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Candida Auris: The Rise of a New Fungal Threat

In June 2016, the Centers for Disease Control and Prevention (CDC) issued an alert regarding an emerging fungal pathogen of concern, Candida auris.1 The organism was first described in 2009 after being isolated from the external ear canal of a patient in Japan; however, the first known isolation of the organism occurred in a Korean pediatric surgery patient with fungemia in 1996.2 Since then, there have been reports of infections due to this organism from more than fifteen countries across multiple continents.3

Scientists Lockhart et al. conducted phylogenetic studies on isolates of C. auris from all over the world. They identified that the genetics of the isolates evaluated appeared to fall into 4 distinct clades with genetic diversity within each clade being relatively minimal. These clusters have appeared almost simultaneously and correlate with the 4 geographic regions from which they were isolated: South Asia, South Africa, South America, and Asia.2 Within the United States between 2013 and May 12, 2017, infections due to C. auris have been observed with increasing frequency and geographic distribution. A total of 77 infections have been reported, originating from New York, New Jersey, Massachusetts, Maryland, Indiana, Oklahoma, and Illinois with a bulk of these cases having been reported in New York and New Jersey (Figure 1).4,5

Of these infections, 55% were identified in male patients, the median age was 70 years (range 21-96 yrs), and the most common culture types in which the organism was isolated was blood (58%), urine (14%), and respiratory samples (10%).5 Genomic analysis of cases seen in the United States has shown that the organisms isolated in New York and New Jersey are genetically similar to strains originating from South Asia, whereas cases in Illinois stem from organisms originating in South America.5,6

C. auris is known to have a virulence profile more similar to C. albicans than other nonalbicans Candida species, and has been associated with multiple cases of fungemia and other invasive fungal infections.7 Acquisition appears to be largely health care-acquired in nature. More specifically, one report of 41 patients with C. auris infection showed that the median time between admission and first isolation was 19 days. Of these 41 patients, 73% had central venous catheters, 61% had urinary catheters, 51% had received some form of surgery within 90 days of diagnosis with C. auris infection, and 41% had received antifungal therapy within 90 days of diagnosis of C. auris infection.2

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