secretions of a Japanese patient in 2009 – hence the name addition auris (Latin for "the ear concerning"). Since then, there have been infections in many countries, from South Korea to India and Kenya to Canada.

In Europe, too, the pathogen has already gained a foothold – especially in Spain and the UK. In London, the first major outbreak occurred in 2015 and 72 patients were infected. The only case in Switzerland to date involved an elderly patient who had become infected in Spain and died in October 2017 in a Geneva hospital.

spreading of Candida auris
(As of Feb. 2019)

Map: watson / source: CDC.gov

From 2013 to 2017, a total of 620 cases were reported in Europe, according to the European Center for Disease Prevention and Control (ECDC), with a significant increase in 2016 and 2017. Most of the messages were in Spain (388 cases) and Great Britain (221 cases). About three-quarters of all reported cases were a harmless colonization of the body with the fungus, but the remainder of the patients experienced blood poisoning or other infections.

Weakened immune system

The reason for this is usually a weakened immune system, for example in the chronically ill, cancer or AIDS patients. Other yeasts colonize the skin or mucous membranes of humans – Candida albicans For example, a rather harmless fungus that usually causes no problems. In congenital or acquired immunodeficiency may be Candida albicans but multiply so much that it leads to a so-called candidosis (also known as "thrush").

Candidosis on the tongue. Image: Shutterstock

That's the way it is Candida auris For a healthy immune system usually no serious threat. In fact, healthy people who are infected with the fungus show no symptoms and spread it without their knowledge. Only a lab test can tell if anyone is from Candida auris is populated. But if there are pre-existing conditions, the yeast can enter the blood stream and there sepsis – a blood poisoning – cause. He can also infect wounds or urinary and respiratory tracts and cause dangerous infections there.

In contrast to his more harmless relatives turns out Candida auris in such cases as a veritable killer. The Centers for Disease Control and Prevention (CDC) estimates that as many as 30 to 60 percent of all infections in which the fungus enters the body are fatal. For the first time in August 2017, the agency issued a warning of a serious global threat.

If this fungus enters the body, it becomes dangerous: 30 to 60 percent of infections end in death. Image: Shutterstock

Multi-resistant pathogen

In addition, that Candida auris not always so easy to identify, but above all, that many of its fungal strains are resistant to one or more of the drugs used to combat fungal infections. In 90 percent of the infections caused by the fungus at least one drug does not work, in 30 percent of the infections there are even two or more drugs.

Such resistances are otherwise known from bacteria – so it is well known that, for example, fewer and fewer antibiotics are effective against multidrug-resistant tuberculosis pathogens. On the other hand, one hardly thinks of mushrooms. Even with antibiotic resistance, however, it is important that primarily people with weakened immune systems are at risk, including newborns, the elderly, diabetics and people who need to take immunosuppressants.

The problem of multidrug-resistant bacteria is exacerbated by the improper use of antibiotics. If it is not possible to stem the abuse of these important medicines and at the same time develop new medicines for multidrug-resistant bacteria, the risk will increase over time even for healthier people who are even less at risk. According to a WHO estimate, multidrug-resistant pathogens could cause more deaths by 2050 than cancer.

"Antibiotic-resistant germs explained in 3 minutes." Video: YouTube / youknow

Persistent mushroom

Mushrooms like Candida auris, which are resistant to antifungals (antifungals), exacerbate this problem. In addition, the yeast fungus is extremely tough: it settles as a biofilm on the surfaces of furniture and medical equipment and can hardly be removed from there. As an elderly patient who is infected with Candida auris Litt, who was admitted to a hospital in New York's Brooklyn district in May 2018, the doctors there discovered after his death that the fungus had infested the entire room – walls, ceiling, floor. Parts of the ceiling and floor covering had to be torn out and disposed of.

For hospitals, this is a nightmare. The fungus can thus be transferred not only from patient to patient, but also through contaminated rooms and equipment. After all, according to the current state of knowledge, the transmission does not take place via the air as with many cold viruses, but only as a smear infection.

The doctors have recognized the danger of yeast. In Switzerland, infectiologists started the research platform Funginos (Fungal Infection Network of Switzerland) back in 2002, which now also deals with cases of Candida aurisInfections. The association Swissnoso, which fights hospital infections, has the mushroom in the sights. When patients are repatriated from abroad to Switzerland, they are first isolated until they are sure that they no longer have multidrug-resistant agents – also Candida auris Not.

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